Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Department of Translational and Precision Medicine, University of Rome "Sapienza", Rome, Italy.
Thyroid. 2022 Jun;32(6):675-681. doi: 10.1089/thy.2021.0558. Epub 2022 Apr 11.
Multiple ultrasound-based risk stratification systems (RSSs) for thyroid nodules are used worldwide. Variations in structure, performance, and recommendations are confusing for physicians and patients and complicate management decisions. The goal of this study was to determine the factors that are associated with choice of RSS and barriers to RSS use. These results are intended to inform development of a universal international thyroid ultrasound RSS. An online survey with questions about usage of RSSs, ultrasound practice and volumes, training, specialty, practice type, and geographic region was made available to members of five professional societies via email. Subgroup analysis was performed to identify the factors that governed use of one or more of five leading RSSs: American Association of Clinical Endocrinology (AACE), American College of Endocrinology (ACE), and Associazione Medici Endocrinologi (AME) Medical Guidelines, American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), American Thyroid Association (ATA) guidelines, European Thyroid Association TIRADS (EU-TIRADS), and Korean Society of Thyroid Radiology/Korean Thyroid Association TIRADS (K-TIRADS). There were 875 respondents from 52 countries (response rate not estimated due to overlapping society membership). More than 7 specialties were represented, with most (538; 61.5%) in endocrinology. The choice of RSS was strongly associated with medical specialty and geographic region. Of 692 respondents who indicated that their practice used an RSS, 213 (30.8%) used more than one. The specialties that were more likely to use multiple RSSs were surgery and others (40%), followed by endocrinology (33.0%), and radiology or nuclear medicine (17%) ( < 0.001). Of 271 (31.0%) respondents who indicated that they do not personally use an RSS, the majority (168; 62%) preferred to describe the specific sonographic characteristics/features that they believe are most relevant in a nodule. Almost one third of respondents indicated use of more than one RSS in their practice, potentially leading to confusion, and a similar proportion reported not using an RSS for various reasons. A unified international system that addresses their concerns and simplifies risk classification of thyroid nodules may benefit practitioners and patients. This is particularly important as newer thyroid nodule management options gain acceptance.
全球范围内使用了多种基于超声的甲状腺结节风险分层系统 (RSS)。这些系统在结构、性能和建议方面存在差异，使医生和患者感到困惑，并使管理决策变得复杂。本研究的目的是确定与 RSS 选择相关的因素以及使用 RSS 的障碍。这些结果旨在为开发通用的国际甲状腺超声 RSS 提供信息。通过电子邮件向五个专业协会的成员提供了一份在线调查，其中包含有关 RSS 使用情况、超声实践和量、培训、专业、实践类型和地理位置的问题。进行了亚组分析，以确定使用以下五个主要 RSS 之一或多个 RSS 的因素：美国临床内分泌医师协会 (AACE)、美国内分泌学会 (ACE) 和内分泌医师协会 (AME) 医学指南、美国放射学会甲状腺成像报告和数据系统 (ACR TI-RADS)、美国甲状腺协会 (ATA) 指南、欧洲甲状腺协会 TIRADS (EU-TIRADS) 和韩国甲状腺放射学会/韩国甲状腺协会 TIRADS (K-TIRADS)。来自 52 个国家的 875 名受访者做出了回应（由于重叠的协会成员，未估计回复率）。代表了 7 个以上的专业，其中大多数（538 名；61.5%）来自内分泌学。RSS 的选择与医疗专业和地理位置密切相关。在 692 名表示其实践使用 RSS 的受访者中，有 213 名（30.8%）使用了多个 RSS。更有可能使用多个 RSS 的专业是外科和其他专业（40%），其次是内分泌学（33.0%）和放射学或核医学（17%）（<0.001）。在 271 名（31.0%）表示他们个人不使用 RSS 的受访者中，大多数（168 名；62%）更喜欢描述他们认为结节中最相关的具体超声特征/特征。近三分之一的受访者表示在其实践中使用了多个 RSS，这可能导致混淆，并且类似比例的受访者出于各种原因报告未使用 RSS。一个统一的国际系统可以解决他们的担忧，并简化甲状腺结节的风险分类，这可能使从业者和患者受益。随着新的甲状腺结节管理选择被接受，这一点尤为重要。
