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

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Abstract

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.

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References

  1. S. Ezzat, D.A. Sarti, D.R. Cain, G.D. Braunstein, Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch. Int Med 154, 1838–1840 (1994)

    Article  CAS  Google Scholar 

  2. G.H. Tan, H. Gharib, C.C. Reading, Solitary thyroid nodule. Comparison between palpation and ultrasonography. Arch. Intern Med 155, 2418–2423 (1995)

    Article  CAS  PubMed  Google Scholar 

  3. D.D. Stark, O.H. Clark, G.A. Gooding, A.A. Moss, High-resolution ultrasonography and computed tomography of thyroid lesions in patients with hyperparathyroidism. Surgery 94, 863–868 (1983)

    CAS  PubMed  Google Scholar 

  4. N. Knudsen, H. Perrild, E. Christiansen, S. Rasmussen, H. Dige-Petersen, T. Jørgensen, Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules in an unselected population with borderline iodine deficiency. Eur. J. Endocrinol. 142, 224–230 (2000)

    Article  CAS  PubMed  Google Scholar 

  5. C. Reiners, K. Wegscheider, H. Schicha, P. Theissen, R. Vaupel, R. Wrbitzky, P.M. Schumm-Draeger, Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96,278 unselected employees. Thyroid 14, 926–932 (2004)

    Article  PubMed  Google Scholar 

  6. N. Kwong, M. Medici, T.E. Angell, X. Liu, E. Marqusee, E.S. Cibas, J.F. Krane, J.A. Barletta, M.I. Kim, P.R. Larsen, E.K. Alexander, The Influence of Patient Age on Thyroid Nodule Formation, Multinodularity, and Thyroid Cancer Risk. J. Clin. Endocrinol. Metab. 100, 4434–4440 (2015)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. J.J. Cronan, Thyroid nodules: is it time to turn off the US machine? Radiology 247, 602–604 (2008)

    Article  PubMed  Google Scholar 

  8. L. Davies, E. Pichiotino, W.C. Black, A.N.A. Tosteson, Developing a registry for thyroid incidentalomas: lessons learned and the path forward. Thyroid 26, 650–656 (2016)

    Article  PubMed  PubMed Central  Google Scholar 

  9. T. Drake, A. Gravely, A. Westanmo, C. Billington, Prevalence of Thyroid Incidentalomas from 1995 to 2016: A Single-Center, Retrospective Cohort Study. J. Endocr. Soc. 29, bvz027 (2019)

    Google Scholar 

  10. S.K. Shetty, M.M. Maher, P.F. Hahn, E.F. Halpern, S.L. Aquino, Significance of incidental thyroid lesions detected on CT: correlation among CT, sonography, and pathology. AJR Am. J. Roentgenol. 187, 1349–1356 (2006)

    Article  PubMed  Google Scholar 

  11. K.K. Soelberg, S.J. Bonnema, T.H. Brix, L. Hegedus, Risk of malignancy in thyroid incidentalomas detected by 18F-fluorodeoxyglucose positron emission tomography: a systematic review. Thyroid 22, 918–925 (2012)

    Article  CAS  PubMed  Google Scholar 

  12. J.F. de Leijer, M.J.H. Metman, A. van der Hoorn, A.H. Brouwers, S. Kruijff, B.M. van Hemel, T.P. Links, H.E. Westerlaan, Focal thyroid incidentalomas on 18F-FDG PET/CT: a systematic review and meta-analysis on prevalence, risk of malignancy and inconclusive fine needle aspiration. Front Endocrinol. (Lausanne) 12, 723394 (2021)

    Article  PubMed  Google Scholar 

  13. J.D. Sinnott, R. Mortimer, J. Smith, E. Skelton, K. Drinkwater, D. Lipscomb, D.C. Howlett, The effect of routine radiological reporting of thyroid incidentalomas on rates of thyroid needle biopsy, thyroid surgery and detection of thyroid malignancy. Clin. Endocrinol. (Oxf.) 87, 825–831 (2017)

    Article  CAS  PubMed  Google Scholar 

  14. R. Negro, S. Piana, M. Ferrari, M. Ragazzi, G. Gardini, S. Asioli, D. Pacchioni, F. Riganti, R. Valcavi, Assessing the risk of false-negative fine-needle aspiration cytology and of incidental cancer in nodular goiter. Endocr. Pr. 19, 444–450 (2013)

    Article  Google Scholar 

  15. M.A. Provenzale, E. Fiore, C. Ugolini, L. Torregrossa, R. Morganti, E. Molinaro, P. Miccoli, F. Basolo, P. Vitti, 'Incidental’ and ‘non-incidental’ thyroid papillary microcarcinomas are two different entities. Eur. J. Endocrinol. 174, 813–820 (2016)

    Article  CAS  PubMed  Google Scholar 

  16. H.S. Ahn, H.J. Kim, K.H. Kim, Y.S. Lee, S.J. Han, Y. Kim, M.J. Ko, J.P. Brito, Thyroid Cancer Screening in South Korea Increases Detection of Papillary Cancers with No Impact on Other Subtypes or Thyroid Cancer Mortality. Thyroid 26, 1535–1540 (2016)

    Article  PubMed  Google Scholar 

  17. Noone A.M., Howlader N., Krapcho M., Miller D., Brest A., Yu M., Ruhl J., Tatalovich Z., Mariotto A., Lewis D.R., Chen H.S., Feuer E.J., Cronin K.A. (eds). SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/

  18. E.G. Grant, F.N. Tessler, J.K. Hoang, J.E. Langer, M.D. Beland, L.L. Berland, J.J. Cronan, T.S. Desser, M.C. Frates, U.M. Hamper, W.D. Middleton, C.C. Reading, L.M. Scoutt, A.T. Stavros, S.A. Teefey, Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J. Am. Coll. Radio. 12, 1272–1279 (2015)

    Article  Google Scholar 

  19. S.R. Chung, J.H. Baek, M.K. Lee, Y. Ahn, Y.J. Choi, T.Y. Sung, D.E. Song, T.Y. Kim, J.H. Lee, Computer-Aided Diagnosis System for the Evaluation of Thyroid Nodules on Ultrasonography: Prospective Non-Inferiority Study according to the Experience Level of Radiologists. Korean J. Radio. 21, 369–376 (2021)

    Article  Google Scholar 

  20. C. Floridi, M. Cellina, G. Buccimazza, A. Arrichiello, A. Sacrini, F. Arrigoni, G. Pompili, A. Barile, G. Carrafiello, Ultrasound imaging classifications of thyroid nodules for malignancy risk stratification and clinical management: state of the art. Gland Surg. 8, S233–S244 (2019)

    Article  PubMed  PubMed Central  Google Scholar 

  21. T. Rago, V. Cantisani, F. Ianni, L. Chiovato, R. Garberoglio, C. Durante, A. Frasoldati, S. Spiezia, R. Farina, G. Vallone, A. Pontecorvi, P. Vitti, Thyroid ultrasonography reporting: consensus of Italian Thyroid Association (AIT), Italian Society of Endocrinology (SIE), Italian Society of Ultrasonography in Medicine and Biology (SIUMB) and Ultrasound Chapter of Italian Society of Medical Radiology (SIRM). J. Endocrinol. Invest 41, 1435–1443 (2018)

    Article  CAS  PubMed  Google Scholar 

  22. B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26, 1–133 (2016)

    Article  PubMed  PubMed Central  Google Scholar 

  23. H. Gharib, E. Papini, J.R. Garber, D.S. Duick, R.M. Harrell, L. Hegedüs, R. Paschke, R. Valcavi, P. Vitti, AACE/ACE/AME task force on thyroid nodules. American association of clinical endocrinologists, American college of endocrinology, and associazione medici endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules-2016 update. Endocr. Pract. 22, 622–639 (2016)

    PubMed  Google Scholar 

  24. E.J. Ha, S.R. Chung, D.G. Na, H.S. Ahn, J. Chung, J.Y. Lee, J.S. Park, R.E. Yoo, J.H. Baek, S.M. Baek, S.W. Cho, Y.J. Choi, S.Y. Hahn, S.L. Jung, J.H. Kim, S.K. Kim, S.J. Kim, C.Y. Lee, H.K. Lee, J.H. Lee, Y.H. Lee, H.K. Lim, J.H. Shin, J.S. Sim, J.Y. Sung, J.H. Yoon, M. Choi, 2021 Korean thyroid imaging reporting and data system and imaging-based management of thyroid nodules: Korean society of thyroid radiology consensus statement and recommendations. Korean J. Radio. 22, 2094–2123 (2021)

    Article  Google Scholar 

  25. F.N. Tessler, W.D. Middleton, E.G. Grant, J.K. Hoang, L.L. Berland, S.A. Teefey, J.J. Cronan, M.D. Beland, T.S. Desser, M.C. Frates, L.W. Hammers, U.M. Hamper, J.E. Langer, C.C. Reading, L.M. Scoutt, A.T. Stavros, ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee. J. Am. Coll. Radio. 14, 587–595 (2017)

    Article  Google Scholar 

  26. P. Perros, K. Boelaert, S. Colley, C. Evans, R.M. Evans, G. Gerrard Ba, J. Gilbert, B. Harrison, SJ. Johnson, TE. Giles, L. Moss, V. Lewington, K. Newbold, J. Taylor, RV. Thakker, J. Watkinson, MR. Williams,British Thyroid Association. Guidelines for the management of thyroid cancer.Clin. Endocrinol. (Oxf.) 81, 1–122 (2018).

    Article  Google Scholar 

  27. B. Thejeel, B. Rahimi, M. Seidler, R. Al-Agha, C. Fung, Evaluation of thyroid ultrasound report quality and assessing effect of adherence to risk stratification criteria on referral for thyroid nodule biopsy. Can. Assoc. Radio. J. 72, 234–241 (2021)

    Article  Google Scholar 

  28. B. Biondi, L. Bartalena, D.S. Cooper, L. Hegedüs, P. Laurberg, G.J. Kahaly, The 2015 European thyroid association guidelines on diagnosis and treatment of endogenous subclinical hyperthyroidism. Eur. Thyroid J. 3, 149–163 (2015)

    Article  Google Scholar 

  29. S.H. Pearce, G. Brabant, L.H. Duntas, F. Monzani, R.P. Peeters, S. Razvi, J.L. Wemeau, 2013 ETA Guideline: management of subclinical hypothyroidism. Eur. Thyroid J. 4, 215–228 (2013)

    Article  Google Scholar 

  30. G. Russ, S. Leboulleux, L. Leenhardt, L. Hegedüs, Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup. Eur. Thyroid J. 3, 154–163 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  31. A. Germano, W. Schmitt, P. Almeida, R. Mateus-Marques, V. Leite, Ultrasound requested by general practitioners or for symptoms unrelated to the thyroid gland may explain higher prevalence of thyroid nodules in females. Clin. Imaging 50, 289–293 (2018)

    Article  PubMed  Google Scholar 

  32. J.J. Shin, D. Caragacianu, G.W. Randolph, Impact of thyroid nodule size on prevalence and post-test probability of malignancy: a systematic review. Laryngoscope 125, 263–272 (2015)

    Article  PubMed  Google Scholar 

  33. A.Y. Hammad, S.I. Noureldine, T. Hu, Y. Ibrahim, H.M. Masoodi, E. Kandil, A meta-analysis examining the independent association between thyroid nodule size and malignancy. Gland Surg. 5, 312–317 (2016)

    Article  PubMed  PubMed Central  Google Scholar 

  34. S.C. Kamran, E. Marqusee, M.I. Kim, M.C. Frates, J. Ritner, H. Peters, C.B. Benson, P.M. Doubilet, E.S. Cibas, J. Barletta, N. Cho, A. Gawande, D. Ruan, F.D. Moore Jr, K. Pou, P.R. Larsen, E.K. Alexander, Thyroid nodule size and prediction of cancer. J. Clin. Endocrinol. Metab. 98, 564–570 (2013)

    Article  CAS  PubMed  Google Scholar 

  35. J.C. Sillery, C.C. Reading, J.W. Charboneau, T.L. Henrichsen, I.D. Hay, J.N. Mandrekar, Thyroid follicular carcinoma: sonographic features of 50 cases. Am. J. Roentgenol. 194, 44–54 (2010)

    Article  Google Scholar 

  36. J.H. Yoon, E.K. Kim, S.W. Hong, J.Y. Kwak, M.J. Kim, Sonographic features of the follicular variant of papillary thyroid carcinoma. J. Ultrasound Med 27, 1431–1437 (2008)

    Article  PubMed  Google Scholar 

  37. D.S. Kim, J.H. Kim, D.G. Na, S.H. Park, E. Kim, K.H. Chang et al. Sonographic features of follicular variant papillary thyroid carcinomas in comparison with conventional papillary thyroid carcinomas. J. Ultrasound Med 28, 1685–1692 (2009)

    Article  PubMed  Google Scholar 

  38. D.S. Ross, Nonpalpable thyroid nodules – managing an epidemic. J. Clin. Endocrinol. Metab. 87, 1938–1940 (2002)

    CAS  PubMed  Google Scholar 

  39. K.D. Burman, L. Wartofsky, Thyroid nodules. N. Engl. J. Med 373, 2347–2356 (2015)

    Article  CAS  PubMed  Google Scholar 

  40. E. Papini, R. Guglielmi, A. Bianchini, A. Crescenzi, S. Taccogna, F. Nardi, C. Panunzi, R. Rinaldi, V. Toscano, C.M. Pacella, Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J. Clin. Endocrinol. Metab. 87, 1941–1946 (2002)

    Article  CAS  PubMed  Google Scholar 

  41. W. Li, Y. Wang, J. Wen, L. Zhang, Y. Sun, Diagnostic performance of american college of radiology TI-RADS: a systematic review and meta-analysis. Am. J. Roentgenol. 216, 38–47 (2021)

    Article  Google Scholar 

  42. M. Castellana, C. Castellana, G. Treglia, F. Giorgino, L. Giovanella, G. Russ, P. Trimboli, Performance of five ultrasound risk stratification systems in selecting thyroid nodules for FNA. J. Clin. Endocrinol. Metab. 105, dgz170 (2020)

    Article  PubMed  Google Scholar 

  43. M. Castellana, G. Grani, M. Radzina, V. Guerra, L. Giovanella, M. Deandrea, R. Ngu, C. Durante, P. Trimboli, Performance of EU-TIRADS in malignancy risk stratification of thyroid nodules: a meta-analysis. Eur. J. Endocrinol. 183, 255–264 (2020)

    Article  CAS  PubMed  Google Scholar 

  44. Q. Zhang, J. Ma, W. Sun, L. Zhang, Comparison of diagnostic performance between the American college of radiology thyroid imaging reporting and data system and american thyroid association guidelines: a systematic review. Endocr. Pract. 26, 552–563 (2020)

    Article  CAS  PubMed  Google Scholar 

  45. R. Yang, X. Zou, H. Zeng, Y. Zhao, X. Ma, Comparison of diagnostic performance of five different ultrasound TI-RADS classification guidelines for thyroid nodules. Front Oncol. 10, 598225 (2020)

    Article  PubMed  PubMed Central  Google Scholar 

  46. G. Mauri, S. Gitto, V. Cantisani, G. Vallone, C. Schiavone, E. Papini, L.M. Sconfienza, Use of the thyroid imaging reporting and data system (TIRADS) in clinical practice: an Italian survey. Endocrine 68, 329–335 (2020)

    Article  CAS  PubMed  Google Scholar 

  47. A.S. Griffin, J. Mitsky, U. Rawal, A.J. Bronner, F.N. Tessler, J.K. Hoang, Improved quality of thyroid ultrasound reports after implementation of the ACR thyroid imaging reporting and data system nodule lexicon and risk stratification system. J. Am. Coll. Radio. 15, 743–748 (2018)

    Article  Google Scholar 

  48. B. Wildman-Tobriner, L. Ngo, T.A. Jaffe, W.L. Ehieli, L.M. Ho, R. Lerebours, S. Luo, B.C. Allen, Automated structured reporting for thyroid ultrasound: effect on reporting errors and efficiency. J. Am. Coll. Radio. 18, 265–273 (2021)

    Article  Google Scholar 

  49. S. Ghazizadeh, T.L. Kelly, Y.S. Khajanchee, J. Fleser, Y. Rozenfeld, M. Neuman, C.W. Hammill, L. Orr, S. Aliabadi-Wahle, Standardization of thyroid ultrasound reporting in the community setting decreases biopsy rates. Clin. Endocrinol. (Oxf.). 94, 1035–1042 (2021)

    Article  PubMed  Google Scholar 

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Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by R.N., G.G. The first draft of the manuscript was written by R.N. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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  1. Division of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy

    Roberto Negro & Gabriele Greco

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Negro, R., Greco, G. Patients undergoing endocrine consultation and first diagnosis of nodular disease: Indications of thyroid ultrasound and completeness of ultrasound reports. Endocrine 80, 600–605 (2023). https://doi.org/10.1007/s12020-023-03301-1

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