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Published on: June 9, 2023
A randomized controlled trial comparing non-selective versus selective TIRADS-based cytology in thyroid cancer
Jakob Dahlberg1,2, Jeanette Carlqvist3,4, Ann Örtoft5
1Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
The British Journal of Surgery
|June 20, 2026
Summary
The EU-TIRADS system helps identify thyroid nodules needing fine needle aspiration (FNA) without missing cancers. While it reduces unnecessary procedures, further refinement is needed to optimize its use in thyroid cancer diagnostics.
Area of Science:
- Endocrinology
- Oncology
- Radiology
Background:
- Ultrasound risk stratification systems aim to differentiate benign from malignant thyroid lesions, reducing unnecessary fine needle aspiration (FNA) cytology.
- This study evaluated if an ultrasound risk stratification system improved the identification of thyroid nodules requiring surgical intervention.
Purpose of the Study:
- To assess the efficacy of the EU-TIRADS (European Thyroid Imaging Reporting and Data System) risk stratification system in guiding FNA cytology for thyroid nodules.
- To determine if selective FNA cytology based on EU-TIRADS criteria improves the identification of neoplastic nodules compared to non-selective FNA.
Main Methods:
- A multi-center, unblinded, interventional randomized trial was conducted in Western Sweden.
- Patients were randomized to either selective FNA cytology based on EU-TIRADS criteria or non-selective FNA cytology.
Main Results:
- The frequency of nodules classified as Bethesda category IV-VI was significantly higher in the selective EU-TIRADS group (26%) compared to the non-selective group (13%).
- The malignancy rate was similar between groups (8% selective vs. 5% non-selective).
- FNA cytology was performed in 71% of patients in the selective group, a reduction from 83% in the non-selective group. Cytology was omitted in 7% of patients with nodules yielding EU-TIRADS 3 or higher in the selective group.
Conclusions:
- The EU-TIRADS system effectively selects neoplastic thyroid nodules for FNA while avoiding missed thyroid cancers.
- The current study suggests that the potential for safely omitting FNA using EU-TIRADS might be overestimated.
- Further refinement of risk stratification systems is necessary for improved thyroid cancer diagnostics.
