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Dahlberg J, Carlqvist J, Larsson E, Nilsson M, Elias E, Muth A. Effects of Implementation of European Thyroid Imaging Reporting and Data System Risk Stratification in a Thyroid Cancer Program in Western Sweden: A Retrospective Cohort Study. Endocr Pract 2024:S1530-891X(24)00533-0. [PMID: 38815693 DOI: 10.1016/j.eprac.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE The European Thyroid Imaging Reporting and Data System (EU-TIRADS) allows for selective fine needle aspiration cytology (FNAC). In 2017, EU-TIRADS was implemented as part of a nationwide standardized care bundle for thyroid cancer in Western Sweden with a population of approximately 1.7 million. The objective of this study was to investigate the clinical value of EU-TIRADS attempting to reduce the number of unnecessary FNACs in referred patients with thyroid nodules. METHODS The study cohort consisted of all patients referred to Sahlgrenska University Hospital due to a palpable, newly detected or growing thyroid nodules or a positron emission tomography-positive finding for examination with thyroid ultrasound and selective cytology between 2018 and 2022. Medical records on EU-TIRADS classification, corresponding FNAC results, and histopathologic diagnosis were retrospectively collected. Adherence to the EU-TIRADS guidelines, use of selective FNAC, and rate of malignancy in patients who underwent surgery were assessed. RESULTS In total, 1246 thyroid nodules in 990 patients were evaluated. The distributions of EU-TIRADS 2 to 5 (number [percentage]) for all examined nodules were 63 (5%), 462 (37%), 443 (36%), and 278 (22%), respectively. FNAC was omitted in 7% of the investigated patients. FNAC was performed in 124 nodules (10%) despite not fulfilling the EU-TIRADS criteria or absence of positron emission tomography-positive findings. The rate of malignancy was 33% and 1/50 in patients who underwent "unnecessary" FNAC. CONCLUSION Implementation of EU-TIRADS in routine management of thyroid nodules led to the selective use of FNAC; however, the clinical impact was limited. This study provides real-world data on the value and magnitude of diagnostic improvement by implementing EU-TIRADS in clinical practice.
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Affiliation(s)
- Jakob Dahlberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Jeanette Carlqvist
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emma Larsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Nilsson
- Sahlgrenska Cancer Center for Cancer Research, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Erik Elias
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Muth
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Edwards M, Brito JP, Salloum RG, Hoang J, Singh Ospina N. Implementation strategies to support ultrasound thyroid nodule risk stratification: A systematic review. Clin Endocrinol (Oxf) 2023; 99:417-427. [PMID: 37393196 PMCID: PMC10529907 DOI: 10.1111/cen.14942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/06/2023] [Accepted: 06/11/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Ultrasound 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. METHODS This 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. RESULTS We 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. CONCLUSIONS Implementation 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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Affiliation(s)
- Matthew Edwards
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Juan P Brito
- Division of Endocrinology, Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, Minnesota, USA
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Jenny Hoang
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida, USA
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Tichanek F, Försti A, Liska V, Hemminki O, Koskinen A, Hemminki A, Hemminki K. Early mortality critically impedes improvements in thyroid cancer survival through a half century. Eur J Endocrinol 2023; 189:355-362. [PMID: 37675794 DOI: 10.1093/ejendo/lvad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/18/2023] [Accepted: 07/03/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES We analyze survival in thyroid cancer from Denmark (DK), Finland (FI), Norway (NO), and Sweden (SE) over a 50-year period (1971-2020), and additionally consider concomitant changes in incidence and mortality. DESIGN Population-based survival study. METHODS Relative 1-, 5/1 (conditional)-, and 5-year survival data were obtained from the NORDCAN database for years 1971-2020. Incidence and mortality rates were also assessed. RESULTS A novel consistent observation was that 1-year survival was worse than 5/1-year survival but the difference between these decreased with time. Relative 1-year survival in thyroid cancer (mean for the 4 countries) reached 92.7% for men and 95.6% for women; 5-year survival reached 88.0% for men and 93.7% for women. Survival increased most for DK which started at a low level and reached the best survival at the end. Male and female incidence rates for thyroid cancer increased 3- and 4-fold, respectively. In the same time, mortality halved for men and for women, it decreased by 2/3. CONCLUSIONS We documented worse relative survival in the first year than in the 4 subsequent years, most likely because of rare anaplastic cancer. Overall survival in thyroid cancer patients increased in the Nordic countries in the course of 50 years; 5-year survival was close to 90% for men and close to 95% for women. Even though overdiagnosis may explain some of 5-year survival increase, it is unlikely to influence the substantial increase in 1-year survival. The unmet need is to increase 1-year survival by diagnosing and treating aggressive tumors before metastatic spread.
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Affiliation(s)
- Filip Tichanek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Alej Svobody 76, 30605 Pilsen, Czech Republic
- Institute of Pathological Physiology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Vaclv Liska
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Alej Svobody 76, 30605 Pilsen, Czech Republic
- Department of Surgery, University Hospital, Faculty of Medicine in Pilsen, Charles University in Prague, 30605 Pilsen, Czech Republic
| | - Otto Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Finland
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anni Koskinen
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Finland
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Kari Hemminki
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Alej Svobody 76, 30605 Pilsen, Czech Republic
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
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Wilkinson T, Cawood T, Lim A, Roche D, Jiang J, Thomson B, Marais M, Hunt P. Correlation of ACR TI-RADS and Patient Outcomes in a Real-World Cohort Presenting for Thyroid Ultrasonography. J Endocr Soc 2023; 7:bvad119. [PMID: 37795193 PMCID: PMC10546907 DOI: 10.1210/jendso/bvad119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Indexed: 10/06/2023] Open
Abstract
Context The American College of Radiology Thyroid Image Reporting and Data System (ACR TI-RADS) was developed to predict malignancy risk in thyroid nodules using ultrasound features. TI-RADS was derived from a database of patients already selected for fine-needle aspiration (FNA), raising uncertainty about applicability to unselected patients. Objective We aimed to assess the effect of ACR TI-RADS reporting in unselected patients presenting for thyroid ultrasound in a real-world setting. Methods Records for all patients presenting for thyroid ultrasonography in Canterbury, New Zealand, were reviewed across two 18-month periods, prior to and after implementation of TI-RADS reporting. Patient outcomes were compared between the 2 periods. Malignancy rates were calculated for nodules 10 mm or larger with a definitive FNA or histology result. Results A total of 1210 nodules were identified in 582 patients prior to implementation of TI-RADS; 1253 nodules were identified in 625 patients after implementation of TI-RADS. TI-RADS category was associated with malignancy rate (0% in TR1 and TR2, 3% in TR3, 5% in TR4, 12% in TR5; P = .02); however, 63% of nodules were graded TR3 or TR4, for which malignancy rate did not meaningfully differ from baseline risk. After implementation of TI-RADS there was a small reduction in the proportion of patients proceeding to FNA (49% vs 60%; P < .01) or surgery (14% vs 18%; P < .05), with no difference in cancer diagnoses (3% vs 4%, not significant). Conclusion TI-RADS category is associated with malignancy rate and may alter clinical decision-making in a minority of patients; however, it is nondiscriminatory in the majority of nodules. In this study of unselected patients, nodules classified as TR5 and thus considered "highly suspicious" for cancer had only a modest risk of malignancy.
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Affiliation(s)
- Tom Wilkinson
- Department of Endocrinology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - Tom Cawood
- Department of Endocrinology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - Anthony Lim
- Department of Radiology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - David Roche
- Canterbury Southern Community Laboratories, Christchurch 8051, New Zealand
| | - Jasmine Jiang
- Department of Endocrinology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - Ben Thomson
- Department of Otolaryngology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - Michelle Marais
- Department of Radiology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
| | - Penny Hunt
- Department of Endocrinology, Te Whatu Ora/Health New Zealand Waitaha/Canterbury, Christchurch 8011, New Zealand
- University of Otago (Christchurch), Christchurch 8011, New Zealand
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Yang Z, Gao X, Yang L. Predictors and a prediction model for positive fine needle aspiration biopsy in C-TIRADS 4 thyroid nodules. Front Endocrinol (Lausanne) 2023; 14:1154984. [PMID: 37554760 PMCID: PMC10405816 DOI: 10.3389/fendo.2023.1154984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/04/2023] [Indexed: 08/10/2023] Open
Abstract
Objectives To screen out the predictors and establish a prediction model of positive fine needle aspiration biopsy (FNAB) in the Chinese Guidelines for Malignant Risk Stratification of Thyroid Nodule Ultrasound (C-TIRADS) 4 thyroid nodules, and this nomogram can help clinicians evaluate the risk of positive FNAB and determine if FNAB is necessary. Methods We retrospectively analyzed data from 547 patients who had C-TIRADS 4 thyroid nodules and underwent fine-needle aspiration biopsy (FNAB) at the Second Affiliated Hospital of Chongqing Medical University between November 30, 2021 and September 5, 2022. Patients who met our inclusion criteria were divided into two groups based on positive or negative FNAB results. We compared their ultrasound (US) features, BRAF V600E status, thyroid function, and other general characteristics using univariate and multivariate logistic regression analyses to identify independent predictors. These predictors were then used to construct a nomogram. The calibration plot, area under the curve (AUC), and decision curve analysis were employed to evaluate the calibration, discrimination, and clinical utility of the prediction model. Results Out of 547 patients, 39.3% (215/547) had a positive result on fine-needle aspiration biopsy (FNAB), while 60.7% (332/547) had a negative result. Univariate logistic regression analysis revealed no significant differences in TPOAb, TgAb, TSH, Tg, nodule location, sex, or solid status between the two groups (P>0.05). However, age, nodule size, internal or surrounding blood flow signal, microcalcifications, aspect ratio, morphology, and low echo showed significant differences (P<0.05). Multivariate logistic regression analysis was conducted to explore the correlation between potential independent predictors. The results showed that only age (OR=0.444, 95% Cl=0.296~0.666, P<0.001), low echo (OR=3.549, 95% Cl=2.319~5.432, P<0.001), microcalcifications (OR=2.531, 95% Cl=1.661~3.856, P<0.001), aspect ratio (OR=3.032, 95% Cl=1.819~5.052, P<0.001), and morphology (OR=2.437, 95% Cl=1.586~3.745, P<0.001) were independent predictors for a positive FNAB. These variables were used to construct a prediction nomogram. An ROC curve analysis was performed to assess the accuracy of the nomogram, and AUC=0.793, which indicated good discrimination and decision curve analysis demonstrated clinical significance within a threshold range of 14% to 91%. Conclusion In conclusion, 5 independent predictors of positive FNAB, including age (≤45 years old), low echo (yes), microcalcifications (yes), aspect ratio (>1) and morphology (irregular), were identified. A nomogram was established based on the above 5 predictors, and the nomogram can be used as a complementary basis to help clinicians make decisions on FNAB of C-TI-RADS 4 thyroid nodules.
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Affiliation(s)
| | | | - Lu Yang
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bolland MJ, Grey A. Increased workload without clinical benefit: Results following implementation of the ACR-TIRADS system for thyroid nodules. Clin Endocrinol (Oxf) 2023. [PMID: 36710430 DOI: 10.1111/cen.14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/21/2022] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The ACR-TIRADS system for stratifying thyroid nodule malignancy risk has been widely promoted and implemented. We audited its introduction at a large public hospital in Auckland, New Zealand. DESIGN Audit of outcomes following thyroid nodule fine needle aspiration (FNA) before/after ACR-TIRADS. PATIENTS Individuals undergoing thyroid FNA 2017-2019. MEASUREMENTS From medical records, we obtained details from the pre-FNA ultrasound (nodule size, TIRADS points/levels, radiologist recommendation for FNA), Bethesda (B) cytology classification, histology and post-FNA follow-up. RESULTS Four hundred and twenty-two individuals had 564 FNAs, 163 had surgery and 54 (13%) had cancer in the primary nodule. 37/54 (69%) cancers were papillary thyroid carcinoma (median size 25 mm, 87% ≥10 mm, 61% ≥20 mm). Following ACR-TIRADS introduction, FNA recommendations increased greater than twofold, FNAs performed by 71%-83%, and the monthly rate of FNAs and operations by 60% and 40%, respectively. However, the proportion of cancers/FNA remained similar (9.9% post-TIRADS vs. 8.7% pre-TIRADS). The proportions of FNA results remained stable for B2-B4 categories, but doubled (11% vs. 5%) for B5-B6: 15 FNAs were needed to identify an additional B5/B6 lesion. TIRADS-5 nodules had a higher proportion of B5/B6 (20%) and a lower proportion of B2 (30%) than TIRADS-3 (2%, 57%, respectively) and TIRADS-4 (9%, 56%) nodules. About 5 additional cancers/year were diagnosed, but they were more often small (49% vs. 8% <2 cm, 17% vs. 0% <1 cm). CONCLUSION ACR-TIRADS introduction increased workload (FNAs and operations), without increasing the proportion of cancers/FNA. It led to a few more cancers being diagnosed, but many were small and of uncertain clinical significance.
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Affiliation(s)
- Mark J Bolland
- Department of Endocrinology, Greenlane Clinical Centre, Auckland, New Zealand
| | - Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Naunheim MR, von Sneidern M, Huston MN, Okose OC, Abdelhamid Ahmed AH, Randolph GW, Shrime MG. Patient Experiences With Thyroid Nodules: A Qualitative Interview Survey. OTO Open 2023; 7:e39. [PMID: 36998550 PMCID: PMC10046705 DOI: 10.1002/oto2.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/04/2023] [Accepted: 01/28/2023] [Indexed: 03/11/2023] Open
Abstract
Objective To qualitatively explore the broad set of preferences and attitudes patients have about thyroid nodules, which influence the decision-making process. Study Design A descriptive survey design was administered as interviews. Setting Outpatient thyroid surgery clinic. Methods Semistructured interviews were conducted with 20 patients presenting for initial evaluation of thyroid nodules at a surgeon's office. Probative, open-ended questions were posed regarding diagnosis, treatment, risk attitudes, and the decision-making process. Thematic analysis was used to develop code-transcribed interviews, and an iterative refinement resulted in underlying themes. Results During the diagnostic process, patients integrated emotional responses (fear, anxiety, and shock) with rationale concerns (likelihood of cancer, risk assessment), and ultimately relied heavily on expert opinion and recommendation. Contextualization with other personal or familial health problems served as helpful touchstones for decision-making. Overtreatment and overdiagnosis were not commonly discussed. When thinking about potential therapies, there was a strong bias to action rather than surveillance among patients. Surgical risk and the possibility of lifelong medication, however, were strong motivators for a subset of patients to seek nonsurgical alternatives. Conclusion Patients describe a decision-making process that incorporates emotional response and rational consideration of risks, contextualized within the personal experience and physician expertise. The bias for action and intervention is strong, and most patients strongly weighted physicians' recommendations. Themes from this qualitative analysis may serve as the backbone for future stated preference research pertaining to thyroid disease.
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Affiliation(s)
- Matthew R. Naunheim
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear Infirmary Boston Massachusetts USA
| | - Manuela von Sneidern
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear Infirmary Boston Massachusetts USA
| | - Molly N. Huston
- Department of Otolaryngology–Head and Neck Surgery Washington University in St Louis St Louis Missouri USA
| | - Okenwa C. Okose
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary Harvard Medical School Boston Massachusetts USA
| | - Amr H. Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary Harvard Medical School Boston Massachusetts USA
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary Harvard Medical School Boston Massachusetts USA
- Department of Surgery, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Mark G. Shrime
- Department of Global Health and Social Medicine Harvard Medical School Boston Massachusetts USA
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Abou Shaar B, Meteb M, Awad El-Karim G, Almalki Y. Reducing the Number of Unnecessary Thyroid Nodule Biopsies With the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS). Cureus 2022; 14:e23118. [PMID: 35425684 PMCID: PMC9004328 DOI: 10.7759/cureus.23118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Thyroid nodules are exceedingly common, occurring in up to 76% of adults. Less than 10% are palpable, and the majority are detected incidentally with an estimated prevalence of 68%, 25%, and 18% using ultrasound (US), CT, and MRI, respectively. The rising use of imaging over the last four decades has led to a significant increase in nodule detection or ‘over-identification,’ fine-needle aspiration (FNA), a higher reported incidence of thyroid cancer, and thyroidectomy. The purpose of this study is to provide a descriptive experience with thyroid nodule FNAs one year prior and one year after the implementation of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) at a prototypical community hospital. Methods A total of 104 patients with 114 thyroid nodules underwent US-guided FNA at Bluewater Health from January 1, 2018, to March 31, 2020, with available cytological results (The Bethesda System). The study population was divided into two cohorts (January 1, 2018, to December 31, 2018 - ‘local best practice cohort’, and March 1, 2019, to March 31, 2020 - ‘ACR TI-RADS cohort’) based on the implementation of the ACR TI-RADS guidelines in March 2019. Results The local best practice cohort (January 1, 2018, to December 31, 2018) comprised 57 thyroid nodules in 52 patients (mean age 66 ± 12; 40 Women). The ACR TI-RADS cohort (March 1, 2019, to March 31, 2020) comprised 57 thyroid nodules in 52 patients (mean age 61 ± 16; 41 Women). There were no statistical differences with respect to age, gender, or thyroid nodule location. Our results show a dramatic decrease in the number of unnecessary FNAs if ACR TI-RADS was implemented from January to December 2018. Thirty (52.6%) of the previously sampled thyroid nodules using the local best practice guidelines would have been followed as per ACR TI-RADS. Conclusion ACR TI-RADS is a reliable classification system in routine practice that significantly reduces the number of unnecessary thyroid FNAs with higher specificity compared to local best practice guidelines.
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