Managing Incidental Thyroid Nodules Detected on Imaging: White Paper of the ACR Incidental Thyroid Findings Committee

Hoang, Jenny K.; Langer, Jill E.; Middleton, William D.; Wu, Carol C.; Hammers, Lynwood; Cronan, John J.; Tessler, Franklin N.; Grant, Edward G.; Berland, Lincoln L.

doi:10.1016/j.jacr.2014.09.038

Cited by 291 publications

(224 citation statements)

References 39 publications

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“…Thyroid nodules appear with nodular or rim calcification on CT images and may likely be malignant (3). However, unlike US which has adequate spatial resolution such as microcalcification or margin detail, CT and MR images have no indicators to differentiate between benign and malignant tumors (6,7). Both benign and malignant tumors demonstrated intermediate signal intensity on T1WI and high signal intensity on T2WI, even if in our case showed high signal intensity in T1WI and STIR.…”

Section: Discussionmentioning

confidence: 56%

“…Tanpitukponse et al reported only a small proportion of incidental finding of thyroid lesions from CT and MRI examinations that were referred from radiologists to clinicians, had undergone additional examination (14). Patient age and nodule size influenced clinicians to make decisions regarding additional examination (6,11,(13)(14)(15). Hoang et al reported that 2 cm is the threshold size of CT and MR examinations for incidental finding of thyroid lesion (6).…”

Section: Discussionmentioning

confidence: 99%

“…Patient age and nodule size influenced clinicians to make decisions regarding additional examination (6,11,(13)(14)(15). Hoang et al reported that 2 cm is the threshold size of CT and MR examinations for incidental finding of thyroid lesion (6). Other factors that should be considered include patient comorbid condition or financial condition.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the malignant lesions in the thyroid are papillary thyroid carcinoma (PTC), followed by follicular, medullary, and anaplastic thyroid carcinoma (5). On CT or MRI, malignant nodules do not have specific imaging findings (6,7). PTC ≤1 cm is defined as papillary thyroid micro-carcinoma (PTMC), and it is the most prevalent type of papillary thyroid carcinoma.…”

Section: Introductionmentioning

confidence: 99%

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Incidental finding of papillary thyroid carcinoma on CT examination of mandibular lesion: Case report

et al. 2017

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Abstract. The number of significant incidental findings identified on radiographic examinations has increased. In total, 169 patients, 87 males and 82 females, with a mean age of 67.3 years (range, 17-92 years), as well as 65 patients (38.5%), 43 (66.2%) female and 22 (33.8%) male had abnormal findings in the thyroid for one year in our institution. Thyroid nodules are the most common incidental findings on oral and maxillofacial evaluations. Computed tomography (CT) and magnetic resonance imaging (MRI) examination are frequently used to detect thyroid abnormality. The present study reported a case of papillary thyroid carcinoma (PTC) detected following CT and MRI examination of a mandibular lesion. The CT examination of the oral and maxillofacial region included the thyroid, which must be examined carefully to detect various diseases, including PTC. Collaboration between radiologists and clinicians is important to manage these incidental findings.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidental finding of papillary thyroid carcinoma on CT examination of mandibular lesion: Case report

et al. 2017

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“…Patients with low-risk findings deemed suitable for observation but who decided upon intervention would not be stopped from doing so, but would be monitored via the registry for outcomes related to their interventions. With the recent publication by the American College of Radiology about suggested management strategies for incidentally detected thyroid nodules, there is now a reasonable place from which to start such a registry (20). The major previous white paper from this organization on abdominal incidentalomas has been adopted widely based on recent survey data (21), so it is likely that the thyroid white paper would be acceptable to radiology colleagues as a starting point in this work.…”

Section: Suggestions For Resolution Of Logistical and Ethical Issues mentioning

confidence: 99%

Developing a Registry for Thyroid Incidentalomas: Lessons Learned and the Path Forward

Davies

Pichiotino

Black

2016

Thyroid

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Background: Incidentalomas are findings on an imaging test done for other reasons, for which there are no matching symptoms in the patient. They are common in the adrenal gland, pancreas, liver, and thyroid, among other sites. Incidentalomas are a problem because we have a limited understanding of their natural history: it is difficult to know how much of a threat they pose to individual patients. An observational registry that would allow a systematic study of thyroid incidentalomas could reveal their natural history and the effect of detection on patients' lives, as well as document the cost to the healthcare system. A registry would help to determine which incidentalomas could be monitored and which require action. Study design: A cohort study was conducted, with case identification via radiology imaging reports with follow-up through a minimum of one year post-identification. Results: In one year, >109,000 imaging studies were performed that might reveal an incidental thyroid finding (computed tomography scans of the neck or chest, magnetic resonance imaging of the neck, plain x-ray of the chest, non-thyroid directed ultrasound of the neck, positron emission tomography scan, or myocardial perfusion scan). A total of 125 patients were identified as having a thyroid nodule, with a <1% reporting rate among eligible imaging studies, much lower than other published estimates of incidental thyroid nodule prevalence on imaging. Of the 125 nodules, 46 had been previously identified (were not ''new''). Of the 79 patients with new nodules, more than half (44; 53%) were not notified of the finding. The approved study design allowed contact only with those who had been clearly notified of their thyroid nodule. Among those who could be reached, many did not recall the finding (6/15; 40%). Of those who did recall the finding, none self-identified it as an incidentaloma. Conclusions: There are serious logistical and ethical hurdles to developing observational registries of incidentalomas, as well as threats to data validity because incidentalomas are incompletely identified, reported, and acted upon. Solutions commonly used to optimize data quality for registries would increase reporting, but could potentially overwhelm the healthcare system and harm patients. A novel interventional design that is proposed here for future work may facilitate both study and amelioration of the problem.

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Improving the Long-term Management of Benign Thyroid Nodules

Cappola

2015

JAMA

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Managing Incidental Thyroid Nodules Detected on Imaging: White Paper of the ACR Incidental Thyroid Findings Committee

Cited by 291 publications

References 39 publications

Incidental finding of papillary thyroid carcinoma on CT examination of mandibular lesion: Case report

Incidental finding of papillary thyroid carcinoma on CT examination of mandibular lesion: Case report

Developing a Registry for Thyroid Incidentalomas: Lessons Learned and the Path Forward

Improving the Long-term Management of Benign Thyroid Nodules

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