The limitations of our study include a selection bias that exists because only the cases that went on to undergo an operation at our center were included in the study population. This leads to a higher than expected ROMs in the unsatisfactory, benign and AUS/FLUS groups, when compared to their expected BSRTC ROMs . Surgically resected AUS/FLUS nodules have actually been reported to have a ROM that ranges between 6% and 48%  as highlighted in the current ATA guidelines. Similarly, a meta-analysis that was reported by our group compared 13 different centers following the implementation of the BSRTC and reported a ROM for AUS/FLUS nodules to be ranging between 19–38% .