Department of Endocrinology, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
Department of General Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
Intern Med J. 2020 Jun;50(6):732-740. doi: 10.1111/imj.14401.
The incidence of thyroid cancer is increasing worldwide without a simultaneous rise in mortality. It is thought that the incidence of non-clinically significant thyroid cancers are on the rise as a result of more sensitive diagnostic imaging.
To determine the number of inappropriate requests for thyroid ultrasound (US), the quality of radiology reporting for thyroid nodules based on accepted guidelines and the resultant number of thyroid cancers identified because of these investigations.
Electronic medical records of patients who underwent thyroid US imaging and thereafter referred to the Endocrine Department at Gold Coast University Hospital, Queensland, between July 2014 and July 2017 were reviewed. Data for 251 patients who had thyroid US were analysed and the final 201 patients who were found to have thyroid nodules were evaluated using descriptive statistics. Indications for thyroid US imaging among referring clinicians were assessed and we compared both clinical management and radiology reporting practices of thyroid nodules to the published 2009 and 2015 American Thyroid Association (ATA) guidelines.
There were 50.2% of patients with initial thyroid US imaging deemed outside of expert recommendations where 42% of these patients required further surveillance imaging and 25.4% required fine needle aspiration of their thyroid nodules. A definite recommendation whether to evaluate thyroid nodules further was provided in 44.8% of radiology reports. There were no radiology reports that described thyroid nodules findings based on patterns as recommended by the 2015 ATA guidelines. Two cases of thyroid cancer were detected including one patient with prior history of thyroid cancer and a second patient with hypothyroidism.
Routine use of US thyroid imaging outside expert recommendation is common. There is lack of standardised reporting when assessing thyroid nodules on US. Limiting the initial use of US in cases of palpable neck lumps and the use of systematic reporting according to the 2017 guidelines published by the American College of Radiology Thyroid Imaging Reporting and Data System may reduce unnecessary investigations for thyroid nodules in the future.
全球范围内甲状腺癌的发病率在不断增加，而死亡率却没有同步上升。人们认为，由于更敏感的诊断成像技术的应用，临床上无意义的甲状腺癌的发病率正在上升。
确定甲状腺超声（US）检查不适当请求的数量、基于公认指南的甲状腺结节放射学报告的质量以及由于这些检查而发现的甲状腺癌数量。
对 2014 年 7 月至 2017 年 7 月期间在昆士兰州黄金海岸大学医院内分泌科就诊并接受甲状腺 US 成像检查的患者的电子病历进行了回顾性分析。对 251 例接受甲状腺 US 检查的患者进行了数据分析，并对最后 201 例发现甲状腺结节的患者进行了描述性统计分析。评估了转诊临床医生进行甲状腺 US 成像的指征，并将甲状腺结节的临床管理和放射学报告实践与 2009 年和 2015 年美国甲状腺协会（ATA）指南进行了比较。
50.2%的初始甲状腺 US 成像检查不符合专家建议，其中 42%的患者需要进一步进行随访成像检查，25.4%的患者需要对甲状腺结节进行细针抽吸活检。44.8%的放射学报告明确建议进一步评估甲状腺结节。没有放射学报告根据 2015 年 ATA 指南推荐的模式描述甲状腺结节的发现。发现了 2 例甲状腺癌，其中 1 例患者有甲状腺癌病史，另 1 例患者有甲状腺功能减退症。
在专家建议之外常规使用甲状腺 US 成像检查较为常见。在评估甲状腺结节的 US 时，缺乏标准化的报告。根据美国放射学院甲状腺成像报告和数据系统 2017 年发布的指南，限制可触及颈部肿块的初始 US 使用，并采用系统报告，可能会减少未来对甲状腺结节的不必要检查。
