Endocrine Abstracts

Objective: We prospectively evaluated the quality of postoperative neck ultrasound (POU) for thyroid cancer patients in our healthcare region after the implementation of European Thyroid Association (ETA) guideline-based POU assessment with one radiology group in 2018.

Methods: Our analysis involved 672 differentiated thyroid cancer (DTC) patients treated at our center between April 1, 2017, and March 1, 2023. POU report quality was compared between radiology group 1, which implemented ETA guideline-based assessment, and other radiology groups. Differences in POU quality were evaluated before and after implementation of guideline-based assessment. Additionally, we evaluated the ability of undetectable (<0.2 ng/mL) or low-detectable (0.21 to 0.99 ng/mL) serum thyroglobulin (Tg) measurements at 1-year follow-up (FU) to predict the absence of persistent disease or relapse at 3-year FU based on American Thyroid Association (ATA) treatment de-escalation guidelines.

Results: Radiology group 1 had significantly higher mean utility scores (UtS) for POU reports of abnormal thyroid bed nodules compared to other radiology groups (4.84 vs. 3.62 for indeterminate nodules, 5.24 vs. 3.95 for suspicious nodules; P < 0.001). All radiology groups had a significant increase in mean UtS for POU reports after the implementation of guideline-based assessment by radiology group 1 compared to reports done between December 2013 and January 2018 (4.98 vs. 3.88 for radiology group 1, 3.81 vs. 2.96 for other radiology groups; P < 0.05). Radiology group 1 continued to have significantly higher mean UtS for POU reports than other groups after implementation (4.98 vs. 3.81, P < 0.0001). Assessing POU reports according to the ETA guideline-based abnormal lesion classification rules revealed that 94% of POU reports describing suspicious thyroid bed nodules and 85% of reports describing suspicious LNs by radiology group 1 were considered sufficient, compared to only 45% and 68% of those reported by other radiology groups. For 242 patients with normal US lesion status (US-N) and Tg < 0.2 ng/mL (Tg-N) at 1-year FU, 233 had US-N at 3-year FU, and the negative predictive value (NPV) for US-N and Tg-N was 96%. For patients with US-N and Tg 0.2–0.99 ng/mL (Tg-I) at 1-year FU, the NPV for US-N and Tg-I was also 96%.

Conclusions: Implementation of 2013 ETA POU reporting guidelines allows provision of high-quality POU reports to clinicians, which can lead to increased accuracy in estimating risk of recurrence of thyroid cancer and reduce unnecessary repeat POU.