03 Nov Practical Approach to Management of Incidental Thyroid Nodules
Medical Research: What is the background for this study? What are the main findings?
Dr. Hoang: The incidental thyroid nodule (ITN) is a very common finding on imaging studies of the neck, chest and cervical spine. The workup of incidental thyroid nodules has led to increased costs from additional procedures and in some cases to increased risk to the patient. Physicians are concerned about the risk of malignancy and a delayed cancer diagnosis, but the majority of incidental thyroid nodules are benign and small incidental thyroid malignancies typically have indolent behavior.
The American College of Radiology (ACR) formed the Incidental Thyroid Findings Committee to derive a practical approach to managing ITNs on CT, MRI, nuclear medicine, and ultrasound studies. This white paper describes consensus recommendations representing the Committee’s review of the literature and their practice experience.
Medical Research: What should clinicians and patients take away from these recommendations?
Dr. Hoang: I recommend that the readers review the flow charts in the paper. The take home points are the following:
- In patients under 35 years of age with an incidental thyroid nodule detected on CT, MRI or extrathyroidal ultrasound, the Committee recommends further evaluation with dedicated thyroid ultrasound if the nodule is ≥1 cm and has no suspicious imaging features and if the patient has normal life expectancy.
- In patients 35 years or older with an incidental thyroid nodule detected on CT, MRI or extrathyroidal ultrasound, the Committee recommends further evaluation with dedicated thryoid ultrasound if the nodule is ≥1.5 cm and has no suspicious imaging features and if the patient has normal life expectancy.
- In patients with focal metabolic activity in the thyroid on 18FDG-PET, the Committee recommends both dedicated thyroid ultrasound and FNA of the PET-avid lesion if the patient has normal life expectancy.
- In patients with focal metabolic activity in the thyroid on other nuclear medicine studies, the Committee recommends dedicated thyroid ultrasound if the patient has normal life expectancy.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Hoang: The ACR Incidental Thyroid Findings Committee recommends that the concepts, terminology, and parameters discussed in this paper become the basis for future research to advance scientific evidence regarding incidental thyroid nodules. In particular, I would be interested if the recommendations are used in practice and if this reduces unnecessary workup of incidental thyroid nodules.
Managing Incidental Thyroid Nodules Detected on Imaging: White Paper of the ACR Incidental Thyroid Findings Committee
Published online: November 1, 2014
Jenny K. Hoang, Jill E. Langer, William D. Middleton, Carol C. Wu, Lynwood W. Hammers, John J. Cronan, Franklin N. Tessler, Edward G. Grant, Lincoln L. Berland
Journal of the American College of Radiology