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

Hu, Xin; Wu, Jiahui; Seal, Paula; Ghaznavi, Sana; Symonds, Christopher; Kinnear, Susan Elizabeth; Paschke, Ralf

doi:10.1530/etj-22-0035

Cited by 8 publications

(10 citation statements)

References 15 publications

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“…Guideline‐based ultrasound malignancy risk stratification is able to classify about 50% of thyroid nodules as benign with a false negative rate <1% 24 . Unfortunately, the application of guideline‐based ultrasound malignancy risk stratification is still limited in routine clinical practice 25,26 . Thus, the first step in auditing the institutional quality of the thyroid nodule evaluation pathway should address the quality of the thyroid ultrasound reports, making sure that all relevant sonographic features are described using standardized terminology, and classified into at least one of the current classification systems 25 …”

Section: Molecular Tests For the Evaluation Of Cytologically Indeterm...mentioning

confidence: 99%

Clinical value of molecular markers as diagnostic and prognostic tools to guide treatment of thyroid cancer

Valderrábano

Eszlinger

Stewardson

et al. 2023

Clinical Endocrinology

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Objective Advances in our understanding of the molecular biology of thyroid tumours is being rapidly translated into their clinical management. This review summarizes the current use of molecular testing in thyroid tumours, focusing on their usefulness as diagnostic and prognostic tools to guide treatment with consideration of present limitations. Design Considerations about molecular testing applications for the diagnosis and treatment of thyroid tumours are divided into four sections/roles: (1) evaluating cytologically indeterminate thyroid nodules; (2) guiding extent of surgery in indeterminate thyroid nodules; (3) completing histological characterization of thyroid tumours and (4) identifying actionable mutations in advanced progressive thyroid cancers. Results Genomic testing can improve the presurgical malignancy risk assessment in indeterminate thyroid nodules. However, a prior in‐depth analysis of institutional quality and outcomes of sonographical, cytological and histological characterization of thyroid tumours is necessary. Presently, it remains uncertain whether knowing the molecular profile of a cytologically indeterminate thyroid nodule might be advantageous to modify the extent of initial surgery. Molecular characterization of thyroid tumours can be a valuable adjunct to morphological diagnosis in some challenging cases, such as in low‐risk follicular cell‐derived neoplasms, or rare tumours. Finally, as selective kinase inhibitors are available, molecular testing in locally advanced/metastatic progressive thyroid cancers should also be integrated into the institutional clinical management pathway to improve outcomes and limit toxicity. Conclusions Molecular testing needs to be implemented into the local evidence‐based clinical management thyroid nodule/cancer pathways to improve its diagnostic and prognostic value and to optimize cost‐effectiveness.

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Section: Molecular Tests For the Evaluation Of Cytologically Indeterm...mentioning

confidence: 99%

Clinical value of molecular markers as diagnostic and prognostic tools to guide treatment of thyroid cancer

Valderrábano

Eszlinger

Stewardson

et al. 2023

Clinical Endocrinology

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“…We identified 2666 potentially eligible studies of which eight were included in this review. 19,[34][35][36][37][38][39][40] The study selection process is summarised in Figure 1. Most studies were performed in North America (7/8), focused on the implementation of ACR TI-RADS and involved radiologists (7/8).…”

Section: Study Identification and General Descriptionmentioning

confidence: 99%

“…In four studies, before/after comparisons showed statistically significant improvement in the quality/utility of thyroid ultrasound reports. 19,34,35,37 In five studies that evaluated, the overall quality of the ultrasound report; four focused on the proportion of reports that included ultrasound features of interest and three in the inclusion of management recommendations according to clinical guidelines. 19,34,35,37,39 Service outcomes focused on the diagnostic utility of thyroid nodule risk stratification; biopsy rates were decreased in two studies and in one of two studies there was an increase in the rates of malignant biopsies.…”

Section: Outcomes Of Interestmentioning

confidence: 99%

“…19,34,35,37 In five studies that evaluated, the overall quality of the ultrasound report; four focused on the proportion of reports that included ultrasound features of interest and three in the inclusion of management recommendations according to clinical guidelines. 19,34,35,37,39 Service outcomes focused on the diagnostic utility of thyroid nodule risk stratification; biopsy rates were decreased in two studies and in one of two studies there was an increase in the rates of malignant biopsies. 38,40 Overall, introduction of thyroid nodule risk stratification resulted in improvement of the implementation outcomes, with variable effects on the evaluated service outcomes.…”

Section: Outcomes Of Interestmentioning

confidence: 99%

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Implementation strategies to support ultrasound thyroid nodule risk stratification: A systematic review

Edwards

Brito

Salloum

et al. 2023

Clinical Endocrinology

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BackgroundUltrasound risk stratification can improve the care of patients with thyroid nodules by providing a structured and systematic approach for the evaluation of thyroid nodule features and thyroid cancer risk. The optimal strategies to support implementation of high quality thyroid nodule risk stratification are unknown. This study seeks to summarise strategies used to support implementation of thyroid nodule ultrasound risk stratification in practice and their effects on implementation and service outcomes.MethodsThis is a systematic review of studies evaluating implementation strategies published between January 2000 and June 2022 that were identified on Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane, Scopus, or Web of Science. Screening of eligible studies, data collection and assessment for risk of bias was completed independently and in duplicate. Implementation strategies and their effects on implementation and service outcomes were evaluated and summarised.ResultsWe identified 2666 potentially eligible studies of which 8 were included. Most implementation strategies were directed towards radiologists. Common strategies to support the implementation of thyroid nodule risk stratification included: tools to standardise thyroid ultrasound reports, education on thyroid nodule risk stratification and use of templates/forms for reporting, and reminders at the point of care. System based strategies, local consensus or audit were less commonly described. Overall, the use of these strategies supported the implementation process of thyroid nodule risk stratification with variable effects on service outcomes.ConclusionsImplementation of thyroid nodule risk stratification can be supported by development of standardised reporting templates, education of users on risk stratification and reminders of use at the point of care. Additional studies evaluating the value of implementation strategies in different contexts are urgently needed.

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

Cited by 8 publications

References 15 publications

Clinical value of molecular markers as diagnostic and prognostic tools to guide treatment of thyroid cancer

Clinical value of molecular markers as diagnostic and prognostic tools to guide treatment of thyroid cancer

Implementation strategies to support ultrasound thyroid nodule risk stratification: A systematic review

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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