Incidental thyroid nodule management recommendations inconsistent

Management recommendations for incidental thyroid nodules that are detected on cervical spine CT in emergency departments are made inconsistently and the decisions given are varied, according to a study published online Mar. 20 by the Journal of the American College of Radiology.

Guidelines for managing incidental thyroid nodules, which are highly prevalent in the general population, are not well-established. This lack of structured advising likely leads to significant practice variability of recommendations, according to lead author Bruce E. Lehnert, MD, of the University of Washington in Seattle, and colleagues. They evaluated the variability of follow-up recommendations for incidental thyroid nodules detected on cervical spine CT amongst a group of academic emergency radiologists.

After retrospectively reviewing 315 radiology reports of cervical spine CT procedures that described thyroid nodules in the emergency department, the researchers discovered that 277 recommendations were made in 181, or 57.5 percent, of the studies. The population’s mean age was 64 years old, and 58 percent were women.

Of the recommendations, 54 percent were for ultrasound, 17.2 percent recommended no follow-up, 13.7 percent were for clinical correlation, 6.2 percent were for thyroid serology, 4.8 percent were for clinical follow-up, 2.2 percent were for comparison with prior studies, 1.3 percent were for fine-needle aspiration, and 0.4 percent were for nuclear scintigraphy.

Lehnert and colleagues found that nodule size was significantly associated with the likelihood of recommendation. Recommendations were made for 51.6 percent of nodules that were less than ten millimeters, 52.4 percent of those between ten and 15 millimeters, 83.3 percent of nodules measured between 15 and 20 millimeters, and 81.6 percent of those greater than or equal to 20 millimeters.

The authors believe that the considerable variability in recommendations for thyroid nodules could be due to uncertainty amongst radiologists about how established ultrasound-based thyroid nodule management guidelines apply to CT. This idea highlights the fact that there are currently no largely accepted CT-based management guidelines for incidental thyroid nodules.

“The American College of Radiology is ideally suited to generate and disseminate such guidelines, potentially resulting in reduced practice variability and improved patient care,” concluded Lehnert and colleagues.