High Variability in Radiologists' Reporting Practices for Incidental Thyroid Nodules Detected on CT and MRI

Abstract

BACKGROUND AND PURPOSE:There are no guidelines for reporting incidental thyroid nodules seen on CT and MR imaging. We evaluated radiologists' current reporting practices for incidental thyroid nodules detected on these imaging modalities.

Radiology Reports for Incidental Thyroid Nodules on CT and MRI: High Variability across Subspecialties

“…These results concur with findings from a survey on how radiologists report ITNs on the basis of scenarios differing in patient age, sex, and nodule size. 3 In this survey, the scenario with the highest variability in responses was that of a 60-year-old woman with a 10-mm ITN: Thirty-six percent of radiologists thought that the nodule should be left in the "Findings" section and not receive work-up, while 35% of radiologists would recommend additional work-up with sonography and 21% would report the nodule in the "Impression" without a recommendation. 3 In our study, which evaluated actual reporting practices, the practices seen in radiology reports for 10-to 19-mm nodules were also almost equally split: Sixty-one percent of ITNs measuring 10 -14 mm and 50% of those measuring 15-19 mm were reported in the "Impression."…”

“…3 In this survey, the scenario with the highest variability in responses was that of a 60-year-old woman with a 10-mm ITN: Thirty-six percent of radiologists thought that the nodule should be left in the "Findings" section and not receive work-up, while 35% of radiologists would recommend additional work-up with sonography and 21% would report the nodule in the "Impression" without a recommendation. 3 In our study, which evaluated actual reporting practices, the practices seen in radiology reports for 10-to 19-mm nodules were also almost equally split: Sixty-one percent of ITNs measuring 10 -14 mm and 50% of those measuring 15-19 mm were reported in the "Impression." This high variability suggests that radiologists are less certain of how to manage ITNs measuring 10 -19 mm than they are for ITNs Ͻ1 cm or Ͼ2 cm, and this size range appears to be one for which future guidelines have the potential to significantly improve reporting consistency.…”

“…10,11 The variation in reporting styles for ITNs seen on CT and MR imaging has been measured in a recent study, which surveyed radiologists on how they reported different scenarios varying in nodule size and patient history. 3 The study demonstrated high variability of ITN reporting, with an overall mean agreement in reporting style of 53% and lower rates of agreement for smaller nodules. A limitation of a survey, however, is that it may not accurately reflect what a radiologist actually does in practice.…”

“…Consequently, the current practice of reporting thyroid nodules on CT and MR imaging by radiologists is highly variable. 3 Some radiologists may report all…”

Developing a Registry for Thyroid Incidentalomas: Lessons Learned and the Path Forward

“…The observational registry design originally outlined could not be operationalized as hoped, and even after modification, there were numerous threats to data validity. Marked variation was found in radiologist and clinician reporting and management of such findings, a widespread problem as previously reported by Hoang et al (16).…”