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Thyroid nodule ultrasound reports in routine clinical practice provide insufficient information to estimate risk of malignancy

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Abstract

Purpose

Ultrasonographic characteristics of thyroid nodules play an important role in estimating the risk of malignancy (ROM). Guidelines mandate all thyroid nodules be characterized by six key ultrasonographic features to estimate the ROM. Our objective was to evaluate how frequently these characteristics were identified by radiologists and the ensuing utility to estimate ROM.

Methods

We retrospectively reviewed 1930 consecutive diagnostic thyroid ultrasound reports from a large community radiology practice. A total of 1339 individual patients were found to have one or more thyroid nodules. Each report was analyzed for six key ultrasonographic features. A utility score (UtS) was calculated (range 0–6) with a single point given for a comment on each feature.

Results

Of the 1339 patients, 75% of the studies reported more than one nodule (mean number of nodules = 3.4). Mean maximal diameter of the largest nodule per patient = 1.8 cm. The mean UtS was 2.57. Nodule size did not influence the UtS.: Nodule <1 cm (UtS: 2.53), 1–2 cm (UtS: 2.68) and >2 cm (UtS: 2.49). We believe a UtS of four or greater is needed to confidently estimate ROM: we found this in 13.7% of reports.

Conclusions

Our retrospective analysis of a large number of consecutive thyroid ultrasound reports in routine clinical practice suggests that the vast majority provide insufficient information to allow the clinician to risk stratify the nodules by estimating the ROM. This could lead to both over-diagnosis and over-treatment of benign/indolent thyroid lesions or under-diagnosis of clinically important thyroid cancers.

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Authors and Affiliations

  1. Section of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada

    Christopher John Symonds, Sana Ghaznavi & Ralf Paschke

  2. Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Canada

    Paula Seal

  3. Section of Medical Oncology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada

    Winson Y. Cheung

Authors
  1. Christopher John Symonds
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  2. Paula Seal
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  4. Winson Y. Cheung
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  5. Ralf Paschke
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Corresponding author

Correspondence to Christopher John Symonds.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any procedures with human participants or animals performed by any of the authors. Ultrasound studies were all performed as part of usual clinical care. Full ethics approval was granted for this study by our Institutional Review Board (IRB).

Informed consent

The need for informed consent was waived by our IRB given the retrospective nature of the anonymous review of ultrasound studies performed for usual clinical care.

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Symonds, C.J., Seal, P., Ghaznavi, S. et al. Thyroid nodule ultrasound reports in routine clinical practice provide insufficient information to estimate risk of malignancy. Endocrine 61, 303–307 (2018). https://doi.org/10.1007/s12020-018-1634-0

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  • DOI: https://doi.org/10.1007/s12020-018-1634-0

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