Grady A T, Sosa J A, Tanpitukpongse T P, Choudhury K R, Gupta R T, Hoang J K
From the Departments of Radiology (A.T.G., T.P.T., K.R.C., R.T.G., J.K.H.).
Surgery (J.A.S.) Duke Cancer Institute (J.A.S.) Duke Clinical Research Institute (J.A.S.), Duke University Medical Center, Durham, North Carolina.
AJNR Am J Neuroradiol. 2015 Feb;36(2):397-402. doi: 10.3174/ajnr.A4089. Epub 2014 Aug 21.
Variability in radiologists' reporting styles and recommendations for incidental thyroid nodules can lead to confusion among clinicians and may contribute to inconsistent patient care. Our aim was to describe reporting practices of radiologists for incidental thyroid nodules seen on CT and MR imaging and to determine factors that influence reporting styles.
This is a retrospective study of patients with incidental thyroid nodules reported on CT and MR imaging between January and December 2011, identified by text search for "thyroid nodule" in all CT and MR imaging reports. The studies included CT and MR imaging scans of the neck, spine, and chest. Radiology reports were divided into those that mentioned the incidental thyroid nodules only in the "Findings" section versus those that reported the incidental thyroid nodules in the "Impression" section as well, because this latter reporting style gives more emphasis to the finding. Univariate and multivariate analyses were performed to identify radiologist, patient, and nodule characteristics that influenced reporting styles.
Three hundred seventy-five patients met the criterion of having incidental thyroid nodules. One hundred thirty-eight (37%) patients had incidental thyroid nodules reported in the "Impression" section. On multivariate analysis, only radiologists' divisions and nodule size were associated with reporting in "Impression." Chest radiologists and neuroradiologists were more likely to report incidental thyroid nodules in the "Impression" section than their abdominal imaging colleagues, and larger incidental thyroid nodules were more likely to be reported in "Impression" (P ≤ .03). Seventy-three percent of patients with incidental thyroid nodules of ≥20 mm were reported in the "Impression" section, but higher variability in reporting was seen for incidental thyroid nodules measuring 10-14 mm and 15-19 mm, which were reported in "Impression" for 61% and 50% of patients, respectively.
Reporting practices for incidental thyroid nodules detected on CT and MR imaging are predominantly influenced by nodule size and the radiologist's subspecialty. Reporting was highly variable for nodules measuring 10-19 mm; this finding can be partially attributed to different reporting styles among radiology subspecialty divisions. The variability demonstrated in this study further underscores the need to develop CT and MR imaging practice guidelines with the goal of standardizing reporting of incidental thyroid nodules and thereby potentially improving the consistency and quality of patient care.
放射科医生对偶然发现的甲状腺结节的报告风格和建议存在差异，这可能会导致临床医生产生困惑，并可能导致患者护理的不一致。我们的目的是描述放射科医生对CT和MR成像中偶然发现的甲状腺结节的报告做法，并确定影响报告风格的因素。
这是一项回顾性研究，研究对象为2011年1月至12月期间在CT和MR成像报告中报告有偶然发现的甲状腺结节的患者，通过在所有CT和MR成像报告中搜索“甲状腺结节”来识别。研究包括颈部、脊柱和胸部的CT和MR成像扫描。放射学报告分为仅在“结果”部分提及偶然发现的甲状腺结节的报告和在“印象”部分也报告偶然发现的甲状腺结节的报告，因为后一种报告风格更强调该发现。进行单因素和多因素分析以确定影响报告风格的放射科医生、患者和结节特征。
375例患者符合有偶然发现的甲状腺结节的标准。138例（占37%）患者的偶然发现的甲状腺结节在“印象”部分有报告。多因素分析显示，只有放射科医生的科室和结节大小与在“印象”部分报告有关。胸部放射科医生和神经放射科医生比腹部影像科同事更有可能在“印象”部分报告偶然发现的甲状腺结节，并且较大的偶然发现的甲状腺结节更有可能在“印象”部分报告（P≤0.03）。直径≥20mm的偶然发现的甲状腺结节患者中，73%在“印象”部分有报告，但对于直径为10 - 14mm和15 - 19mm的偶然发现的甲状腺结节，报告的变异性较高，分别有61%和50%的患者在“印象”部分有报告。
CT和MR成像中偶然发现的甲状腺结节的报告做法主要受结节大小和放射科医生的亚专业影响。对于直径为10 - 19mm的结节，报告差异很大；这一发现部分可归因于放射学亚专业科室之间不同的报告风格。本研究中显示的变异性进一步强调了制定CT和MR成像实践指南的必要性，目标是规范偶然发现的甲状腺结节的报告，从而可能提高患者护理的一致性和质量。
