Objective:To determine the sensitivity of ACR-TIRADS scoring by comparing its results with those obtained on biopsy of respective specimens.Method:This prospective study including N=205 patients with thyroid nodules was conducted in ENT Department of MTI Hayatabad Medical complex, Peshawar during the period from May 1, 2019 to April 30, 2022. Preoperative ultrasonography with assigning of TIRADS scores was performed in all patients. Appropriate thyroidectomies were performed in these patients and specimen biopsied. Pre-op TIRADS scores were compared with biopsy results. To determine the sensitivity of TIRADS, TR1 and TR2 were considered ‘benign’ and TR3, TR4, TR5 were considered ’malignant’ for comparison with biopsy results.Results:The mean age of patients was 37.68 years with standard deviation of ±11.52. The M: F ratio was 1:3.5. Nineteen patients (9.27%) had solitary thyroid nodules & 186 (90.73%) had multinodular goiters. TIRADS scoring was benign for 171 (83.41%) and malignant for 34 (16.58%) nodules. The biopsy results revealed 180 (87.80%) nodules to benign and the rest as malignant. The sensitivity, specificity and diagnostic accuracy were calculated at 80%, 92.77% and 91.21% respectively. Chi square test and p-value determination showed that there was a strong positive concordance between TIRADS scores & biopsy results which is highly significant (p=.001).Conclusion:The Ultrasonographic ACR-TIRADS scoring and risk stratification system is highly sensitive for detecting malignancy in thyroid nodules. It is, therefore, a reliable technique in the initial assessment of thyroid nodules and decisions can safely be based on its results. In cases of doubt, clinical judgment should be exercised before making final decision.