Enhancing ACR TI-RADS Predictive Value: A Logistic Regression Approach With Size and Age to Personalized Fine Needle Aspiration Decision-Making
- 1Department of Internal Medicine, Division of Endocrinology, SSM Health/ Saint Louis University School of Medicine, Saint Louis, Missouri
- 2Department of Internal Medicine, Division of Endocrinology, John Cochran VA Medical Center, Saint Louis, Missouri
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.
Methods: 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).
Results: 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.
Conclusions: 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.
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BibTeX
@article{amini2026enhancing,
title = {{Enhancing ACR TI-RADS Predictive Value: A Logistic Regression Approach With Size and Age to Personalized Fine Needle Aspiration Decision-Making}},
author = {Mehdia Amini and Ekta Shrestha and Allina Ghimire and Jennifer Newman and Alan B. Silverberg and Stewart G. Albert},
journal = {AACE Endocrinology and Diabetes},
year = {2026},
month = may,
doi = {10.1016/j.aed.2026.05.002},
url = {https://doi.org/10.1016/j.aed.2026.05.002},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Enhancing ACR TI-RADS Predictive Value: A Logistic Regression Approach With Size and Age to Personalized Fine Needle Aspiration Decision-Making
AU - Mehdia Amini
AU - Ekta Shrestha
AU - Allina Ghimire
AU - Jennifer Newman
AU - Alan B. Silverberg
AU - Stewart G. Albert
PY - 2026
DA - 2026/05/14
JO - AACE Endocrinology and Diabetes
DO - 10.1016/j.aed.2026.05.002
UR - https://doi.org/10.1016/j.aed.2026.05.002
AB - 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. Methods: 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). Results: 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. Conclusions: 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.
SN - 3050-9157
ER -