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Impact of high‐quality ultrasound following community ultrasound on surgical planning and active surveillance in patients with thyroid cancer
Author(s) -
Cohen Oded,
Blank Annat,
Meiersdorf Shmuel,
Hod Keren,
Gabay Shiran,
Guindy Michal,
Khafif Avi
Publication year - 2021
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.14415
Subject(s) - medicine , thyroid cancer , ultrasound , thyroid , retrospective cohort study , cancer , radiology , surgery
Objective Ultrasound (US) has gained a critical role in thyroid cancer treatment planning, yet it is limited by its user‐dependent nature. The aim of this study was to compare the impact of US performed by radiologists specializing in thyroid imaging (hqUS) and US performed by radiographers in the community (cUS) on treatment plans of patients diagnosed with well‐differentiated thyroid malignancies. Design Retrospective single‐centre case series with chart review. Patients Patients diagnosed with thyroid cancer during 2017‐2019 that had cUS followed by hqUS pre‐operative counselling were included in this retrospective analysis. Measurements The main outcome was management alternations based on one of two sonographic measures: (1) extrathyroid extension (ETE); (2) The presence of central or lateral lymph nodes suspicious for metastases (LNM), which were compared with the final pathology. Results Among those with non‐recurrent tumour (n = 76), ETE was reported 22 times more by hqUS compared with cUS (28.9% vs 1.3%, P < .001). Central and lateral LNM were reported approximately 6.5 and 1.5 times more by hqUS, respectively (25.0% vs 3.9%, P < .001 and 15.8% vs., 9.2%, P = .227, respectively). Overall, hqUS altered the initial treatment plan of 35.5% of patients. In 27.6% of patients, hqUS and its subsequent surgery resulted in a change to the patients' 2015 ATA risk stratification system. In 40% of patients with microcarcinomas, hqUS findings mandated surgery according to findings that were not reported by cUS. False‐positive rate was 5.2%. Conclusions Community US may under‐diagnose important features such as ETE and LNM, leading to potential under‐treatment in many patients. High‐quality US of the neck should be considered in patients with differentiated thyroid carcinoma before making any treatment decisions.