MINNEAPOLIS ― It is not unusual for a clinician to identify thyroid incidentalomas on non-thyroid dedicated imaging studies. However, discovered, clinical guidelines recommend evaluation of all thyroid incidentalomas to risk-stratify for cancer.
A study in the journal Thyroid looked at how thyroid incidentalomas are reported on chest CT and sought to determine the association of reporting location with the likelihood of evaluation and risk of long-term outcomes.1
Minneapolis VA Health Care System-led researchers conducted a retrospective cohort study of 1,460 previously identified veterans with thyroid incidentalomas on chest CT from their single VA institution between 1995-2016. Participants had a mean age of 70.4 years and 94.9% were male.
The authors explained that reporting of the incidentaloma was categorized as either in the body of the report alone or in the impression. The study team extracted demographic data, vital status, thyroid ultrasound, endocrinology consult, thyroid nodule FNA, thyroid surgery, thyroid cancer diagnosis, and death from thyroid cancer.
Among the veterans in the cohort, 707 incidentalomas (48.4%) were reported in the impression and 753 (51.6%) were reported in the body section. Results indicated that veterans with thyroid incidentalomas reported in the impression vs. body were significantly more likely to be evaluated within six months (35.5% vs 5.1%; P = <0.001), 12 months (38.5% vs 6.5%; P = <0.001), and at any time during the follow-up period (47.8% vs 13.2%; P = <0.001).
In addition, researchers reported that veterans with thyroid incidentalomas reported in the impression vs. body were more likely to undergo thyroidectomy (18 [2.6%] vs 6 [0.8%]; P = 0.009), although no difference was identified in the proportion of Veterans diagnosed with thyroid cancer (11 [1.6%] vs 6 [0.8%]; P = 0.18), thyroid-cancer related mortality (4 [0.6%] vs 1 [0.1%]; P = 0.16), or all-cause mortality (63.2% vs 66.5%; P = 0.19).
“Thyroid incidentalomas on chest CT are inconsistently reported and often receive no subsequent evaluation. The location of reporting affects whether a clinical evaluation is performed, yet reporting does not affect the proportion of veterans who died of any cause and may have little effect on the proportion of veterans who received a diagnosis of thyroid cancer or died from thyroid cancer,” the authors concluded. “These findings suggest that the guideline recommendation to evaluate all thyroid incidentalomas should be re-evaluated.”
- Drake T, Gravely A, Ensrud K, Billington CJ. Reporting of Incidental Thyroid Nodules on Chest CT and the Impact on Nodule Evaluation: A Retrospective Cohort Study. Thyroid. 2022 Sep 21. doi: 10.1089/thy.2022.0349. Epub ahead of print. PMID: 36128846.
