Using the EU-TIRADS ultrasound system improves identification of thyroid nodules needing surgery, minimizing unnecessary biopsies.

• A higher percentage of nodules classified as Bethesda IV-VI were found in the selective group (26%) vs. non-selective (13%), p=0.039.
• The malignancy rate was similar: 8% for selective vs. 5% for non-selective.

Less need for cytology: 71% of patients in the selective group underwent FNA compared to 83% in the non-selective group.

Surgeons should be aware that while EU-TIRADS aids selection, the estimation of patients avoiding FNA might be over-inflated, suggesting further refinement is necessary.