Increased workload without clinical benefit: Results following implementation of the ACR‐TIRADS system for thyroid nodules
Authors' conclusion
ACR-TIRADS introduction increased workload (FNAs and operations), without increasing the proportion of cancers/FNA. It led to a few more cancers being diagnosed, but many were small and of uncertain clinical significance.
Study context
- Population
- Individuals undergoing thyroid fine needle aspiration (FNA) 2017–2019 at a large public hospital in Auckland, New Zealand
- Participants
- 422 individuals564 FNAs
- Comparison
- Post-TIRADS vs pre-TIRADS
- Outcome
- Proportion of cancers/FNA
Methodological detailsbefore/after study, single-centre, before/after ACR-TIRADS
- Before/after study
- Single-centre
- Before/after ACR-TIRADS
Main finding
As reported in the abstract
Further findings
FNA results B5-B6
- FNA results B5-B6 — FNAs needed to identify an additional B5/B6 lesion
- 15
Workload after ACR-TIRADS introduction
- FNA recommendations increased
- greater than twofold
- FNAs performed increased
- 71%-83%
- Monthly rate of FNAs increased
- 60%
- Monthly rate of operations increased
- 40%
FNA results B5-B6
- B2-B4 proportions remained stable
Cytology by TIRADS level (B5/B6; B2)
- TIRADS-5: B5/B6; B2
- 20%; 30%
- TIRADS-3: B5/B6; B2
- 2%; 57%
- TIRADS-4: B5/B6; B2
- 9%; 56%
Cancer diagnoses
- Cancer in primary nodule
- 54 (13%)
- Papillary thyroid carcinoma
- 37/54 (69%)
- Additional cancers diagnosed per year
- About 5
- Small cancers <2 cm (post vs pre)
- 49% vs. 8%
- Small cancers <1 cm (post vs pre)
- 17% vs. 0%
Original publication
Increased workload without clinical benefit: Results following implementation of the ACR‐TIRADS system for thyroid nodules. Clin Endocrinol (Oxf). Published 5 February 2023. doi:10.
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