Abstract Background: Thyroid nodules are common entities, which is frequently discovered in daily practice. B-mode US is the most sensitive, non invasive, easy to use method for detect thyroid nodules and describe it properly. Aim of Study: The aim of this study is to evaluate the usefulness of Thyroid imaging reporting and data system in the differentiation of thyroid nodules in correlation with fine needle aspiration cytopathology. Patients and Methods: This study conducted 60 patients (47 females and 13 males; age between (18-70 years) with mean age was (41±11.52) years) during the period from December 2020 to December 2021 at Oncology Center - Mansoura University (OCMU). All patients had undergone thyroid ultrasound as well as ultrasound-guided fine needle aspiration (FNA). Results: The study included 60 patients with thyroid nodules (41 benign and 19 malignant). Positive predictive value for nodules in this study was 0% for TIRADS 1 and TIRADS 2 nodules, 3.6% for TIRADS 3 nodules, 55.6% for TIRADS 4 nodules and 100% for TIRADS 5 nodules. Conclusion: The ACR TIRADS risk-stratification system is simple, non invasive, easy to use method for assessing thyroid nodules which provide management and recommen-dations, aiming to reduce unnecessary biopsies and excessive surveillance.