The Oregon Clinic, Portland, OR, USA.
Providence Cancer Institute, Portland, OR, USA.
Clin Endocrinol (Oxf). 2021 Jun;94(6):1035-1042. doi: 10.1111/cen.14431. Epub 2021 Feb 22.
With the rising incidence of thyroid cancer, a standardized approach to the evaluation of thyroid nodules is essential. Despite the presence of multiple national guidelines detailing evaluation and management of these nodules, significant variability exists in the information that is collected and reported to clinicians from diagnostic imaging. The aim of this study was to evaluate the impact of thyroid ultrasound standardization on thyroid cancer detection in a community practice setting.
As part of a physician-driven quality improvement project, a multidisciplinary team created an electronic worksheet to be utilized by sonographers to capture suspicious findings based on societal guidelines and agreed on institutional criteria for recommending fine needle aspiration (FNA) of thyroid nodules.
For a one-year period prior to and after the intervention, all ultrasounds performed for suspected thyroid pathology, excluding patients undergoing follow-up imaging, were reviewed at two affiliated community hospitals served by a single radiology and pathology group.
The number of fine needle biopsies recommended and performed, as well as the percentage of FNAs positive for malignancy were evaluated.
A total of 608 and 675 ultrasounds were reviewed in pre- and post-standardization periods, respectively. Following standardization, there was a similar percentage of FNAs recommended (35% vs. 37%, p = .68), fewer FNAs per total ultrasounds performed (36% vs. 31%, p = .03), fewer FNAs performed when FNA was not explicitly recommended (9.9% vs. 2.8%, p = .000046) and an increased detection of cytology consistent with, or suspicious for, malignancy (5% vs. 11.5%, p = .0028).
Standardization of thyroid imaging protocol and management recommendations can reduce the number of FNAs performed and increase the percentage of positive tests in a community setting.
随着甲状腺癌发病率的上升，对甲状腺结节进行标准化评估至关重要。尽管有多项国家指南详细说明了这些结节的评估和管理，但从诊断影像学向临床医生报告的信息仍存在很大差异。本研究旨在评估甲状腺超声标准化对社区实践中甲状腺癌检测的影响。
作为医生驱动的质量改进项目的一部分，一个多学科团队创建了一个电子工作表，供超声医师根据社会指南和机构推荐甲状腺结节细针抽吸（FNA）的标准来捕获可疑发现。
在干预前后的一年期间，对两家附属社区医院进行的所有疑似甲状腺疾病的超声检查进行了回顾，这些医院由一个放射科和病理科小组提供服务，除了正在进行随访成像的患者。
评估了推荐和进行的细针活检数量以及 FNA 恶性肿瘤阳性的百分比。
分别在标准化前和标准化后审查了 608 例和 675 例超声检查。标准化后，推荐的 FNA 比例相似（35% vs. 37%，p=0.68），每例超声检查进行的 FNA 数量减少（36% vs. 31%，p=0.03），当未明确推荐 FNA 时进行的 FNA 数量减少（9.9% vs. 2.8%，p=0.000046），细胞学检测为疑似或符合恶性肿瘤的比例增加（5% vs. 11.5%，p=0.0028）。
甲状腺成像方案和管理建议的标准化可以减少进行的 FNA 数量，并增加社区环境中阳性测试的百分比。
