Clinical Medicine & Physiology
ACR TI-RADS Thyroid Nodule Calculator: TR1–TR5 Point Sum & FNA Biopsy Size Threshold
Score thyroid ultrasound nodules using Franklin N. Tessler et al.’s (2017) American College of Radiology TI-RADS 5-feature point system (TR1 to TR5) and determine size-based Fine-Needle Aspiration (FNA) vs Surveillance recommendations.
Prevent unnecessary benign thyroid biopsies via ACR TI-RADS additive feature scoring!
Published by the American College of Radiology Thyroid Imaging, Reporting and Data System committee (Tessler et al., 2017, JACR), ACR TI-RADS assigns additive points across five sonographic categories: Composition (Cystic/Spongiform = 0, Mixed cystic-solid = 1, Solid = 2), Echogenicity (Anechoic = 0, Hyperechoic/Isoechoic = 1, Hypoechoic = 2, Very hypoechoic = 3), Shape (Wider-than-tall = 0, Taller-than-wide = 3), Margin (Smooth/Ill-defined = 0, Lobulated/Irregular = 2, Extra-thyroidal extension = 3), and Echogenic Foci (None/Comet-tail = 0, Macrocalcifications = 1, Peripheral rim = 2, Punctate echogenic foci = 3; additive within Echogenic Foci)!
Total points map to five risk levels coupled to maximum nodule diameter (cm): TR1 (0 pts, Benign) and TR2 (2 pts, Not Suspicious) require NO FNA; TR3 (3 pts, Mildly Suspicious) recommends FNA at >= 2.5 cm (follow-up >= 1.5 cm); TR4 (4–6 pts, Moderately Suspicious) recommends FNA at >= 1.5 cm (follow-up >= 1.0 cm); and TR5 (>= 7 pts, Highly Suspicious) recommends FNA at >= 1.0 cm (follow-up >= 0.5 cm)!
| ACR TI-RADS Category | Total Feature Points | FNA Biopsy Size Cutoff | Ultrasound Surveillance Cutoff |
|---|---|---|---|
| TR1 (Benign) / TR2 (Not Suspicious) | 0 pts (TR1) | 1–2 pts (TR2) | No FNA | No routine US follow-up |
| TR3 (Mildly Suspicious) | 3 pts | >= 2.5 cm | >= 1.5 cm (at 1, 3, 5 yr) |
| TR4 (Moderately Suspicious) | 4 to 6 pts | >= 1.5 cm | >= 1.0 cm (at 1, 2, 3, 5 yr) |
| TR5 (Highly Suspicious) | >= 7 pts | >= 1.0 cm | >= 0.5 cm (annual up to 5 yr) |
Total ACR TI-RADS Feature Point Sum
Sums Composition (B2: 0..2), Echogenicity (B3: 0..3), Shape (B4: 0 or 3), Margin (B5: 0, 2, or 3), and Echogenic Foci points (B6: 0..6).
=IF(OR(B2 < 0, B2 > 2, B3 < 0, B3 > 3, AND(B4 <> 0, B4 <> 3), AND(B5 <> 0, B5 <> 2, B5 <> 3), B6 < 0, B6 > 6, B7 <= 0), "Invalid ACR TI-RADS Feature Points or Diameter", SUM(B2:B6))ACR TI-RADS Level & Size-Specific FNA / Follow-Up Recommendation
Pairs total points SUM(B2:B6) with maximum nodule diameter B7 (cm) to output exact ACR management guidance.
=IF(OR(B2 < 0, B2 > 2, B3 < 0, B3 > 3, AND(B4 <> 0, B4 <> 3), AND(B5 <> 0, B5 <> 2, B5 <> 3), B6 < 0, B6 > 6, B7 <= 0), "Invalid ACR TI-RADS Feature Points or Diameter", IF(SUM(B2:B6) = 0, "TR1 (Benign): No FNA", IF(SUM(B2:B6) <= 2, "TR2 (Not Suspicious): No FNA", IF(SUM(B2:B6) = 3, IF(B7 >= 2.5, "TR3: Recommend FNA (>= 2.5 cm)", IF(B7 >= 1.5, "TR3: US Follow-Up (>= 1.5 cm)", "TR3: No FNA or Follow-Up (< 1.5 cm)")), IF(SUM(B2:B6) <= 6, IF(B7 >= 1.5, "TR4: Recommend FNA (>= 1.5 cm)", IF(B7 >= 1, "TR4: US Follow-Up (>= 1.0 cm)", "TR4: No FNA or Follow-Up (< 1.0 cm)")), IF(B7 >= 1, "TR5: Recommend FNA (>= 1.0 cm)", IF(B7 >= 0.5, "TR5: US Follow-Up (>= 0.5 cm)", "TR5: No Routine FNA (< 0.5 cm)")))))))Try the example
Use the original values or change them to test your understanding.