{
  "abstract": "Background: The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) stratifies thyroid nodules by malignancy risk and aims to reduce unnecessary fine-needle aspiration (FNA). We evaluated whether incorporating patient age and nodule size improves the positive predictive value for clinically relevant thyroid neoplasia.\n\nMethods: We retrospectively reviewed thyroid ultrasound examinations of patients age 18-75, first applying standard ACR TI-RADS criteria and then fitting logistic regression models using a composite predictor defined as TI-RADS category multiplied by nodule size in millimeters (TI-RADS × mm).\n\nResults: Of 446 eligible patients, 171 (38%) met standard ACR criteria for FNA. Fourteen (3.0%) had clinically relevant thyroid lesions (carcinoma or neoplasm) on surgical pathology. Standard ACR criteria for FNA define TI-RADS categories versus abrupt size thresholds. In this evaluation, logistic regression using TI-RADS × mm supported a continuous risk gradient. Age was not independently associated with malignancy risk but was associated with a higher frequency of benign nodules meeting biopsy criteria, yielding an inverse age–risk relationship among nodules meeting threshold criteria. We propose an exploratory model to consider a continuum of nodule size and age of the patient risk model could influence and individualized approach for FNA.\n\nConclusions: TI-RADS × mm scores provide a continuous estimate of malignancy risk. While TI-RADS ≤2 is reassuring and TI-RADS 5 is strongly suspicious, the lower risk category of TI-RADS 3 may benefit from individualized, shared decision-making that considers patient age and nodule size, particularly in borderline cases.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, Division of Endocrinology, SSM Health/ Saint Louis University School of Medicine, Saint Louis, Missouri",
    "Department of Internal Medicine, Division of Endocrinology, John Cochran VA Medical Center, Saint Louis, Missouri"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Mehdia Amini"
    },
    {
      "affs": [
        0
      ],
      "name": "Ekta Shrestha"
    },
    {
      "affs": [
        0
      ],
      "name": "Allina Ghimire"
    },
    {
      "affs": [
        0
      ],
      "name": "Jennifer Newman"
    },
    {
      "affs": [
        0
      ],
      "name": "Alan B. Silverberg"
    },
    {
      "affs": [
        0
      ],
      "name": "Stewart G. Albert"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7jxefgsbjz0t3.bib",
  "cited_by": 0,
  "doi": "10.1016/j.aed.2026.05.002",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13728237/",
  "id": "7jxefgsbjz0t3",
  "issns": [
    "3050-9157"
  ],
  "landing_url": "https://doi.org/10.1016/j.aed.2026.05.002",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research Article"
    ],
    [
      "openalex",
      "2712|Thyroid Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7161153262",
  "pdf_url": null,
  "pmcid": "PMC13728237",
  "pmid": "42978764",
  "published": "2026-05-14",
  "publisher": "American Association of Clinical Endocrinology",
  "ris": "https://research.draconitic.com/paper/7jxefgsbjz0t3.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T12:23:57Z",
      "native_id": "PMC13728237",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.aed.2026.05.002"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Thyroid Cancer Diagnosis and Treatment",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Enhancing ACR TI-RADS Predictive Value: A Logistic Regression Approach With Size and Age to Personalized Fine Needle Aspiration Decision-Making",
  "title_text": "Enhancing ACR TI-RADS Predictive Value: A Logistic Regression Approach With Size and Age to Personalized Fine Needle Aspiration Decision-Making",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:21:15Z",
  "url": "https://research.draconitic.com/paper/7jxefgsbjz0t3",
  "venue": "AACE Endocrinology and Diabetes",
  "versions": []
}