Completeness of Ultrasound Reporting Impacts Time to Biopsy for Benign and Malignant Thyroid Nodules

Program: Abstracts - Orals, Poster Previews, and Posters
Session: SAT 270-310-Thyroid Neoplasia (posters)
Saturday, April 2, 2016: 1:15 PM-3:15 PM
Exhibit/Poster Hall (BCEC)

Poster Board SAT 274
Alexandra Inman*1, Kaye Ong1, Pari Tiwari2, Patrick Vos2, Adam S White1 and Sam Wiseman1
1University of British Columbia, Vancouver, BC, 2Univeristy of British Columbia, Vancouver, BC
The thyroid ultrasound report is an important communication tool between the radiologist and treating physician. Associations with malignancy have been found in nodules with the presence of a solid component, hypoechogenicity, microcalcifications, increased vascularity, irregular or infiltrative margins, and taller-than-wide shape (1,2). In addition, size (in 3D), number, and presence and size of abnormal lymph nodes should also be reported. At our centre, we set out to study the frequency of inclusion of guideline recommended elements for thyroid ultrasound reporting of nodular disease, and whether it was associated with time to tissue diagnosis. Initial ultrasound reports of adults who underwent thyroid surgery for benign (n=100) or malignant (papillary or follicular subtypes, n=108) thyroid nodules, between 2009 and 2014, were retrospectively examined for their inclusion of guideline recommended elements. Date of initial tissue diagnosis was also noted. Patients were excluded from the study when imaging or biopsy results were unavailable, they had cancer of another subtype, or a prior thyroid biopsy/surgery. On average 5.1 elements of 11 (46.4%) were included in ultrasound reports of all nodules. An average of 4.9 elements were reported for benign nodules, and 5.4 for malignant (p=0.953). The setting of the ultrasound (tertiary versus community setting) did not influence number of elements reported. The average time from first ultrasound to biopsy was 66 days. This was not different for benign or malignant nodules (71.9 days versus 59.5 days respectively, p=0.656), or for tertiary and community settings. A higher number of reported elements was significantly associated with fewer days between first ultrasound and tissue diagnosis (p=0.015). This was true for both benign and malignant subgroups (p=0.007 and p=0.001, respectively). In all patients, reporting of nodule location, lymph nodes, and vascularity was associated with a fewer number of days from first ultrasound to biopsy (p=0.048, 0.001, 0.038). Guideline recommended ultrasound elements were largely underreported in our study population. This underreporting was associated with delayed tissue diagnosis of thyroid cancer, and represents an important area for patient care quality improvement.

(1) Kwok JK et al., Radiology 2011; 260:892-899 (2) Cooper DS et al., Thyroid 2009; 19:1-43

Nothing to Disclose: AI, KO, PT, PV, ASW, SW

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