The Effect of Routine Radiological Reporting of Thyroid Incidentalomas on Rates of Thyroid Needle Biopsy, Thyroid Surgery and Detection of Thyroid Malignancy

Abstract

Objective

This study looked at the effect of a changing radiology reporting policy to routinely review the thyroid gland where visible and report on any thyroid lesion, recommending further investigation as appropriate.

Context

Incidentaloma is a term used to describe a lesion found on imaging unrelated to the clinical issue under investigation. There is variability in the radiological reporting of thyroid incidentalomas and conflicting recommendations as to how these lesions should be managed.

Design

Data were collected retrospectively during a two year period, including 12 months before and 12 months after the change in reporting policy and categorised according to whether the lesion under investigation was a thyroid incidentaloma or a symptomatic thyroid lesion.

Patients

All patients undergoing ultrasound guided fine-needle aspiration cytology (FNAC) or core biopsy were included.

Measurements

The effects of the change in policy were analysed including rates of needle biopsy, rates of malignancy and subsequent surgical intervention.

Results

There was a 122% increase in thyroid incidentalomas undergoing needle biopsy, the majority of these were detected on computed tomography. The number of malignancies increased from 1 to 4 from year 1 to year 2. All patients were >35 years old. One patient had a positron emission tomography (PET) detected cancer, 2/4 of the non-PET detected malignancies were <1.5cm.

Conclusion

This study posits that routine radiological reporting of thyroid incidentalomas, with further investigation when clinically appropriate, is warranted. The results suggest that lesion size and CT characteristics are not reliable criteria to triage patients for investigation/biopsy.

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