British Thyroid Association U-Score Useful for Identifying and ruling out Benign thyroid Nodules, suggests study

The clinical necessity for precise thyroid nodule evaluation is paramount, yet previous research comparing the American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) and the British Thyroid Association (BTA) U-score has often produced heterogeneous outcomes, leading Prasad Mothayapan and his colleagues from the University of Malaya to initiate this study to bridge the clinical gap and definitively compare their diagnostic performance.

Therefore, in the six-year retrospective cohort study at Universiti Malaya, researchers evaluated 255 surgical patients to compare the diagnostic performance of ACR-TIRADS and BTA U-scores. Two independent radiologists reviewed ultrasound images against histopathology—the reference standard—to determine sensitivity, specificity, predictive values, and inter-rater reliability.

Key Clinical Findings of the Study Include:

• Enhanced Sensitivity: The study shows that BTA U-score demonstrated a higher sensitivity rate of 88.9% compared to the 84.1% achieved by ACR-TIRADS, indicating a robust capacity for detecting positive cases.

• Comparable Specificity: Both systems showed limited and nearly identical specificity in this cohort, with the BTA system recording 29.2% and the ACR system recording 26.0% .

• Superior Negative Prediction: A critical finding for clinicians is the BTA system's higher negative predictive value of 72.4% versus 62.1% for ACR-TIRADS, making the BTA score more reliable for excluding malignancy.

• Consistent Inter-observer Agreement: Both diagnostic frameworks maintained a moderate inter-rater agreement with a Cohen’s Kappa of 0.5, suggesting that the systems remain reliable regardless of the radiologist's experience level.

• Overall Diagnostic Accuracy: The total accuracy of the two systems remained closely matched, with the BTA U-score reaching 59% and ACR-TIRADS following closely at 55.1% .

The results suggest that both ACR-TIRADS and the BTA U-score provide comparable diagnostic accuracy for the detection of malignant thyroid nodules, though the BTA system maintains a slight advantage in overall accuracy and predictive reliability.

Thus, the study concludes clinicians might consider the BTA U-score particularly advantageous in clinical settings where the primary goal is the confident identification and exclusion of benign nodules to reduce unnecessary surgical interventions.

While the study provides valuable comparative data, its single-center etrospective nature indicates that future multi-center prospective research could further refine these findings and enhance diagnostic protocols for diverse patient populations.

Reference

Mothayapan, P., Khoo, K. S., Jeyabalan, J., Muhammad Gowdh, N. F., Vijayananthan, A., Aung, K. P., & Ng, K. L. (2026). Comparing the Diagnostic Performance of ACR-TIRADS and BTA U-Score in Classifying Thyroid Nodules: A Single Centre Retrospective Cohort Study. Indian Journal of Surgery.