The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) stratifies patients with thyroid nodules for further evaluation. We evaluated the accuracy of this risk stratification and compared it with that of fine-needle aspiration cytology (FNAC) and final pathology. The nodules (n = 381) of 329 patients (mean age, 45.5 y; 251 female) who underwent thyroid surgery from January 2021 to September 2023 were retrospectively analyzed for the ACR TI-RADS, FNAC, and final pathology results. The nodules were categorized according to risk of malignancy as 75.9% ACR TI-RADS 5, 72.6% ACR TI-RADS 4, 38.9% ACR TI-RADS 3, and 33.3% ACR TI-RADS 2. Considering ACR TI-RADS 5 and 4 as high-risk categories, the sensitivity, specificity, positive-predictive value, and negative-predictive value of the ACR TI-RADS categories were 77.9%, 57.3%, 73.8%, and 62.8%, respectively. With both ACR TI-RADS and FNAC high-risk categories combined, the sensitivity and specificity improved to 82.4% and 58.6%, respectively. The ACR TI-RADS score effectively predicts malignancy in higher-risk categories; however, some malignant cases were found within lower-risk categories, implying the need for careful utilization of this system. Combining high-risk ACR TI-RADS and FNAC results improves the diagnostic accuracy of thyroid nodules. Confirmation from further prospective studies is required.

Background/Objectives: The parapharyngeal space is a complex anatomical region that houses critical neurovascular structures and serves as the origin of rare tumors, which account for 0.5–1% of head and neck neoplasms. Magnetic resonance imaging (MRI) is useful for their preoperative assessment. However, its accuracy in real-world clinical settings remains underexplored. This study aimed to investigate the diagnostic accuracy of MRI for parapharyngeal tumors at two tertiary centers. Methods: This retrospective study included patients who underwent MRI and surgical excision at two tertiary centers in Saudi Arabia between 2018 and 2024. Two reviewers independently extracted their MRI data and compared them with the final pathological data to determine the diagnostic performance of MRI. Results: Of the 31 patients (58.1% female; median age, 37.5 years), 90.3% had benign tumors. Neurogenic (41.9%) and salivary (25.8%) tumors were most common; 61.3% were located within the pre-styloid space. The benign and malignant groups had comparable baseline characteristics. MRI demonstrated moderate overall diagnostic agreement (κ = 0.525) and near-perfect concordance for schwannomas (κ = 0.912) and paragangliomas (κ = 0.839) but poor agreement for hemangiopericytomas (κ = −0.051). It had high accuracy (90.3%), specificity (92.9%), and negative predictive value (96.3%) for detecting malignancy but limited sensitivity (66.7%) or positive predictive value (50.0%). Nonetheless, cautious interpretation is required due to the limited prevalence of malignancy in the cohort (n = 3). Conclusions: MRI demonstrated high specificity for benign parapharyngeal space lesions in routine clinical reporting within this retrospective cohort, reflecting strong radiologic–pathologic agreement. Estimates of sensitivity and positive predictive value for malignancy were influenced by the limited number of malignant cases. Accordingly, the reported diagnostic performance measures should be interpreted as descriptive and exploratory, characterizing real-world MRI performance rather than definitive diagnostic accuracy.

Background/Objectives: The co-occurrence of a carotid body tumor (CBT) and papillary thyroid carcinoma (PTC) is a rare clinical event. The frequency of this dual pathology in recent reports has sparked a debate on whether it represents a true pathophysiological association or an artifact of increased diagnostic surveillance. This study aims to report the prevalence, clinicopathological characteristics, management, and outcomes of concurrent CBT and PTC in a contemporary cohort. Methods: We conducted a retrospective review of patients who underwent CBT resection at two tertiary centers between 2014 and 2024. Data on patient demographics, tumor characteristics, preoperative imaging, surgical management (single stage vs. staged), final histopathology, and clinical outcomes were collected and analyzed. Results: Overall, 32 patients with surgically resected CBTs were included. Eleven patients (34.4%) had thyroid nodules identified on preoperative imaging. The mean age of the participants was 57.2 ± 16.3 years. Females represented the majority of the population (n = 27, 84.4%). Nine patients underwent thyroid surgery with subsequent pathological confirmation. Management involved resection at two different time intervals in five cases (55.6%) and a single-stage operation in four (44.4%). On final pathology, PTC was confirmed in eight patients (25.0%). During the follow-up period, no recurrences of either tumor type were observed. Conclusions: The prevalence of concurrent PTC in patients with CBTs is significantly higher than previously reported, reaching 25% in our cohort. This incidental finding raises the possibility of surveillance bias or underlying genetic mechanisms. Management with either a single-stage or staged surgical approach was not associated with major complications. The prognosis for patients with this dual pathology is excellent and appears to be dictated by the independent characteristics of each tumor.