Thyroid nodule ultrasound reports in routine clinical practice provide insufficient information to estimate risk of malignancy
Thyroid nodule ultrasound reports in routine clinical practice provide insufficient information to estimate risk of malignancy
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DOI：
10.1007/s12020-018-1634-0
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发表时间：
2018-08-01
期刊：
影响因子：
3.7
通讯作者：
Paschke, Ralf
中科院分区：
文献类型：
--
作者：
Symonds, Christopher John;Seal, Paula;Paschke, Ralf
甲状腺结节的超声特征对判断其恶性肿瘤的危险性具有重要意义。指南要求所有甲状腺结节都要通过六个关键的超声特征来评估ROM。我们的目的是评估放射科医生识别这些特征的频率以及随后评估ROM的效用。我们回顾性地回顾了来自大型社区放射学实践的1930个连续诊断甲状腺超声报告。共有1339例患者被发现有一个或多个甲状腺结节。每个报告都分析了六个关键的超声特征。计算效用分数（ut）（范围0-6），并为每个特性的评论给出一个单点。在1339例患者中，75%的研究报告了一个以上的结节（平均结节数= 3.4）。每个患者最大结节的平均最大直径为1.8 cm。平均ut为2.57。结节大小不影响ut。：结节< 1 cm (ut: 2.53), 1-2 cm （ut: 2.68）和> 2 cm （ut: 2.49）。我们认为需要4或更大的ut来自信地估计ROM：我们在13.7%的报告中发现了这一点。我们对常规临床实践中大量连续甲状腺超声报告的回顾性分析表明，绝大多数报告提供的信息不足，无法让临床医生通过估计ROM来对结节进行风险分层。这可能导致对良性/惰性甲状腺病变的过度诊断和过度治疗，或对临床上重要的甲状腺癌的诊断不足。
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.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.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.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.