Incomplete ultrasound thyroid reporting underlines need for standardization

A new study analyzing thyroid ultrasound (US) reports found “widespread” underreporting of crucial elements, according to authors of an Oct. 20 American Journal of Roentgenology study. The failures could have led to missed cancer diagnoses.

Several guidelines have been created to help radiologists differentiate between benign or low-risk nodules, but studies have found that US reporting done by radiologists is less accurate and suboptimal for surgical planning, wrote first author Manolhas Karkada, with the Faculty of Medical Science at Dalhousie University in Halifax, Nova Scotia, Canada, and colleagues.

The researchers retrospectively analyzed 971 first-time thyroid US exams performed between January and June 2013 in Nova Scotia. Of the total studies performed, 478 identified a nodule. Exams which found a nodule were analyzed for 10 reporting elements.

Studies which did not contain a comment on the 10 elements ranged from 154 to 433. Forty-six percent of the nodules were unclassified and agreement in assigned grading by clinical specialists was “very poor,” the authors found.

Additionally, radiologist grading found 57 of 127 biopsies were done on nodules which warranted biopsy and 16 of 95 were performed unnecessarily.

“The results of our study show that a very large percentage of thyroid US examinations reported in our region are missing important data elements required by current reporting guidelines and that reports that fail to classify thyroid nodules or comment on the need for fine-needle aspiration biopsy (FNAB) are interpreted very differently by clinical thyroid specialists regarding the actual risk of malignancy,” Karkada and colleagues wrote.

This confusion would have led the radiation oncologist to miss four cancers and an additional three would have been missed by the endocrinologist, the authors wrote.

Overall, Karkada et al. argued their results drive home the need to standardize reporting guidelines.

“These results reinforce the need for radiologists to incorporate evidence-based guidelines and, preferably, a standard when reporting thyroid US examinations, particularly when assigning the risk of malignancy and recommending the need for biopsy,” they concluded.