Session: MON 471-496-Thyroid Neoplasia & Case Reports
Poster Board MON-480
Methods: This retrospective review identified 83 new patients referred to the Hospital at the University of Pennsylvania (HUP) endocrinology practice from 3/1/12 - 8/13/12 who had US exams ( O_US) performed facilities outside HUP prior to referral and repeat US exams performed at HUP either in our endocrinology or combined endocrinology-radiology thyroid nodule clinic. O_US and HUP_US reports were evaluated for presence of a specific recommendation (FNA or surveillance) and concordance of the recommendation with ATA and SRU guidelines.
Results: O_US reports provided a specific clinical recommendation regarding FNA in 47/83 (57%) patients: 40 recommended FNA of a specific nodule, 7 recommended no FNA. In the 40 where O_US reports recommended FNA, HUP_US recommendations were concordant in 24 (65%), but in 14 (35%) HUP_US led to change of management either because FNA was considered not indicated (12.5%, 5 pts) or FNA of a different nodule was indicated (22.5% 9 pts), diagnosing 1 cancer. HUP_US reports recommended FNA in 2/7 (29%) pts where O_US did not recommend FNA, diagnosing 1 cancer. No clinical recommendation was provided in 36 (43%) O_US reports. For these pts, HUP_US reports recommended FNA in 21 pts (58%) diagnosing 4 thyroid cancers. In the remaining 15 pts (42%) HUP_US did not detect nodules meeting ATA or SRU criteria for FNA. HUP_US recommended FNA in 52/83 (63%) patients. For all 52 pts, the HUP_US recommendation was consistent with ATA guidelines. In 49/52 (92%) this recommendation was consistent with SRU guidelines. The 3 discrepancies were based upon size cutoffs for 2 nodules and knowledge of a family history of thyroid cancer in 1 pt, leading to FNA of a <1cm calcified nodule.
Conclusions: Our results indicate many O_US reports fail to provide specific recommendations regarding FNA of thyroid nodules. In O_US reports that did provide a specific recommendation for FNA, when evaluated with repeat imaging and application of ATA and SRU guidelines, clinical management changed in 35% and led to the diagnosis of thyroid cancer in 6/83 (7%). This suggests that patients may benefit from having their US exams at centers with expertise in both the performance and interpretation of the thyroid ultrasound.
Nothing to Disclose: CAW, CJAN, JEL, SJM
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