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Andrea Leoncini Clinic for Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland

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Chiara Camponovo Thyroid Unit, Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland

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Gaetano Paone Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland

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Elena Gamarra Thyroid Unit, Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland

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Giorgio Treglia Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland

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Pierpaolo Trimboli Thyroid Unit, Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland

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reliable and recommended by thyroid experts ( 2 , 3 ). Over the past decade, Thyroid Imaging and Reporting Data Systems (TIRADS) have achieved wide global adoption ( 4 ). One of their primary objectives is to standardize the lexicon used in thyroid

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Gilles Russ Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France

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Steen J. Bonnema Department of Endocrinology, Odense University Hospital, Odense, Denmark

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Murat Faik Erdogan Department of Endocrinology and Metabolism, University of Ankara School of Medicine, İbni Sina Hastanesi, Ankara, Turkey

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Cosimo Durante Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy

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Rose Ngu Head Neck and Thyroid Imaging, Department of Radiology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom

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Laurence Leenhardt Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France

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on the “classic pattern” concept, a tool for US classification of thyroid nodules was developed by Horvath et al. [ 14 ] in 2009, known as the Thyroid Imaging Reporting and Data System (TIRADS). This is a system similar to the one used for breast

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Kristine Z Swan Department of ORL, Head- and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark

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Johnson Thomas Department of Endocrinology, Mercy Hospital, Springfield, Missouri, USA

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Viveque E Nielsen Department of ORL, Head- and Neck Surgery, Odense University Hospital, Odense, Denmark

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Marie Louise Jespersen Department of Pathology, Aarhus University Hospital, Aarhus, Denmark

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Steen J Bonnema Department of Endocrinology, Odense University Hospital, Odense, Denmark

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(TIRADS) created by the American College of Radiology (ACR), the American Thyroid Association classification system, the French TIRADS, k-TIRADS, and the EU-TIRADS ( 2 , 3 , 4 , 5 , 6 ). These systems are based on a subjective assessment of the nodule

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Tommaso Piticchio Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland

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Gilles Russ Department of Thyroid and Endocrine Tumor Diseases, La Pitie-Salpetriere Hospital, 83 Bd de l’Hopital, Paris, France

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Maija Radzina Riga Stradins University, Radiology Research Laboratory, Riga, Latvia
University of Latvia, Faculty of Medicine, Riga, Latvia

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Francesco Frasca Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy

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Cosimo Durante Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

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Pierpaolo Trimboli Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland

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studies in the field assessed the diagnostic efficacy of RSSs by selecting series of TNs suitable for either FNAC or surgery. This type of cohort may not accurately reflect the distribution of TNs across TIRADS categories among patients regularly visiting

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Tamas Solymosi Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary
Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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Laszlo Hegedűs Department of Endocrinology, Odense University Hospital, Odense, Denmark

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Steen J Bonnema Department of Endocrinology, Odense University Hospital, Odense, Denmark

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Andrea Frasoldati Endocrinology Unit of Arcispedale S Maria Nuova, Reggio Emilia, Italy

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Laszlo Jambor Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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Zsolt Karanyi Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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Gabor L Kovacs 1st Department of Medicine, Flohr Ferenc Hospital, Kistarcsa, Hungary

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Enrico Papini Regina Apostolorum Hospital in Albano, Rome, Italy

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Karoly Rucz 1st Department of Medicine, University of Pecs, Pecs, Hungary

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Gilles Russ Unité Thyroïde et Tumeurs Endocrines – Pr Leenhardt Hôpital La Pitie Salpetriere, Sorbonne Université, Paris, France

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Endre V Nagy Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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extension (ETE) ( 4 , 5 , 6 ). Several US thyroid nodule risk-classification systems have been proposed by scientific societies ( 6 , 7 , 8 , 9 , 10 , 11 ). These thyroid nodule image reporting and data systems (TIRADS) aim at providing indications

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Yulia P. Sych Department of Endocrinology 1 at I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation

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Valentin V. Fadeev Department of Endocrinology 1 at I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation

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Elena P. Fisenko Laboratory of Ultrasound Diagnostics, Federal State Research Institution “B.V. Petrovsky National Research Centre of Surgery”, Moscow, Russian Federation

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Marina Kalashnikova Department of Endocrinology 1 at I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation

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less operator-dependent, a number of classification systems have been proposed, starting with the Thyroid Imaging Reporting and Data System (TIRADS) created by Hovarth et al. [ 3 ] with later modifications by other groups and authors. By the time the

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Roussanka D. Kovatcheva Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria

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Alexander D. Shinkov Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria

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Inna D. Dimitrova Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria

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Ralitsa B. Ivanova Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria

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Kalin N. Vidinov Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria

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Radina S. Ivanova Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria

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developed over the past decade. In 2009, Horvath et al. [ 7 ] first proposed US Thyroid Imaging Reporting and Data System (TIRADS) followed by Park et al. [ 8 ], Kwak et al. [ 9 ], and Russ et al. [ 10 ], who tried to improve the diagnostic performance and

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Giorgio Grani Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Livia Lamartina Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Valeria Ramundo Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Rosa Falcone Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Cristiano Lomonaco Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Laura Ciotti Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Martina Barone Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Marianna Maranghi Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Vito Cantisani Diagnostic and Ultrasound Innovations Unit, Azienda Ospedaliera Universitaria Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy

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Sebastiano Filetti Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Cosimo Durante Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy

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Radiology (ACR) TIRADS; (3) the American Thyroid Association (ATA) guidelines; (4) the European Thyroid Association (EU-TIRADS); and (5) the Korean TIRADS (K-TIRADS). For the purposes of this study, nodules that could not be classified according to the ATA

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Tamas Solymosi Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary

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Laszlo Hegedüs Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

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Steen Joop Bonnema Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

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Andrea Frasoldati Endocrinology Unit of Arcispedale S. Maria Nuova, Reggio Emilia, Italy

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Laszlo Jambor Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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Gabor Laszlo Kovacs 1st Department of Medicine, Flohr Ferenc Hospital, Kerepestarcsa, Hungary

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Enrico Papini Regina Apostolorum Hospital in Albano, Rome, Italy

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Karoly Rucz 1st Department of Medicine, University of Pecs, Pecs, Hungary

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Gilles Russ Unité Thyroïde et Tumeurs Endocrines – Pr Leenhardt Hôpital La Pitie Salpetriere, Sorbonne Université, Paris, France

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Zsolt Karanyi Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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Endre V. Nagy Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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]. Several US thyroid nodule risk-classification systems have been proposed by scientific societies [ 10 - 16 ]. These thyroid nodule image reporting and data systems (TIRADS) aim at providing indications for FNA, based on the combined results of the TIRADS

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X Y Hu Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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J Wu Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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P Seal EFW Radiology, Calgary, Alberta, Canada

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S A Ghaznavi Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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C Symonds Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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S Kinnear Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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R Paschke Department of Medicine, Section of Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Departments of Medicine, Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

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) Management Guidelines, the 2016 Korean Thyroid Association/Korean Society of Thyroid Radiology Guidelines (K-TIRADS), the 2017 European Thyroid Imaging and Reporting Data System (EU-TIRADS), the 2020 Chinese Thyroid Imaging Reporting and Data System (C-TIRADS

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