Impact of Reporting ACR TI-RADS Scores on Concordance of Thyroid Biopsy Requests with Guidelines
DOI:
https://doi.org/10.58600/eurjther3043Keywords:
ACR TI-RADS, fine-needle aspiration biopsy, structured reporting, thyroid nodule, ultrasonography, ultrasound reportingAbstract
Objective: Thyroid nodules are frequently encountered in clinical practice, and risk stratification systems such as the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) have been developed to standardize management. This study aimed to evaluate whether the presence of an ACR TI-RADS score in ultrasound reports influences the concordance of biopsy requests with guideline recommendations.
Methods: This retrospective study included 498 patients referred for thyroid fine-needle aspiration biopsy during the study period. Patients were divided into two groups according to whether an ACR TI-RADS score was present in the ultrasound report (Group A, n = 91) or not (Group B, n = 407). For reports without a score, TI-RADS categories were retrospectively assigned based on descriptive findings. Biopsy requests were classified as concordant or discordant according to the ACR TI-RADS size thresholds, with additional consideration of documented nodule growth or explicit radiologist recommendations. Concordance rates were compared between groups, across TI-RADS categories, and among referring departments.
Results: Overall, 267 biopsy requests (53.6%) were concordant with guideline recommendations. Concordance was lower in Group A than in Group B (40.7% vs. 56.5%, p = 0.009). Concordance rates increased significantly across higher TI-RADS categories (p < 0.001). Among patients with reported TI-RADS scores, discordant requests were most frequently observed in TR3 and TR4 nodules. Significant differences were observed among referring departments (p = 0.002). Discordant requests were associated with smaller nodule size (p < 0.001).
Conclusion: The presence of a reported ACR TI-RADS score was associated with a higher rate of guideline-discordant biopsy requests and did not improve concordance with ACR TI-RADS size-based biopsy thresholds. These findings suggest that structured risk labeling alone may be insufficient to improve biopsy referral behavior. Further prospective studies incorporating clinical outcomes and explicit management recommendations are warranted.
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Copyright (c) 2026 Ali Salbas, Bengisu Sunbul, Dilek Sural, Atilla Hikmet Cilengir, Ozge Yildirim Salbas, Ali Murat Koc, Mehmet Serkan Gur
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