Reducing unnecessary thyroid fine needle aspirations using American College of Radiology's thyroid imaging reporting and data system: A 5-year retrospective audit.

Abstract

Background

With the growing investigative imaging techniques available in medicine, increasing numbers of thyroid lesions are being identified, either symptomatically or as incidental findings. Ultrasonography remains a key first-line investigation into evaluating these lesions, and accurately stratifying whether further investigation or management is required. Methods

This study retrospectively analysed a 5-year patient cohort (2013–2017) who underwent fine needle aspirate (FNA) investigation of thyroid lesions at a large regional public hospital in Victoria, Australia. We aimed to identify whether using the American College of Radiology's thyroid imaging reporting and data system (ACR TI-RADS) in grading the initial ultrasound (US) images would have resulted in a reduction in the number of patients undergoing invasive testing and if all malignant lesions would still have been captured. Results

Application of TI-RADS criteria retrospectively to the audited population demonstrated a theoretical 56.16% (n = 164) reduction in FNAs with 0.00% of malignant nodules missed (n = 14). Sensitivity for referral to FNA testing based on ACR TI-RADS grading was high (100%) with a moderately low specificity (58.99%). Conclusion

Further management of thyroid lesions guided by ACR TI-RADS grading on initial US assessment is recommended, due to significant potential reduction in FNAs performed without loss of sensitivity for malignant nodules.