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Evaluation of Guideline Adherence and Subsequent Follow-Up Outcomes for Incidental Thyroid Nodules Detected in Hybrid
Edward M Lawrence1, Tyler M Prout, Lori Mankowski-Gettle
1From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI.
Objective:
Incidental thyroid nodules (ITNs) are common, and variability regarding follow-up and recommendation practices exist. The study purpose was to determine adherence to the American College of Radiology (ACR) ITN criteria and analyze recommendation outcomes.
Methods:
ITNs listed in the impression section on computed tomography, magnetic resonance imaging, and positron emission tomography studies over a 6-month period were included. Report recommendations were compared with ACR white paper criteria for adherence (concordant recommendation) or nonadherence (discordant recommendation). Reader characteristics, further ITN workup, and pathology were recorded. A P value less than 0.05 was used for significance.
Results:
Three hundred fifty patients (mean age, 64.6 years) were included with a median ITN size of 18-mm. Most nodules (289/350) were reported on computed tomography and were identified for follow-up due to size (235/350). Only 39 of 350 reports (11.1%) did not follow ACR recommendations. Patient age was significantly related to recommendation adherence ( P < 0.05) as opposed to radiologist practice type (ie, community-based or academic) which was not. Nonadherence most often involved recommending ultrasound follow-up for nonactionable small ITNs. The rate of fine-needle aspiration biopsy from concordant ITNs was significantly higher than discordant ITNs ( P < 0.05). Six patients, all with concordant recommendations, had malignant final pathology results.
Conclusion:
Recommendation adherence to the ACR ITN criteria was high, approaching 90%. Nonadherence was mostly due to recommending thyroid ultrasound when not indicated and was correlated with a younger patient age. The rate of fine-needle aspiration biopsy stemming from nonindicated ultrasounds was significantly lower and did not result in the diagnosis of any malignancies.
