Evaluation of Thyroid Ultrasound Report Quality and Assessing Effect of Adherence to Risk Stratification Criteria on Referral for Thyroid Nodule Biopsy

Thejeel, Bashiar; Rahimi, Behruz; Seidler, Michael; Al-Agha, Rany; Fung, Christopher

doi:10.1177/0846537119900634

Cited by 11 publications

(8 citation statements)

References 29 publications

(39 reference statements)

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“…With this aim, over the years, endocrine and radiologic societies have published guidelines for the proper execution of thyroid US with relative malignancy risk strati cation (22)(23)(24)(25)(26). In this setting, real data about the use by radiologists of a proper lexicon, a complete report, and a risk strati cation system are scarce (27).…”

Section: Introductionmentioning

confidence: 99%

Patients undergoing endocrine consultation and first diagnosis of nodular disease: Indications of thyroid ultrasound and completeness of ultrasound reports

Negro

Greco

2023

Endocrine

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To evaluate reasons for performing ultrasonography (US) and completeness of US reports in patients undergoing endocrine consultation with the rst diagnosis of nodular disease. MethodsSince January 1 to June 30, 2021, we prospectively collected patient data (age and thyroid-stimulating hormone concentrations), reasons for performing thyroid US, and completeness of reports regarding the description of the thyroid gland and nodules. In the case of multiple nodules, we considered the nodule suspected of malignancy and the largest one. To evaluate the accuracy of thyroid nodule description, we referred to the ve characteristics suggested by the TIRADS system. ResultsA total of 341 patients with thyroid nodules received endocrine consultation (female, 78%). The most frequent reasons for performing thyroid US were unrelated to a suspected thyroid disease (31.7%), followed by incidentaloma (23.5%), dysfunction or positivity for thyroid antibodies (19.1%), symptomatic or visible nodules (17.6%), and family history (8.2%). Gland texture was not reported in 41.9%. The depth of the lobes was the dimension reported most frequently (42.2%), but the diameter was not reported in 57.8% of the cases. As regards the description of the most relevant nodule, length was reported more frequently (75.9%). Margins and echogenicity were more frequently described (54.5% and 44.3%, respectively) than other characteristics (composition, 27%; echogenic foci, 6.7%; shape, 0.6%). No reports had indicated the malignancy risk strati cation. ConclusionsThe results of the study demonstrate that in patients undergoing endocrine consultation with rst detected thyroid nodules, US was mostly performed in asymptomatic cases, US reports were incomplete, and no risk strati cation system was reported.

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Section: Introductionmentioning

confidence: 99%

Patients undergoing endocrine consultation and first diagnosis of nodular disease: Indications of thyroid ultrasound and completeness of ultrasound reports

Negro

Greco

2023

Endocrine

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“…In experienced hands, the false-negative rate of thyroid nodule malignancy risk stratification using ultrasound may be as low as 2.2% ( 5 ). Certain centers have noted that adherence to the use of a nodule risk stratification system leads to a substantial reduction in referrals for unnecessary FNAB, ranging from 19 to 55% reduction with ACR-TIRADS and 14% reduction with the ATA system in one study ( 6 , 7 ). In addition, previous studies that prompted radiologists to use ACR-TIRADS saw a significant increase in the number of nodule features and recommendation of management in the ultrasound reports ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Improvement in thyroid ultrasound report quality with radiologists’ adherence to 2015 ATA or 2017 TIRADS: a population study

Seal³

et al. 2022

European Thyroid Journal

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Objectives: There has been slow adoption of thyroid ultrasound guidelines with adherence rates as low as 30% and no population-based studies investigating adherence to guideline-based malignancy risk assessment. We therefore evaluated the impact of adherence to the 2015 ATA guidelines or 2017 ACR-TIRADS guidelines on the quality of thyroid ultrasound reports in our healthcare region. Methods: We reviewed 899 thyroid ultrasound reports of patients who received fine needle aspiration biopsy and were diagnosed with Bethesda III or IV nodules or thyroid cancer. Ultrasounds were reported by radiology group 1, group 2, or other groups, and were divided into pre-2018 (before guideline adherence) or 2018-onwards. Reports were given a utility score (0 to 6) based on how many relevant nodule characteristics were included. Results: Group 1 had a pre-2018 utility score of 3.62 and 39.4% classification reporting rate, improving to 5.77 and 97.0% among 2018-onwards reports. Group 2 had a pre-2018 score of 2.8 and reporting rate of 11.5%, improving to 5.58 and 93.3%. Other radiology groups had a pre-2018 score of 2.49 and reporting rate of 32.2%, improving to 3.28 and 61.8%. Groups 1 and 2 had significantly higher utility scores and reporting rates in their 2018-onward reports when compared to other groups’ 2018-onward reports, pre-2018 group 1 reports, and pre-2018 group 2 reports. Conclusions: Dedicated adherence to published thyroid ultrasound reporting guidelines can lead to improvements in report quality. This will reduce diagnostic ambiguity and improve clinician’s decision-making, leading to overall reductions in unnecessary FNA biopsy and diagnostic surgery.

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“…Diagnostic ultrasound stratification systems function as "rule-out tools" that prevent unnecessary FNAs in thyroid nodules. There is evidence that the application of such systems in routine clinical practice reduces unnecessary FNAs whilst not unduly increasing the rate of missed cancers or cancer-related morbidity and mortality (8,9).…”

Section: Introductionmentioning

confidence: 99%

Real-world application of ATA Guidelines in over 600 aspirated thyroid nodules: is it time to change the size cut-offs for FNA?

Ioakim

Syed

Zavros

et al. 2022

European Thyroid Journal

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Background: The 2015 American Thyroid Association (ATA) guidelines recommend the following size cut-offs based on sonographic appearances for subjecting nodules to fine-needle aspiration (FNA) biopsy: low-risk 15mm, intermediate-risk and high-risk 10mm. Objective: We conducted a ‘real world’ study evaluating the diagnostic performance of the ATA cut-offs against increased thresholds, in the interest of safely limiting FNAs. Methods: We performed a retrospective analysis of prospectively collected data on 604 nodules which were sonographically risk stratified as per the ATA guidelines and subsequently subjected to ultrasound-guided FNA. Nodules were cytologically stratified into ‘benign’ (Bethesda class 2) and ‘non-benign’ (Bethesda classes 3-6). We obtained the negative predictive value (NPV), accuracy, FNAs that could be spared, missed ‘non-benign’ cytologies and missed carcinomas on histology, according to the ATA cut-offs compared to higher cut-offs. Results: In low-risk nodules, the high performance of NPV (≈91%) is unaffected by increasing the cut-off to 25mm, and accuracy improves by 39.4%; 46.8% of FNAs could be spared at the expense of few missed B3-B6 cytologies (7.9%) and no missed carcinomas. In intermediate-risk nodules, a 15mm cut-off increases the NPV by 11.3% and accuracy by 40.7%. The spared FNAs approach 50%, while B3-B6 cytologies are minimal, with no missed carcinomas. In high-risk nodules, low NPV (<35%) and accuracy (<46%) were obtained regardless of cut-off. Moreover, the spared FNAs achieved at higher cut-offs involved numerous missed ‘non-benign’ cytologies and carcinomas. Conclusion: It would be clinically safe to increase the ATA cut-offs for FNA in low-risk nodules to 25mm and in intermediate-risk nodules to 15mm.

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Evaluation of Thyroid Ultrasound Report Quality and Assessing Effect of Adherence to Risk Stratification Criteria on Referral for Thyroid Nodule Biopsy

Cited by 11 publications

References 29 publications

Patients undergoing endocrine consultation and first diagnosis of nodular disease: Indications of thyroid ultrasound and completeness of ultrasound reports

Patients undergoing endocrine consultation and first diagnosis of nodular disease: Indications of thyroid ultrasound and completeness of ultrasound reports

Improvement in thyroid ultrasound report quality with radiologists’ adherence to 2015 ATA or 2017 TIRADS: a population study

Real-world application of ATA Guidelines in over 600 aspirated thyroid nodules: is it time to change the size cut-offs for FNA?

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