Hu X Y, Wu J, Seal P, Ghaznavi S A, Symonds C, Kinnear S, Paschke R
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Eur Thyroid J. 2022 Jun 14;11(3):e220035. doi: 10.1530/ETJ-22-0035.
There has been slow adoption of thyroid ultrasound guidelines with adherence rates as low as 30% and no population-based studies investigating adherence to guideline-based malignancy risk assessment. We therefore evaluated the impact of adherence to the 2015 ATA guidelines or 2017 ACR-TIRADS guidelines on the quality of thyroid ultrasound reports in our healthcare region.
We reviewed 899 thyroid ultrasound reports of patients who received fine-needle aspiration biopsy and were diagnosed with Bethesda III or IV nodules or thyroid cancer. Ultrasounds were reported by radiology group 1, group 2, or other groups, and were divided into pre-2018 (before guideline adherence) or 2018 onwards. Reports were given a utility score (0-6) based on how many relevant nodule characteristics were included.
Group 1 had a pre-2018 utility score of 3.62 and 39.4% classification reporting rate, improving to 5.77 and 97.0% among 2018-onwards reports. Group 2 had a pre-2018 score of 2.8 and reporting rate of 11.5%, improving to 5.58 and 93.3%. Other radiology groups had a pre-2018 score of 2.49 and reporting rate of 32.2%, improving to 3.28 and 61.8%. Groups 1 and 2 had significantly higher utility scores and reporting rates in their 2018-onward reports when compared to other groups' 2018-onward reports, pre-2018 group 1 reports, and pre-2018 group 2 reports.
Dedicated adherence to published thyroid ultrasound reporting guidelines can lead to improvements in report quality. This will reduce diagnostic ambiguity and improve clinician's decision-making, leading to overall reductions in unnecessary FNA biopsy and diagnostic surgery.
甲状腺超声指南的采用进展缓慢，依从率低至30%，且尚无基于人群的研究调查对基于指南的恶性风险评估的依从情况。因此，我们评估了遵循2015年美国甲状腺协会（ATA）指南或2017年美国放射学会（ACR）-甲状腺影像报告和数据系统（TIRADS）指南对我们医疗区域内甲状腺超声报告质量的影响。
我们回顾了899份接受细针穿刺活检并被诊断为贝塞斯达III级或IV级结节或甲状腺癌患者的甲状腺超声报告。超声报告由第1组、第2组或其他组的放射科医生出具，并分为2018年前（在遵循指南之前）或2018年及以后。根据所包含的相关结节特征数量，报告被赋予一个效用评分（0 - 6分）。
第1组在2018年前的效用评分为3.62分，分类报告率为39.4%，在2018年及以后的报告中分别提高到5.77分和97.0%。第2组在2018年前的评分为2.8分，报告率为11.5%，提高到5.58分和93.3%。其他放射科组在2018年前的评分为2.49分，报告率为32.2%，提高到3.28分和61.8%。与其他组2018年及以后的报告、2018年前第1组报告和2018年前第2组报告相比，第1组和第2组在2018年及以后的报告中效用评分和报告率显著更高。
专门遵循已发布的甲状腺超声报告指南可提高报告质量。这将减少诊断的模糊性，改善临床医生的决策，从而总体上减少不必要的细针穿刺活检和诊断性手术。
