{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T03:36:38Z","timestamp":1773027398430,"version":"3.50.1"},"reference-count":11,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,2,5]],"date-time":"2023-02-05T00:00:00Z","timestamp":1675555200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The ACR\u2010TIRADS system for stratifying thyroid nodule malignancy risk has been widely promoted and implemented. We audited its introduction at a large public hospital in Auckland, New Zealand.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Audit of outcomes following thyroid nodule fine needle aspiration (FNA) before\/after ACR\u2010TIRADS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>Individuals undergoing thyroid FNA 2017\u22122019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>From medical records, we obtained details from the pre\u2010FNA ultrasound (nodule size, TIRADS points\/levels, radiologist recommendation for FNA), Bethesda (B) cytology classification, histology and post\u2010FNA follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four hundred and twenty\u2010two individuals had 564 FNAs, 163 had surgery and 54 (13%) had cancer in the primary nodule. 37\/54 (69%) cancers were papillary thyroid carcinoma (median size 25\u2009mm, 87% \u226510\u2009mm, 61% \u226520\u2009mm). Following ACR\u2010TIRADS introduction, FNA recommendations increased greater than twofold, FNAs performed by 71%\u221283%, and the monthly rate of FNAs and operations by 60% and 40%, respectively. However, the proportion of cancers\/FNA remained similar (9.9% post\u2010TIRADS vs. 8.7% pre\u2010TIRADS). The proportions of FNA results remained stable for B2\u2212B4 categories, but doubled (11% vs. 5%) for B5\u2212B6: 15 FNAs were needed to identify an additional B5\/B6 lesion. TIRADS\u20105 nodules had a higher proportion of B5\/B6 (20%) and a lower proportion of B2 (30%) than TIRADS\u20103 (2%, 57%, respectively) and TIRADS\u20104 (9%, 56%) nodules. About 5 additional cancers\/year were diagnosed, but they were more often small (49% vs. 8% &lt;2\u2009cm, 17% vs. 0% &lt;1\u2009cm).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ACR\u2010TIRADS 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14883","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T05:39:46Z","timestamp":1675057186000},"page":"328-334","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Increased workload without clinical benefit: Results following implementation of the ACR\u2010TIRADS system for thyroid nodules"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0465-2674","authenticated-orcid":false,"given":"Mark J.","family":"Bolland","sequence":"first","affiliation":[{"name":"Department of Endocrinology Greenlane Clinical Centre Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7803-0096","authenticated-orcid":false,"given":"Andrew","family":"Grey","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Auckland Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1754-9485.2009.02060.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2017.01.046"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.16.17613"},{"key":"e_1_2_7_6_1","unstructured":"National Ethics Advisory Committee. National ethical standards for health and disability research and quality improvement. Ministry Health. 2019."},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.18.2164"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1754-9485.13161"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.15343"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i1152"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvaa031"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2019190026"}],"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.14883","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cen.14883","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.14883","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T14:25:43Z","timestamp":1692282343000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cen.14883"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,5]]},"references-count":11,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1111\/cen.14883"],"URL":"https:\/\/doi.org\/10.1111\/cen.14883","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"value":"0300-0664","type":"print"},{"value":"1365-2265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,5]]},"assertion":[{"value":"2022-09-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}