What to Do With Incidental Thyroid Nodules on Imaging? An Approach for the Radiologist

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

“…3,4 This factor may contribute to confusion, inconsistent reporting, and even overinvestigation of small thyroid nodules. This study evaluates how radiologists claim to report thyroid lesions incidentally detected on CT and MR imaging and quantifies the variability in this self-described practice.…”

“…A review by Hoang et al 4 proposed a set of criteria for reporting ITNs on CT, MR imaging, and PET. The work-up system, known as the Duke 3-tiered system, has since been evaluated in a retrospective study that compared the 3-tiered system with a Ն10-mm-sized threshold for consecutive ITNs detected on CT neck studies.…”

“…The survey scenarios were designed to simulate the spectrum of ITNs encountered in clinical practice and to cover categories in the Duke 3-tiered system, which was devised for guiding work-up for ITNs detected on CT and MR imaging. 1,4 These criteria are divided into 3 mutually exclusive categories: Category 1 consists of nodules of any size with aggressive imaging findings, including associated suspicious lymph nodes, local invasion, or focal metabolic activity on PET. Nodules not meeting the criteria for category 1 are considered to have indeterminate imaging findings on CT and MR imaging and are grouped into categories 2 and 3.…”

“…The Society of Radiologists in Sonography and other societies have published recommendations for biopsy of nodules seen on sonography, 3 but no medical organizations have specific published recommendations for the work-up of thyroid nodules seen on CT and MR imaging. 4 The Society of Radiologists in Sonography recommendations cannot be simply extrapolated to CT-and MR imaging-detected nodules because the sonographic signs of microcalcifications and solid composition cannot be reliably appreciated on CT and MR imaging. 5 Furthermore, CT and MR imaging allow a more comprehensive evaluation of neck nodes than is possible with the limited number of images captured during a thyroid sonography examination.…”

The Impact of Subclinical Disease and Mechanism of Detection on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Olmsted County, Minnesota During 1935 Through 2012

“…Radiologists at Duke University have developed a system of reporting for these nodules that recommend work-up with ultrasound if the nodule seen in CT/ MRI/PET is greater or equal than 1.5 cm. Nodules not meeting these criteria should not be mentioned in the report (27). This reporting strategy could potentially reduce the fineneedle aspiration biopsy rate for thyroid incidentalomas by 34-46% (28).…”