{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:46:25Z","timestamp":1778132785206,"version":"3.51.4"},"reference-count":35,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clinical Hemorheology and Microcirculation"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Current guidelines recommend Fine Needle Aspiration (FNA) based on nodule size and ultrasound characteristics; however, these guidelines still lead to a certain amount of unnecessary FNAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To develop a dynamic nomogram prediction model based on the ACR Thyroid Imaging, Reporting, and Data System (TI-RADS) to reduce unnecessary FNAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This multicenter study analyzed 3313 thyroid nodules undergoing FNA. Univariate and multivariate logistic regression models were constructed. Patients were divided into a training cohort and two validation cohorts to compare diagnostic performance and unnecessary FNAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      This nomogram achieved performance of Area Under the Curve (AUC) 0.914 (95%CI: 0.894\u20130.934), 0.923 (95%CI: 0.900\u20130.946), 0.948 (95%CI: 0.918\u20130.978) in the training, internal and external validation cohort. Using this model, the unnecessary FNA rates for nodules in ACR TI-RADS category 3 (TR3) have decreased from 99.4% to 0%, in TR4 from 77.6% to 47.1%, and in TR5 from 25.4% to 18.9% in Center1, in TR3 have decreased from 91.9% to 0%, in TR4 from 60.0% to 21.1%, and in TR5 from 11.5% to 4.5% in Center 2 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This dynamic nomogram achieved better prediction of malignant thyroid nodules compared with the mentioned risk stratification system, leading to a more rational FNA strategy.<\/jats:p>\n                  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