Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
Endocr Pract. 2023 Dec;29(12):948-954. doi: 10.1016/j.eprac.2023.09.006. Epub 2023 Sep 16.
Excessive use of thyroid ultrasound (TUS) contributes to the overdiagnosis of thyroid nodules and thyroid cancer. In this study, we evaluated drivers of and clinical trajectories following TUS orders.
We conducted a retrospective review of 500 adult patients who underwent an initial TUS between 2015 and 2017 at Mayo Clinic in Rochester, MN. A framework was employed to classify the indication for TUS, and it was characterized as inappropriate when ordered without a guideline-based indication. Medical records were reviewed for up to 12 months following the TUS, and clinical outcomes were evaluated.
The mean age mean age (SD) was 53.6 years (16.6), 63.8% female, and 86.6% white. TUS orders were triggered by incidental findings on unrelated imaging (31.6%), thyroid symptoms (20.4%), thyroid abnormalities on routine physical examination (17.2%), and thyroid dysfunction workup (11.8%). In females and males, the most common reason were incidental findings on imaging (female, 91/319, 28.5% and male, 67/181, 37.0%). In primary care practice, TUS orders were mostly triggered by symptoms (71/218, 32.5%), while thyroid dysfunction workup was the primary reason in endocrinology (28/100, 28.0%). We classified 11.2% (56/500) TUS orders as likely to have been ordered inappropriately based on current guidelines. Finally, 119 patients (119/500, 23.8%) had a thyroid biopsy with 11.8% had thyroid cancer (14/119. 11.8%).
Incidental findings on imaging, symptoms, and routine physical exam findings in asymptomatic patients were the most prevalent drivers of TUS. Furthermore, 1 in 10 TUS were likely inappropriately ordered based on current practice guidelines.
过度使用甲状腺超声（TUS）会导致甲状腺结节和甲状腺癌的过度诊断。本研究评估了 TUS 检查的驱动因素以及 TUS 检查后的临床轨迹。
我们对 2015 年至 2017 年间在明尼苏达州罗切斯特市梅奥诊所接受初次 TUS 检查的 500 例成年患者进行了回顾性分析。采用框架对 TUS 检查的适应证进行分类，无基于指南的适应证时则归类为不适当。对 TUS 检查后长达 12 个月的病历进行了回顾，并评估了临床结局。
患者的平均年龄（SD）为 53.6 岁（16.6），女性占 63.8%，白人占 86.6%。TUS 检查的触发因素包括无关影像学检查的偶然发现（31.6%）、甲状腺症状（20.4%）、常规体格检查发现甲状腺异常（17.2%）和甲状腺功能障碍检查（11.8%）。在女性和男性中，最常见的原因是影像学检查的偶然发现（女性 91/319，28.5%；男性 67/181，37.0%）。在初级保健实践中，TUS 检查的触发因素主要是症状（71/218，32.5%），而内分泌学中甲状腺功能障碍检查是主要原因（28/100，28.0%）。根据当前指南，我们将 11.2%（56/500）的 TUS 检查归类为可能不适当的检查。最后，对 500 例患者中的 119 例进行了甲状腺活检，其中 11.8%（14/119）患有甲状腺癌。
影像学检查的偶然发现、无症状患者的症状和常规体格检查发现是 TUS 最常见的驱动因素。此外，根据当前的实践指南，有 10%的 TUS 检查可能不适当。
