Introduction: To perform a Latin-American multicentric study for the prediction of benign and malignant thyroid nodules using Alpha Score, and to compare it with ACR TIRADS® and Bethesda®. Materials and Methods: A prospective multicentric study in 10 radiological hospitals and institutions of Latin America was performed and 818 thyroid nodules were analyzed by ultrasound and classified by using both ACR TIRADS® and Alpha Score; fine-needle aspiration biopsy was performed when needed and classified with Bethesda. The relationships between predictors were analyzed by using binary logistic regression, statistical significance was defined by a p-value of 0.05, with an error margin of 4% and 95% confidence intervals. Results: Alpha Score 2.0 establishes five types of malignant predictors: microcalcifications, irregular borders, taller-than-wide shape, predominant solid texture and hypoechogenicity; a diameter equal to or greater than 1.5 cm adds an extra point to the final score. Resulting classification divides TNs into 4 categories: benign (1.9%), low suspicion (8.7%), mild suspicion (13.6%) and high suspicion (75.7%) of malignancy probability; sensitivity of 82%, specificity of 74%, the positive predictive value of 94%, the negative predictive value of 51%, the statistical accuracy of 81%, odds ratio of 108.89 and correlation with ACR TIRADS of 0.77 and Bethesda of 0.91. Conclusions: Alpha Score 2.0 has superior diagnostic accuracy and performance compared to the previously published Alpha Score and is able to classify a benign TN in a precise, safe and accurate way, avoiding unnecessary FNABs or determining the necessity of FNAB in cases of moderate to high suspicion of malignancy.
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