The effect of routine radiological reporting of thyroid incidentalomas on rates of thyroid needle biopsy, thyroid surgery and detection of thyroid malignancy

Patients undergoing endocrine consultation and first diagnosis of nodular disease: Indications of thyroid ultrasound and completeness of ultrasound reports

PURPOSE

To evaluate reasons for performing ultrasonography (US) and completeness of US reports in patients undergoing endocrine consultation with the first diagnosis of nodular disease.

METHODS

Since January 1 to June 30, 2021, we prospectively collected patient data (age and thyroid-stimulating hormone concentrations), reasons for performing thyroid US, and completeness of reports regarding the description of the thyroid gland and nodules. In the case of multiple nodules, we considered the nodule suspected of malignancy and the largest one. To evaluate the accuracy of thyroid nodule description, we referred to the five characteristics suggested by the ACR TI-RADS system.

RESULTS

A total of 341 patients with thyroid nodules received endocrine consultation (female, 78%). The most frequent reasons for performing thyroid US were unrelated to a suspected thyroid disease (31.7%), followed by incidentaloma (23.5%), dysfunction or positivity for thyroid antibodies (19.1%), symptomatic or visible nodules (17.6%), and family history of any thyroid disease (8.2%). Gland texture was not reported in 41.9%. The depth of the lobes was the dimension reported most frequently (42.2%), but any diameter was not reported in 57.8% of the cases. As regards the description of the most relevant nodule, length was reported more frequently (75.9%). Margins and echogenicity were more frequently described (54.5% and 44.3%, respectively) than other characteristics (composition: 27%; shape: 8.8%; echogenic foci: 6.7%). No reports had indicated the malignancy risk stratification.

CONCLUSIONS

The results of the study demonstrate that in patients undergoing endocrine consultation with first detected thyroid nodules, US was mostly performed in asymptomatic cases, US reports were incomplete, and no risk stratification system was reported.

The influence of incidental detection of thyroid nodule on thyroid cancer risk and prognosis-A systematic review

BACKGROUND

Clinically inapparent thyroid nodules discovered serendipitously on imaging for nonthyroid indications are termed as thyroid incidentalomas. It is unclear whether these incidentalomas have a lower prevalence of malignancy or slower tumour progression compared to symptomatic nodules. The aims of this systematic review were to determine the impact of incidental detection of thyroid nodules on both the risk of malignancy and on prognosis in patients with thyroid cancer.

METHOD

PubMed and MEDLINE® on Web of Science databases were searched from inception to March 2020 for English language articles reporting on human studies of thyroid cancer risk and/or prognosis in incidental and nonincidental nodules.

RESULTS

Eighteen observational studies published between 1998 and 2020 were eligible for analysis; four studies reported on risk, nine on prognosis and five studies reported on both risk and prognosis. When comparing the incidental and nonincidental groups in the risk study, the odds of incidental detection in the cancer and benign groups ranged from 0.16 to 0.5 and 0.06 to 0.38, respectively (odds ratio [OR] = 0.64-2.86) in case-control studies (n = 6); the risk of malignancy for thyroid nodules ranged from 4% to 23.5% in the incidental and 3.8% to 28.7% in the nonincidental groups (relative risk = 0.13-6.27) in the cohort studies (n = 3). A meta-analysis of the eligible case-control studies (n = 3) showed a nonsignificant summated OR of 1.04 (95% confidence interval = 0.63-1.70; p = .88). In the prognosis study, five direct and thirteen indirect markers of prognosis were compared between the incidental and nonincidental groups. A meta-analysis was not possible but incidentally detected thyroid cancer had better progression-free and overall survival.

CONCLUSION

Current evidence suggests that investigation and management of thyroid nodules should not be influenced by the mode of detection.

Effect of Decreasing the ACR TI-RADS Point Assignment for Punctate Echogenic Foci When They Occur in Mixed Solid and Cystic Thyroid Nodules

OBJECTIVE. Using the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS), this study sought to determine whether decreasing the point assignment for punctate echogenic foci in mixed solid and cystic nodules would reduce the number of benign mixed solid and cystic nodules that were biopsied and would not substantially increase the number of missed mixed carcinomas MATERIALS AND METHODS. A multiinstitutional database of 3422 pathologically proven thyroid nodules was evaluated to identify all mixed solid and cystic nodules with punctate echogenic foci. We determined the numbers of mixed benign and malignant nodules that would receive ACR TI-RADS recommendations of fine-needle aspiration, follow-up, and no further evaluation if the points assigned to punctate echogenic foci were changed from 3 points to 1 or 2 points. RESULTS. A total of 287 mixed nodules were adequately characterized for evaluation. When the number of points assigned to punctate echogenic foci was changed from 3 points to 1 point, the point categories changed for 198 mixed nodules. Seven carcinomas would not undergo biopsy, but six of those seven would receive follow-up, and 44 benign nodules would not undergo biopsy. When 2 points were assigned to punctate echogenic foci, the point categories changed for 66 mixed nodules. Three carcinomas would not undergo biopsy, but all three of these would receive follow-up, and eight benign nodules would not undergo biopsy. CONCLUSION. Consideration should be given to decreasing the number of points assigned to punctate echogenic foci in mixed solid and cystic thyroid nodules, given the substantial decrease in the number of benign nodules requiring biopsy and the recommendation of follow-up for any carcinoma 1 cm or larger that did not undergo biopsy.

Value of CT Features in the Diagnosis of Papillary Thyroid Tumors in Incidental Thyroid Nodules

The present work has investigated the value of computed tomography (CT) features in the diagnosis of papillary thyroid tumors in the incidental thyroid nodules (ITNs). In the 82 enrolled patients, 101 thyroid nodules were incidentally found by the neck CT scanning, among which 49 were histologically confirmed to be papillary thyroid carcinoma (PTC) while the other 52 were nodular goiter (NG). The tumor location, size, shape, tiny calcification, cystic change, and signs of an irregular ring, marginal defects, and enhanced blurring were all depicted by CT features. Both univariate and multivariate analyses were employed to identify independent predictors of PTC. The univariate analysis of PTC and NG showed that four CT features were statistically significant, including tiny calcification and signs of an irregular ring, marginal defects, and enhanced blurring. Furthermore, the multivariate logistic regression model indicated that signs of an irregular ring, marginal defects, and enhanced blurring were strongly correlated with PTC, of which the odds ratio (OR) was 27.374 (95% CI: 5.871∼127.636), 28.587 (95% CI: 4.139∼197.460), and 4.315 (95% CI: 0.858∼21.694), respectively. In the predictive model of PTC, the value of sensitivity, specificity, accuracy, and Youden index was 87.8%, 94.2%, 91.1%, and 0.82 with a likelihood ratio of 15.1. Therefore, the signs of an irregular ring, marginal defects, and enhanced blurring may be helpful in the diagnosis of PTC in incidentally found thyroid nodules.

Assessment of The Bethesda System for Reporting Thyroid Cytopathology

OBJECTIVES

Long-term follow-up is important for determining performance characteristics of thyroid fine-needle aspiration (FNA).

METHODS

Histologic or 3 or more years of clinical follow-up was used to calculate performance characteristics of thyroid FNA before and after implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) classification was also investigated.

RESULTS

Follow-up was obtained for 1,277/1,134 and 1,616/1,393 aspirates/patients (median clinical follow-up, 9.9 and 4.4 years, pre- and post-TBSRTC, respectively). Nondiagnostic, suspicious for follicular neoplasm, and suspicious for malignancy (SFM) diagnoses decreased and benign diagnoses increased post-TBSRTC, while atypical rate remained less than 1%. Negative predictive value for benign nodules and positive predictive value (PPV) for SFM increased significantly. Eleven nodules were reclassified as NIFTP, slightly decreasing PPV/risk of malignancy (ROM).

CONCLUSIONS

Appropriate ROM for thyroid FNA can be achieved through application of TBSRTC terminology with minimal use of atypical category.