Integrated Role of TI-RADS and Bethesda Classification in the Evaluation and Management of Suspicious Thyroid Nodules: A Review

Abstract

Combining the Thyroid Imaging-Reporting and Data System (TI-RADS) and the Bethesda Classification significantly improves the diagnostic accuracy of identifying malignant thyroid nodules compared to using either system alone. While TI-RADS uses ultrasound features to stratify risk, the Bethesda system classifies cytopathological results from fine-needle aspiration (FNA). Currently, the primary diagnostic procedures for assessing nodular goiter before surgery include thyroid gland ultrasonography and ultrasound-guided fine-needle aspiration biopsy (FNAB). The assessment of the accuracy of the Thyroid Imaging Reporting and Data System (TI-RADS) in conjunction with the Bethesda Classification plays an important role in improving the management of suspicious thyroid nodules. TI-RADS is an ultrasound-based risk stratification system designed to categorize thyroid nodules according to their likelihood of malignancy based on features such as composition, echogenicity, margins, calcifications, and shape. On the other hand, the Bethesda System for Reporting Thyroid Cytopathology classifies fine-needle aspiration (FNA) cytology results into six categories, each associated with a defined risk of malignancy and recommended clinical management. When used together, these two systems provide complementary diagnostic information that enhances clinical decision-making. In conclusion, the combined use of TI-RADS and the Bethesda Classification enhances the accuracy of diagnosing and managing suspicious thyroid nodules. Their integration provides a more reliable risk stratification framework, reduces unnecessary interventions, and improves patient outcomes. However, careful interpretation and correlation with clinical findings remain essential to optimize their effectiveness.