Study population:
A total of 200 thyroid ultrasound reports were analysed (100 in each phase).
Nodule size categories were based on the cut off ranges for biopsy as per TIRADS (<15mm, 15-25mm, >25mm). The majority of nodules for both phases fell in the
Effect on nodule description and risk categories:
Table 1 shows the frequency of nodule characteristics in each phase of the study.
In phase one the majority of reports did not include the five ACR TIRADS feature categories. Shape was not described for 96% and margins not described for 85% of nodules. 61% of reports had no description of echogenicity, and 26% did not describe composition. 66% made no mention of the presence or absence of echogenic foci.
After introducing the structured reporting templates in phase two, shape was described in 92% of reports and margins in 93%. Echogenicity was described in 95% of reports and composition in 96%. 88% of reports commented on the presence or absence of echogenic foci.
97% of reports in phase two adopted the TI RADS scoring system to assess the nodule (vs 1% in phase one).
Effect on Management Recommendations:
Fig. 1 shows the management recommendations in each phase of the study. After implementing the TIRADS management recommendations in phase two, the number of reports without management recommendations decreased to 7%, compared with 54% in phase one.
The number of nodules recommended for biopsy was similar in both phases (36% in Phase 1 and 39% in Phase 2). The number of nodules recommended for no further follow up increased from 0 to 28%.
Effect on FNA results
Fig. 2 shows the FNA results for each phase of the study. After implementing the TI RADS in phase two, the number of FNAs performed decreased from 33% to 20%. The number of non diagnostic biopsies also decreased from 27% to 5%. In both phases of the study the majority of nodules sampled were benign, 52% in phase one and 75% in phase two. Phase one detected two cases of papillary thyroid cancer and one case of metastatic cancer to the thyroid, whereas no such cases were found in phase two.
Department / hospital specific findings:
Table 2 shows the results for requesting department and indication for ultrasound. For both phases of the study the ultrasound requests came from a variety of specialties, with surgery, endocrinology, ENT and oncology requesting the majority of thyroid ultrasound studies.
In both phases of the study the most common reason for request for thyroid ultrasound was to further image an incidental thyroid nodule found on another imaging modality, eg CT or nuclear medicine study, these made up 29% of the requests in phase one and 35% in phase two. Follow up of a thyroid nodule was the indication for ultrasound in 25% and 24% of the cases for phase one and two respectively.
Multinodular goitre was the indication for ultrasound in 23% of cases for phase one and 26% of cases in phase two. Less common reasons for ultrasound included palpable lump (4% in phase one and 3% in phase two), and deranged thyroid function tests (5% in phase one and 4% in phase two).