ACR-TIRADS Institution and Effect on Thyroid Surgeries in Veterans: A 10-Year Retrospective Study

Risk stratification systems (RSSs) have had an increasing role in standardizing thyroid ultrasound reports. The VA Northern California Healthcare System (VA-NCHCS) Radiology department adopted the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) in 2018. We aimed to assess what effect the adoption of TI-RADS at VA-NCHCS had on thyroid surgical practices.

A 10-year retrospective review of the VA corporate data warehouse was completed (approximately 5 years prior and 5 years after universal adoption of TI-RADS) (i.e: 1/1/2013-7/1/2018 and 7/2/2018-12/30/2023). Using CPT and diagnosis codes, data were collected on all thyroid surgeries, including demographics, type of surgery performed, final pathology, staging of malignancy, and any incidental findings. A two-sample t-test with equal and unequal variances was used for comparative statistics.

3985 patients (1921 PRE-TIRADS vs. 2064 POST-TIRADS) and 7908 thyroid ultrasounds (3411 vs. 4497) were identified. 2859 FNAs were performed (1245 vs. 1614). One hundred and ninety-three surgeries (96 vs. 97) were performed with a decreasing trend in surgeries for benign pathology (56 vs. 45) and an increasing trend in surgeries for malignancy (39 vs. 51). We identified an increase in partial thyroidectomy surgeries for cancer diagnoses (11 vs. 18). Finally, there was a significant decrease in total thyroidectomies performed for benign pathology (30 vs. 13, p = 0.02).

After the institution of TIRADs at our single institution, there was a dramatic increase in the number of ultrasounds and FNAs performed, despite near stable thyroid surgical numbers. There was a significant trend towards less-invasive surgical practices.