- Design
- Retrospective multicentre analysis of report text, 89 sites
- Population
- 304,455 thyroid ultrasound reports and 11,246 biopsies, 2017–2023
- Primary outcome
- TI-RADS use and documentation of biopsy criteria
- Effect
- TI-RADS 1.6% to 54.1%; nodules meeting criteria 23.3% to 8.0%
A US radiology network analysed 304,455 thyroid ultrasound reports and 11,246 ultrasound-guided biopsies across 89 sites from 2017 to 2023, using text mining.
Reports using ACR TI-RADS language rose from 1.6% to 54.1%. Among those, the share documenting a nodule meeting size-based biopsy criteria fell from 23.3% to 8.0%. Yet the biopsy rate stayed about the same, at 29.1 and 27.7 per 1,000 examinations. Half of the reports immediately before biopsy used TI-RADS language.
The gap between fewer reported biopsy indications and a stable biopsy rate suggests biopsies are still being driven by factors outside the report. The study could not judge whether individual biopsies were appropriate.
- Use TI-RADS terminology and state explicitly whether a nodule meets biopsy criteria
- Recommend follow-up interval rather than biopsy for nodules below the threshold
- Audit whether biopsies in your unit match the report's recommendation
- Share the reporting template with referring endocrinologists and surgeons
Why it matters
Biopsy rates did not fall even as reports flagged fewer nodules, so the report alone is not steering decisions.
Don't overread it
Report-level text mining cannot say whether any individual biopsy was appropriate.
The statistics, in plain English
The fall from 23.3% to 8.0% is a large absolute change, but it is a correlation over time, not proof that TI-RADS itself reduced biopsy indications.
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