ACRTIRADS es un sistema que se basa en una puntuación/score de un determinado nódulo

tiroideo, en base a sus características sonográficas. EUTIRADS no es un sistema de puntuación,

asignándose la categoría según determinadas características ecográficas.

En caso de ACR, se requieren tener multiples características de sospecha para ser asignado
como riesgo intermedio/alto, mientras que en EUTIRADS, podría bastar con una característica
que sea como de alto riesgo.

** Las caracteristicas de alto riesgo: non oval shape,

Una principal diferencia es el problema de asignación de categoría. En el ACR-TIRADS la

categoría es dada según una puntuación establecida, en base a hallazgos sonográficos. En el
EU-TIRADS, al no ser un sistema de puntuación, existe riesgo de overlap entre categorías.

En la categoría de leve sospecha (mild/low, ACR3 EU3) los umbrales para realización de FNA
varía, siendo mayor en ACR (2.5) que en EU (2.0).

** El valor de 2.0 es porque las metastasis en tumores menor a eso son muy raras.

EUTIRADS 1 significa que no existen nódulos, en ACRTIRADS 1 existe un nódulo, con

características mayoritariamente benignas.

En cuanto a las subcategorías, existen diferencias porcentuales en cuanto al riesgo de cancer

de un determinado nódulo, siendo mayor en EUTIRADS respecto al ACR.

*** Los americanos usan el doppler para diferenciar si es quiste de solido. En cambio en
EUTIRADS, se desaconseja el uso del doppler para estratificación del riesgo de cancer.
ACRTIRADS es un sistema que se basa en una puntuación/score de un determinado nódulo
tiroideo, en base a sus características sonográficas. EUTIRADS no es un sistema de puntuación,
asignándose la categoría según determinadas características ecográficas.

En caso de ACR, se requieren tener multiples características de sospecha para ser asignado
como riesgo intermedio/alto, mientras que en EUTIRADS, podría bastar con una característica
que sea como de alto riesgo.

** Las caracteristicas de alto riesgo: non oval shape,

Una principal diferencia es el problema de asignación de categoría. En el ACR-TIRADS la

categoría es dada según una puntuación establecida, en base a hallazgos sonográficos. En el
EU-TIRADS, al no ser un sistema de puntuación, existe riesgo de overlap entre categorías.

En la categoría de leve sospecha (mild/low, ACR3 EU3) los umbrales para realización de FNA
varía, siendo mayor en ACR (2.5) que en EU (2.0).

** El valor de 2.0 es porque las metastasis en tumores menor a eso son muy raras.

EUTIRADS 1 significa que no existen nódulos, en ACRTIRADS 1 existe un nódulo, con

características mayoritariamente benignas.

En cuanto a las subcategorías, existen diferencias porcentuales en cuanto al riesgo de cancer

de un determinado nódulo, siendo mayor en EUTIRADS respecto al ACR.

*** Los americanos usan el doppler para diferenciar si es quiste de solido. En cambio en
EUTIRADS, se desaconseja el uso del doppler para estratificación del riesgo de cancer.

ACTR1 benigno No FNA

ACTR2 no sospechoso No FNA

ACTR3 mild sospec sigue si 1.5 FNA 2.5

ACTR4 med sospec sigue si 1 / FNA 1.5

ACTR5 high sospec sigue si 0.5 / FNA 1.0

EUTR1 normal (No nodulos)

EUTR2 benigno No FNA, excepto si compresivo

EUTR3 low FNA 2.0

EUTR4 int FNA 1.5

EUTR5 high FNA 1.0. Si menos FNA o sigue.

ACR TR1 0.3

ACR TR2 1.5

ACR TR3 4.8

ACR TR4 9.1

ACR TR5 33

EU TR1

EU TR2 aprox. 0

EU TR3 2-4%

EU TR4 6-17%

EU TR5 26-87%

EUTIRADS

R1: US examination for thyroid nodules should include

a malignancy risk assessment based on risk stratification

and scoring. Use of the standardized lexicon, report,

and drawing is advised.

R2: Pure cysts and entirely spongiform nodules should

be considered as benign. FNA is not indicated (unless for

therapeutic purposes, in case of compressive symptoms).

R3: Oval-shaped, isoechoic, or hyperechoic nodules

with smooth margins and no high-risk features should be

considered at low risk of malignancy. FNA should usually

be performed only for nodules >20 mm.

R4: Oval-shaped, mildly hypoechoic nodules with

smooth margins and no high-risk features should be considered

at intermediate risk of malignancy. FNA should

usually be performed for nodules >15 mm.

R5: Nodules having at least 1 suspicious US feature (i.e.,

a non-oval shape, irregular margins, microcalcifications, or

marked hypoechogenicity) should be considered at high risk

of malignancy, increasing with the number of suspicious

features. FNA should be performed for nodules >10 mm

R6: US assessment of the lymph nodes is advised for

all thyroid nodules but is mandatory for intermediateand

high-risk ones. In case of a suspicious lymph node of

thyroid origin, FNA of the lymph node and FNA of the

most suspicious thyroid nodule(s) should be performed.

R7: R7: Capsular bulging, disruption, or abutment by the

thyroid nodule are indicative of extrathyroidal extension

and should be described in the report.

R8: Macrocalcifications alone are not specific for malignancy.

Their presence should be correlated with other

US features supporting FNA. True microcalcifications

should be differentiated from other echogenic spots, and

such nodules must undergo FNA. Echogenic spots with

comet-tail artifacts are suggestive of benignity.

R9: The routine use of Doppler US is not recommended

for US malignancy risk stratification.

R10: Elastography should not replace grayscale study,

but it may be used as a complementary tool for assessing

nodules for FNA, especially due to its high NPV.

R11: Routine determination of nodule growth by serial

thyroid US assessments, in order to predict cancer, is

not justified

ACTR1 benigno No FNA

ACTR2 no sospechoso No FNA

ACTR3 mild sospec sigue si 1.5 FNA 2.5

ACTR4 med sospec sigue si 1 / FNA 1.5

ACTR5 high sospec sigue si 0.5 / FNA 1.0

EUTR1 normal (No nodulos)

EUTR2 benigno No FNA, excepto si compresivo

EUTR3 low FNA 2.0

EUTR4 int FNA 1.5

EUTR5 high FNA 1.0. Si menos FNA o sigue.

ACR TR1 0.3

ACR TR2 1.5

ACR TR3 4.8

ACR TR4 9.1

ACR TR5 33

EU TR1

EU TR2 aprox. 0
EU TR3 2-4%

EU TR4 6-17%

EU TR5 26-87%

EUTIRADS

R1: US examination for thyroid nodules should include

a malignancy risk assessment based on risk stratification

and scoring. Use of the standardized lexicon, report,

and drawing is advised.

R2: Pure cysts and entirely spongiform nodules should

be considered as benign. FNA is not indicated (unless for

therapeutic purposes, in case of compressive symptoms).

R3: Oval-shaped, isoechoic, or hyperechoic nodules

with smooth margins and no high-risk features should be

considered at low risk of malignancy. FNA should usually

be performed only for nodules >20 mm.

R4: Oval-shaped, mildly hypoechoic nodules with

smooth margins and no high-risk features should be considered

at intermediate risk of malignancy. FNA should

usually be performed for nodules >15 mm.

R5: Nodules having at least 1 suspicious US feature (i.e.,

a non-oval shape, irregular margins, microcalcifications, or

marked hypoechogenicity) should be considered at high risk

of malignancy, increasing with the number of suspicious

features. FNA should be performed for nodules >10 mm

R6: US assessment of the lymph nodes is advised for

all thyroid nodules but is mandatory for intermediateand

high-risk ones. In case of a suspicious lymph node of

thyroid origin, FNA of the lymph node and FNA of the

most suspicious thyroid nodule(s) should be performed.

R7: R7: Capsular bulging, disruption, or abutment by the

thyroid nodule are indicative of extrathyroidal extension

and should be described in the report.

R8: Macrocalcifications alone are not specific for malignancy.

Their presence should be correlated with other

US features supporting FNA. True microcalcifications

should be differentiated from other echogenic spots, and

such nodules must undergo FNA. Echogenic spots with

comet-tail artifacts are suggestive of benignity.

R9: The routine use of Doppler US is not recommended

for US malignancy risk stratification.

R10: Elastography should not replace grayscale study,

but it may be used as a complementary tool for assessing

nodules for FNA, especially due to its high NPV.

R11: Routine determination of nodule growth by serial

thyroid US assessments, in order to predict cancer, is

not justified