One hundred thirty-eight (37%) patients had incidental thyroid nodules reported in the “Impression” section. • Evaluation of enlarged glands or glands with nodules (1-3). These results concur with findings from a survey on how radiologists report ITNs on the basis of scenarios differing in patient age, sex, and nodule size.3 In this survey, the scenario with the highest variability in responses was that of a 60-year-old woman with a 10-mm ITN: Thirty-six percent of radiologists thought that the nodule should be left in the “Findings” section and not receive work-up, while 35% of radiologists would recommend additional work-up with sonography and 21% would report the nodule in the “Impression” without a recommendation.3 In our study, which evaluated actual reporting practices, the practices seen in radiology reports for 10- to 19-mm nodules were also almost equally split: Sixty-one percent of ITNs measuring 10–14 mm and 50% of those measuring 15–19 mm were reported in the “Impression.” This high variability suggests that radiologists are less certain of how to manage ITNs measuring 10–19 mm than they are for ITNs <1 cm or >2 cm, and this size range appears to be one for which future guidelines have the potential to significantly improve reporting consistency. Thyroid : official journal of the American Thyroid Association 2015. Currently, FDG PET-CT in medullary thyroid cancer is most commonly used in cases where conventional imaging modalities are negative or inconclusive in the presence of elevating tumor markers such as calcitonin and carcino-embryonic antigen (CEA). This is particularly true for the cervical region. This book reviews the sonographic features of the cervical structures, including the thyroid, parathyroids, salivary glands, lymph nodes, larynx and hypopharynx, and blood vessels. Incidental thyroid nodules (ITNs) are a common radiologic finding, seen in 1 in 6 patients undergoing CT and MR imaging examinations of the neck.1,2 Unlike nodules seen on sonography, there are no reliable signs of malignancy and no well-accepted guidelines for reporting ITNs detected on CT and MR imaging. {"url":"/signup-modal-props.json?lang=us\u0026email="}. The 3-tiered system reduces FNA rate for incidental thyroid nodules by 34-46% (3,11), The 3-tiered system captures the same proportion of thyroid cancers compared to a 1cm size cutoff (3), Incidental thyroid cancers missed by the 3-tiered system represent 1% of all thyroid cancers having surgery and are small papillary cancers that are lower in stage (12). 6. The high prevalence of thyroid nodules combined with the generally indolent growth of thyroid cancer present a challenge for optimal patient care. Incidental Thyroid Nodules on CT or MRI. Thyroid nodules are often detected incidentally by . Finally, we did not evaluate the outcomes of the reporting styles and recommendations because we were focused on radiologist reporting practices. The topic of thyroid and parathyroid glands is covered in this comprehensive new issue of Neuroimaging Clinics of North America, guest edited by Laurie Loevner. A, A 46-year-old man with a 12-mm incidental nodule in the left thyroid lobe detected on chest CTA performed to evaluate an abdominal aortic aneurysm. On multivariate analysis, study indication and radiology division remained significant (P < .05). CT scan. On MRI, both malignant and benign thyroid nodules can have isointense T1 and hyperintense T2 signals . Grant, E.G., et al. Thyroid lymphoma may presents as a focal mass, multiple thyroid nodules, or diffuse enlargement of the gland, with rapid growth. CT findings in ITNs match the sonographic findings in only 53% of patients, and CT misses other thyroid nodules or multinodularity in 40% of patients . MATERIALS AND METHODS: This is a retrospective study of patients with incidental thyroid nodules reported on CT and MR imaging between January and December 2011, identified by text search for "thyroid nodule" in all CT and MR imaging reports. A prior study found that the overall rate of recommending additional imaging decreased as radiologists' experience increased.8 However, we did not observe this trend. thyroid nodules detected on imaging [3] and the ACR AC for thyroid diseases [4]. Isoechoic Nodules. Other costs to consider are patient anxiety, time lost and potential complications of diagnostic lobectomy. Materials and methods: CT scans on all 96 patients with thyroid nodules who underwent both enhanced CT examination of neck and thyroidectomy from 2014 to 2016 in . Interventional Radiologists perform thyroid nodule ablation by inserting a needle or probe directly into the thyroid nodule through the skin. In routine clinical practice, radiologists are very likely to encounter incidental thyroid abnormalities during interpretation of imaging studies of the neck, chest, or spine. One mechanistic explanation underlying the observed increase in thyroid cancer incidence is the presence of a large reservoir of asymptomatic, indolent thyroid cancers that may never reach clinical attention. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking. In contrast, there were less variability and more agreement in reporting styles for larger nodules and subcentimeter nodules. Conclusions: Reporting practices for incidental thyroid nodules detected on CT and MR imaging are predominantly influenced by nodule size and the radiologist's subspecialty. Hoang JK, Raduazo P, Yousem DM, Eastwood JD. Small thyroid cancers are typically indolent and most patients die with rather than of thyroid cancer 6,7. One of the main differences between ACR TI-RADS and other systems is that it uses a set of imaging characteristics that can be independently assessed, whereas the ATA and several other systems use a pattern-based approach. , A study using population-based SEER data to predict thyroid cancer outcomes as a function of tumor and patient variables using a proportional hazards model found that tumor size only increased mortality when size exceeded 2.5 cm. This was a retrospective study of 401 patients with thyroid nodules reported on CT or MR imaging between January 1, 2011, and December 31, 2011, at a single large academic institution with 8 subspecialty clinical divisions and 59 subspecialty radiologists. Thyroid incidentalomas are very common and can be initially detected on computed tomography, MR, ultrasound, PET, or other modalities. An Italian study examining US examinations in individuals without thyroid disease reported an ITN prevalence of 33%, similar to findings from a large Korean study showing prevalence of thyroid nodules or cysts to be 34% among subjects undergoing thyroid US during routine health evaluations. (view reference) Hoang JK, Middleton WD, Farjat AE, et al. Clin Imaging 2007;31(2):109-113. no known thyroid disease with a thyroid nodule < 1.0 cm noted incidentally with follow-up imaging recommended . Nodule size can be reliably assessed on US and has been incorporated into both the ATA guidelines and the ACR TI-RADS management recommendations in the form of size thresholds for FNA or surveillance that vary depending on the risk categorization for a given nodule , , ( Table 1 ). From age 20 to 60, relative risk of malignancy decreases 2.2% per year. 16-18% of patients will have an incidental nodule seen on CT and MRI (2,3). Objective: To quantitatively assess the imaging characteristics of thyroid nodules in dual-energy computed tomography (CT) imaging for differentiation of benign and malignant lesions.. Materials and Methods: Dual-energy CT imaging was performed on 97 surgically removed thyroid nodule specimens prior to their pathologic examination. Nodules detected this way are usually smaller than those found during a physical exam. Smith-Bindman R, Lebda P, Feldstein VA, Sellami D, Goldstein RB, Brasic N, Jin C, Kornak J. New for this edition: • Book is 4-color for first time with new anatomic variants added to each chapter • Inside cover lists common acronyms and treatment of acute contrast media reactions • Discussion of biopsy of thyroid nodules ... Magnetic resonance imaging (MRI) has a limited role in characterizing thyroid nodules, although it appears to be effective in the diagnosis of cervical lymph node metastasis. Detection of thyroid nodules is common on chest CT that is being performed for unrelated reasons. FNA and surgical series tend to overestimate malignancy risk for ITNs because of ascertainment bias, because many low-risk nodules will not undergo FNA or surgery, and therefore, would be underrepresented in the cytopathologic or histopathologic data. We calculated the proportion of ITNs reported in the “Impression” section of the report and recommended for further evaluation. Notes. Autopsy studies have reported incidental thyroid nodules in up to 50% of subjects . Thyroid ultrasound testing is the most common way to visualize or hypothyroidlsm at your thyroid gland 1. Thyroid lymphoma. There were no recommendations for investigations other than sonography. Hoang JK, Riofrio A, Bashir MR, Kranz PG, Eastwood JD. 1,3-5 However, US is easily affected by the . This Online Course covers the breadth and depth of the field of thyroid imaging. They are common but occasionally represent thyroid cancer 1.This article discusses the epidemiology of incidental thyroid nodules and recommendations for further evaluation. This pocket book provides a comprehensive review of the current use of PET/CT in thyroid cancer, offering a multidisciplinary perspective and explaining the role of PET/CT in relation to other imaging modalities. Notes. Nonetheless, existing literature offers some justification for a less aggressive management approach for elderly patients. Some of the recommendations are summarized below. Ultrasound (US) is generally the modality of choice for characterizing ITNs, but US studies performed for unrelated indications, such as assessing neck vasculature or in a screening context, can result in incidental detection of nodules. Found insideWhat started as the notes from a Massachusetts General Hospital resident is now the second edition of a well-respected exam review tool. A.Evaluation of Thyroid nodule • Clinically palpable nodule :4-7 % of general population. Praise for this book:[Four stars] At once a textbook, a surgical atlas, and a source of current practice guidelines. Radiology Strategies is designed to help the medical student and non-radiology practitioner learn to make effective use of radiologic tests based on a patient's signs and symptoms. High Variability in Radiologists' Reporting Practices for Incidental Thyroid Nodules Detected on CT and MRI. High-resolution thyroid ultrasonography is the test of choice for determining the need for tissue sampling or imaging surveillance. Although incidental detection of an ITN often leads to further evaluation to exclude or diagnose malignancy, fortunately, most ITNs are benign, and most thyroid cancers are papillary thyroid carcinomas, which generally have an excellent prognosis. 2014. Increasing utilization of cross-sectional imaging modalities, including a 10% per year growth in CT imaging use over a similar time period and increased use of point-of-care sonography, because of higher quality and lower cost of US equipment, is thought to contribute to a large portion of the observed increase in thyroid cancer diagnoses. Additionally, recommendations were not commonly included in radiology reports. The most common study indication for CT or MR imaging was evaluation of malignancy (52%). Suspicious findings. From a medical-legal perspective, guidelines would also serve as a resource for radiologists when facing the dilemma of whether and how to report incidentalomas.15, The Duke 3-tiered system for CT, MRI, or PET-detected thyroid nodules1,13,14,a. In otherwise healthy patients without suspicious imaging features, the ACR recommends US for nodules meeting a minimum size threshold of 1 cm in patients younger than 35 years and 1.5 cm in patients 35 years and older. American College of Radiology View all recommendations from this society October 16, 2017 . Sonographic findings determine the need for FNA or sonographic follow-up or may reassure against the need for further nodule evaluation, but not all ITNs require dedicated evaluation with sonography. Thyroid Imaging. Its mass effect on the trachea narrowing it in the transverse dimension is well demonstrated. Thyroid nodules, on the other hand, are primarily found on ultrasounds, and are presumed to be present in more than half of the global population. A multivariable logistic regression model was fitted to identify factors that were associated with ITNs that were reported in the “Impression” sections of reports and recommended for further evaluation. With increased use of imaging for screening, diagnosis, and Magnetic resonance imaging (MRI) has a limited role in characterizing thyroid nodules, although it appears to be effective in the diagnosis of cervical lymph node metastasis. Of those who did die from thyroid cancer, all had significant-risk thyroid cancers that were not subtle on imaging and/or cytology and were easily discerned at the time of thyroid nodule evaluation. In: AJNR Am J Neuroradiol, in press, 2015, 15. Abdominal division radiologists were less likely to report ITNs in the “Impression” section of the report than radiologists in other divisions. A high proportion of patients having imaging are older and/or have comorbidities. Data were collected on factors that could influence reporting styles and included characteristics of the radiologists, patients, and nodules. Most trials evaluate the role of SUVmax, but there is no . Purpose: To evaluate computed tomography (CT) detection of solitary thyroid calcification for identifying thyroid papillary carcinoma and to determine whether the predictive ability changes when the size increases after enhancement. Often, before pursuing further evaluation, review of prior available imaging may be helpful to determine the presence or absence of the nodule on a prior imaging study, even if not explicitly mentioned in the imaging report, and interval change can provide critical information regarding the malignancy risk of the nodule. Larger nodules were more likely to be reported in the “Impression” sections of reports. Hoang JK, Langer JE, Middleton WD et-al. Validation of the ACR TI-RADS criteria has been performed in a multi-institutional study of more than 3000 nodules that found that the vast majority (86%) of nodules showed empiric malignancy risks within 1% of the specified ACR TI-RADS risk thresholds. The mean nodule size was 16.9 ± 9.8 mm for ITNs reported in the “Impression” compared with 15.4 ± 7.4 mm for ITNs not reported in the “Impression” section (On-line Table). Found insideThis book, "Histopathology-An Update" is a comprehensive book that deals with the latest advances in the field of histopathology. ITNs were reported in the “Impression” section in 23% of the studies interpreted by abdominal radiologists compared with 43% for chest radiologists and 50% for neuroradiologists (On-line Table). In general, thyroid nodule prevalence varies somewhat linearly with age and shows a strong female predominance. The 3-tiered system results in a net 54% reduction in ITN reported in the impression section of the report (13). The following is a summary of the findings. Thyroid nodules are the most common in the thyroid gland. Fig. There are several limitations to this study. CT of the chest is responsible for the majority of ITNs [5]. In an elderly cohort of patients with ITNs undergoing US and FNA described above, close to half had a comorbidity, such as coronary artery disease, or another primary malignancy at the time of nodule evaluation that more than doubles the risk of all-cause mortality, suggesting that even if workup yields a malignant cytologic diagnosis, there may be relatively little benefit on overall survival. b Sagittal grey scale ultrasound of the thyroid demonstrates a heterogeneous nodule with predominant cystic component. To capture only ITNs, we excluded patients if the imaging study was performed to evaluate the thyroid, if they had prior evaluation of the thyroid (such as previous thyroid sonography or biopsy), or if they had a personal history of thyroid cancer. Small ITNs may be considered less important relative to other abnormalities and, therefore, are not included in the “Impression” section of the reports. MRI for neck pain, or chest CT for pneumonia. Between these extremes, ACR TI-RADS and ATA differ slightly in the size threshold used, with ACR TI-RADS using higher size thresholds for FNA. ADVERTISEMENT: Supporters see fewer/no ads. The aim of this article is to provide a pictorial review of a broad spectrum of incidental and non-incidental thyroid findings on CT scans. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Diagnosis and Evaluation of Thyroid Nodules-the Clinician’s Perspective, Image-Guided Biopsies and Interventions of Mediastinal Lesions, Genetic Syndromes Affecting Both Children and Adults, Added Value of Magnetic Resonance Imaging for the Evaluation of Mediastinal Lesions, Ultrasound of the Normal Thyroid with Technical Pearls and Pitfalls, Radiologic Clinics of North America Volume 58 Issue 6. Hobbs H, Bahl M, Nelson RC, Kranz PG, Esclamado RM, Wnuk N, Hoang JK. The present work has investigated the value of computed tomography (CT) features in the diagnosis of papillary thyroid tumors in the incidental thyroid nodules (ITNs). Journal club: incidental thyroid nodules detected at imaging—can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered system? In addition to nodule composition and calcifications, other imaging features in the sonographic literature that affect risk of malignancy in thyroid nodules include echogenicity, shape, and margins. • 9-13 % incidence of malignancy in thyroid nodule. Revised to reflect the current cardiothoracic radiology curriculum for diagnostic radiology residency, this concise text provides the essential knowledge needed to interpret chest radiographs and CT scans. Evaluate with US. Although this malignancy risk estimate is lower than that obtained in FNA or surgical series, the linking of a cohort of more than 8000 patients with cancer registry data allowed that study to capture cancers detected as late as 6 years after the US evaluation. Found insideThis book provides a comprehensive and up-to-date overview of the role of diagnostic and interventional radiology in respect of liver malignancies. In some situations, large nodules may be present, which may be referred to as nodular Hashimoto thyroiditis In some cases, your doctor will recommend the use of a contrast agent to help get better images. More than 96% of thyroid cancers are papillary and follicular cancers (well-differentiated) and have an excellent prognosis (8). Calcified Thyroid Adenoma. Now in its second edition, the Oxford Textbook of Endocrinology and Diabetes is a fully comprehensive, evidence-based, and highly-valued reference work combining basic science with clinical guidance, and providing first rate advice on ... , , . Often, thyroid nodules are discovered incidentally during a routine physical examination or on imaging tests like CT scans or neck ultrasound done for completely unrelated reasons. In press. Bringing together conventional contrast media studies, computed tomography, ultrasound, magnetic resonance imaging, radionuclide imaging including hybrid imaging using SPECT-CT and PET-CT, DXA studies and digital interventional procedures ... The other 2 sonographic determinants of cancer risk in the above population-based study were microcalcifications and an entirely solid composition. 6 ), whereas ATA recommends FNA for spongiform nodules above 2 cm. September 16, 2021 - September is Thyroid Cancer Awareness Month. This study aimed to investigate the diagnostic role of computed tomography (CT) for differentiating the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) 4−5 nodules with coarse calcifications. 2 A, B ) is similar to that of CT. Evaluate with US. However, because overall mortality from thyroid cancer has remained relatively stable, several investigators have described this phenomenon as a problem of overdiagnosis. 2015;12 (2): . For this purpose, focal radiotracer uptake on a nuclear medicine study is considered a suspicious imaging feature, because focal ITN uptake on PET confers a relatively high risk of malignancy (as high as 50%–60%). Incidental Thyroid Nodules on CT or MRI. When this procedure was first being performed, radiologists used a chemical called ethanol to dehydrate and destroy . In addition, incidental cancers may also be detected at a greater rate because of rising rates of fine-needle aspiration (FNA) and thyroid surgeries. Third, nearly half of reports did not include a description of the nodule size and were therefore excluded from the analyses examining the relationship between nodule size and reporting style. However, MR imaging represents a much smaller contribution to incidentaloma detection than CT. , . Thyroid Nodule less than1.0 cm Noted or No Nodule Found equals No, proceed to check Final Reports for CT, CTA, MRI or MRA of the Chest or Neck with Follow-Up Imaging Recommended AND Incidental Thyroid Nodule less than 1.0 cm Noted in Report. AJNR Am J Neuroradiol 2013, 9. 2 C, D). Abdominal division radiologists were less likely to recommend work-up for ITNs than those in other divisions. BACKGROUND AND PURPOSE: Variability in radiologists' reporting styles and recommendations for incidental thyroid nodules can lead to confusion among clinicians and may contribute to inconsistent patient care. These could be a topic of future study. neck and chest CTs) and the frequency of ITNs on these studies (up to 25% on chest CT (48) and 16-18% on CT or MRI of the neck (49,50)). Hahn SY, Shin JH, Han BK et al. With advances in cross-sectional imaging, the detection of incidental thyroid nodules has increased significantly. Additional work-up for ITNs was recommended in 7% of patients with known malignancy compared with 31% of patients having imaging for other indications (On-line Table). Cross-sectional imaging including computed tomography (CT) and magnetic resonance imaging (MRI) detect incidental thyroid nodules (ITNs) and can be used in the evaluation of thyroid cancers and goiter. The decision to workup ITN should also account for the patients’ comorbidities and life expectancy. Designed for busy medical students, The Radiology Handbook is a quick and easy reference for any practitioner who needs information on ordering or interpreting images. Radiologist experience was not significantly associated with reporting ITNs in the “Impression” section. Over the last few decades, the incidence of thyroid cancer has increased significantly, which might be attributable to increased detection by newer diagnostic imaging techniques. Age<35 years, <1cm nodule. Part of the Cases in Radiology series, this book follows the easy-to-use format of question and answer in which the patient history is provided on the first page of the case, and radiologic findings, differential diagnosis, teaching points, ... Thank you for your interest in spreading the word on American Journal of Neuroradiology. The incidental thyroid nodule is a scenario in which we need to carefully consider the consequences of our report and recommendations (1). Second, at our institution, abdominal imaging radiologists perform sonography-guided thyroid biopsies and observe firsthand the high number of benign biopsies, potentially making them less apt to recommend further work-up. A CT scan uses x-rays to create sectional scans of the thyroid. , Nonetheless, PET-detected ITNs comprise a substantial portion of imaging-detected incidentalomas , and account for a quarter of thyroid cancers initially detected on imaging. The study was approved by our institutional review board. Because our aim was to study the factors that influenced reporting, it was only what the radiologist saw and interpreted that was relevant. Patients were identified by performing a text search of CT and MR imaging reports for the phrase “thyroid nodule” by using the Duke Enterprise Data Unified Content Explorer, a Web application for cohort identification and data extraction. AJR American journal of roentgenology 2014;202:18-24, 12. The mass is seen on cross sectional CT as an irregularly enhancing mass connected to the thyroid gland on more cranial views. One of the early studies examining ITNs in both CT and US detected an increased malignancy risk for thyroid incidentalomas in patients less than 35 years of age. http://www.cms.gov/apps/physician-fee-schedule/ (accessed December 2012). An autopsy study found 50% of patients with no clinical history of thyroid disease had thyroid nodules, and the majority were multiple [1]. Another radiologist characteristic that was studied was years of experience. Such nodules are a common occurrence in the general population and a frequent incidental finding on computed tomography (CT) and magnetic resonance imaging (MRI). World journal of surgery 2010;34:28-35, 7. Radiology Reports for Incidental Thyroid Nodules on CT and MRI: High Variability across Subspecialties, Incidental thyroid nodules on CT: evaluation of 2 risk-categorization methods for work-up of nodules, Clinical and economic impact of incidental thyroid lesions found with CT and MR, High variability in radiologists' reporting practices for incidental thyroid nodules detected on CT and MRI, Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study, Current thyroid cancer trends in the United States, An observational trial for papillary thyroid microcarcinoma in Japanese patients. INSTRUCTIONS: This measure is to be submitted . One later study showed better prediction of malignancy when dichotomizing at an age threshold of 52 years. 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