{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T01:02:45Z","timestamp":1773709365182,"version":"3.50.1"},"reference-count":25,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute of the National Institutes of Health","doi-asserted-by":"publisher","award":["K08CA248972"],"award-info":[{"award-number":["K08CA248972"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012487","name":"UF Research Opportunity Seed Fund Award","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012487","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Florida Integrated Data Repository"},{"DOI":"10.13039\/100014589","name":"UF Health Office of the Chief Data Officer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014589","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences of the NIH under University of Florida Clinical and Translational Science Awards","doi-asserted-by":"publisher","award":["UL1TR000064"],"award-info":[{"award-number":["UL1TR000064"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences of the NIH under University of Florida Clinical and Translational Science Awards","doi-asserted-by":"publisher","award":["UL1TR001427"],"award-info":[{"award-number":["UL1TR001427"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Thyroid nodules are common in clinical practice, and inappropriate selection of patients for thyroid biopsy can contribute to thyroid cancer overdiagnosis or delayed diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This work aimed to evaluate the frequency of inappropriate thyroid biopsies in practice, following a framework that integrates thyroid nodule ultrasound (US) features and patient-specific clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study was conducted at a single academic center in the United States. Participants included adult patients who underwent their first thyroid fine-needle aspiration (FNA) biopsy between January 1, 2016, and December 31, 2023, at the University of Florida. Data collection included thyroid US characteristics, clinical factors (eg, comorbidities, patient preferences), and context for biopsy decision-making. Main outcome measures included the appropriateness of thyroid biopsy assessed using a tiered framework incorporating US features and additional clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 899 patients were evaluated, with 441 meeting the inclusion criteria and undergoing 481 thyroid biopsies. Of these, 388 of 481 (80.7%) were classified as likely appropriate (L-APP) based on the American College of Radiology Thyroid Imaging Reporting and Data System criteria. In 34 of 481 (7%) of cases, clinical factors such as thyroid cancer risk features, comorbidities, symptoms, or patient preferences led to reclassification from likely inappropriate (L-INAP) to L-APP. In 50 of 481 (10%) of cases, limited life expectancy (eg, chemotherapy, end-stage disease) led to reclassification from L-APP to possibly or extremely inappropriate (EXT-INAP). EXT-INAP biopsies occurred in only 0.8% (4\/481) of cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study underscores the value of integrating US findings with clinical context to guide thyroid biopsy decisions and enhance patient-centered care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf577","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T12:28:25Z","timestamp":1761222505000},"page":"e1014-e1022","source":"Crossref","is-referenced-by-count":1,"title":["Determining Thyroid Biopsy Appropriateness: A Retrospective Study Integrating Clinical Context and Ultrasound Features"],"prefix":"10.1210","volume":"111","author":[{"given":"Saad","family":"Habib","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, University of Florida , Gainesville, FL 32606 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6660-2213","authenticated-orcid":false,"given":"Gilberto","family":"Perez Rodriguez Garcia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Arizona , Phoenix, AZ 85004 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongyue","family":"Zhang","sequence":"additional","affiliation":[{"name":"UF Health Cancer Center, University of Florida , Gainesville, FL 32606 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6976-9967","authenticated-orcid":false,"given":"Arkaprava","family":"Roy","sequence":"additional","affiliation":[{"name":"UF Health Cancer Center, University of Florida , Gainesville, FL 32606 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6780-6135","authenticated-orcid":false,"given":"Yonghui","family":"Wu","sequence":"additional","affiliation":[{"name":"Health Outcomes and Bioinformatics Department, University of Florida , Gainesville, FL 32606 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan P","family":"Brito","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic Rochester , Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7229-5061","authenticated-orcid":false,"given":"Naykky M","family":"Singh Ospina","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, University of Florida , Gainesville, FL 32606 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"2026031619582152400_dgaf577-B1","volume-title":"Thyroid Nodule","author":"Zamora","year":"2025"},{"issue":"9","key":"2026031619582152400_dgaf577-B2","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1001\/jama.2018.0898","article-title":"The diagnosis and management of thyroid nodules: a review","volume":"319","author":"Durante","year":"2018","journal-title":"JAMA"},{"issue":"3","key":"2026031619582152400_dgaf577-B3","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1007\/s12020-018-1639-8","article-title":"Patients' knowledge about the outcomes of thyroid biopsy: a patient survey","volume":"61","author":"Singh Ospina","year":"2018","journal-title":"Endocrine"},{"issue":"4","key":"2026031619582152400_dgaf577-B4","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1111\/cen.14599","article-title":"Development and pilot testing of a conversation aid to support the evaluation of patients with thyroid nodules","volume":"96","author":"Singh Ospina","year":"2022","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"6","key":"2026031619582152400_dgaf577-B5","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1016\/j.surg.2013.07.006","article-title":"Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States","volume":"154","author":"Sosa","year":"2013","journal-title":"Surgery"},{"issue":"12","key":"2026031619582152400_dgaf577-B6","doi-asserted-by":"crossref","first-page":"4434","DOI":"10.1210\/jc.2015-3100","article-title":"The influence of patient age on thyroid nodule formation, multinodularity, and thyroid cancer risk","volume":"100","author":"Kwong","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2026031619582152400_dgaf577-B7","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.eprac.2021.02.003","article-title":"Thyroid nodule evaluation and management in older adults: a review of practical considerations for clinical endocrinologists","volume":"27","author":"Ospina","year":"2021","journal-title":"Endocr Pract"},{"issue":"4","key":"2026031619582152400_dgaf577-B8","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1089\/thy.2017.0655","article-title":"Quantitative analysis of the benefits and risk of thyroid nodule evaluation in patients &gt;\/=70 years old","volume":"28","author":"Wang","year":"2018","journal-title":"Thyroid"},{"issue":"5","key":"2026031619582152400_dgaf577-B9","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1002\/cncr.29122","article-title":"Increased thyroid cancer incidence corresponds to increased use of thyroid ultrasound and fine-needle aspiration: a study of the Veterans Affairs health care system","volume":"121","author":"Zevallos","year":"2015","journal-title":"Cancer"},{"issue":"1","key":"2026031619582152400_dgaf577-B10","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1007\/s12020-024-03727-1","article-title":"Defining inappropriate thyroid biopsy? -proposed definition based on clinical evidence and stakeholder engagement","volume":"85","author":"Nguyen","year":"2024","journal-title":"Endocrine"},{"issue":"9","key":"2026031619582152400_dgaf577-B11","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1016\/j.jacr.2021.04.019","article-title":"ACR TI-RADS recommendations: a call to contextualize radiologists' recommendations for thyroid nodules with the clinical scenario","volume":"18","author":"Singh Ospina","year":"2021","journal-title":"J Am Coll Radiol"},{"issue":"2","key":"2026031619582152400_dgaf577-B12","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1007\/s12020-021-02732-y","article-title":"De-implementing low-value care in endocrinology","volume":"73","author":"Ospina","year":"2021","journal-title":"Endocrine"},{"issue":"12","key":"2026031619582152400_dgaf577-B13","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1001\/jamaoto.2022.3167","article-title":"Sociodemographic disparities in the diagnostic management of pediatric thyroid nodules","volume":"148","author":"Moon","year":"2022","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"1","key":"2026031619582152400_dgaf577-B14","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12874-018-0657-9","article-title":"Methods of sample size calculation in descriptive retrospective burden of illness studies","volume":"19","author":"Johnston","year":"2019","journal-title":"BMC Med Res Methodol"},{"key":"2026031619582152400_dgaf577-B15","doi-asserted-by":"crossref","first-page":"1309005","DOI":"10.3389\/fendo.2024.1309005","article-title":"A comparative analysis of core needle biopsy and repeat fine needle aspiration in patients with inconclusive initial cytology of thyroid nodules","volume":"15","author":"Su","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"5","key":"2026031619582152400_dgaf577-B16","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.jacr.2017.01.046","article-title":"ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee","volume":"14","author":"Tessler","year":"2017","journal-title":"J Am Coll Radiol"},{"issue":"2","key":"2026031619582152400_dgaf577-B17","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2013a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"2026031619582152400_dgaf577-B18","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"issue":"1","key":"2026031619582152400_dgaf577-B19","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1159\/000521288","article-title":"Charlson comorbidity Index: a critical review of clinimetric properties","volume":"91","author":"Charlson","year":"2022","journal-title":"Psychother Psychosom"},{"issue":"5","key":"2026031619582152400_dgaf577-B20","doi-asserted-by":"crossref","first-page":"2877","DOI":"10.1007\/s00330-020-07384-6","article-title":"Unnecessary thyroid nodule biopsy rates under four ultrasound risk stratification systems: a systematic review and meta-analysis","volume":"31","author":"Kim","year":"2021","journal-title":"Eur Radiol"},{"issue":"4","key":"2026031619582152400_dgaf577-B21","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/cen.14942","article-title":"Implementation strategies to support ultrasound thyroid nodule risk stratification: a systematic review","volume":"99","author":"Edwards","year":"2023","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"6","key":"2026031619582152400_dgaf577-B22","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.2214\/AJR.18.20056","article-title":"Incomplete thyroid ultrasound reports for patients with thyroid nodules: implications regarding risk assessment and management","volume":"211","author":"Karkada","year":"2018","journal-title":"AJR Am J Roentgenol"},{"issue":"4","key":"2026031619582152400_dgaf577-B23","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.eprac.2023.12.015","article-title":"Assessing the frequency of deferrable thyroid nodule biopsies to de-escalate low-value care","volume":"30","author":"Alexis","year":"2024","journal-title":"Endocr Pract"},{"issue":"1","key":"2026031619582152400_dgaf577-B24","doi-asserted-by":"crossref","first-page":"38","DOI":"10.2214\/AJR.19.22691","article-title":"Diagnostic performance of American college of radiology TI-RADS: a systematic review and meta-analysis","volume":"216","author":"Li","year":"2021","journal-title":"AJR Am J Roentgenol"},{"issue":"2","key":"2026031619582152400_dgaf577-B25","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s12020-023-03519-z","article-title":"Clinician feedback using a shared decision-making tool for the evaluation of patients with thyroid nodules-an observational study","volume":"83","author":"Singh Ospina","year":"2024","journal-title":"Endocrine"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgaf577\/64922318\/dgaf577.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/111\/4\/e1014\/64922318\/dgaf577.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/111\/4\/e1014\/64922318\/dgaf577.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T23:58:46Z","timestamp":1773705526000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/111\/4\/e1014\/8300707"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":25,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,10,24]]},"published-print":{"date-parts":[[2026,3,17]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgaf577","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2025,10,24]]}}}