Incomplete thyroid ultrasound reports for patients with thyroid nodules: Implications regarding risk assessment and management

OBJECTIVE. The purpose of this study was to determine the completeness of thyroid ultrasound (US) reports, assess for differences in report interpretation by clinicians, and evaluate for implications in patient care. MATERIALS AND METHODS. We retrospectively reviewed thyroid US examinations performed between January and June 2013 in Nova Scotia, Canada. Baseline examinations that identified a nodule were evaluated for 10 reporting elements. Reports that lacked a comment regarding malignancy risk or a recommendation for biopsy were considered unclassified and were graded by three clinical specialists in accordance with the 2015 American Thyroid Association management guidelines. Interrater agreement was assessed using the Cohen kappa statistic. A radiologist reviewed the images of unclassified nodules, and on the basis of radiologic grading, biopsy rates and pathologic findings were compared between nodules that did and did not warrant biopsy. RESULTS. Of 971 first-time thyroid US studies, 478 detected a nodule. The number of reports lacking a comment on the 10 elements ranged from 154 to 433 (32–91%). A total of 222 nodules (46%) were unclassified, and agreement in assigned grading by the clinical specialists was very poor (κ = 0.07; p < 0.05). According to radiologist grading, only 57 of 127 biopsies were performed on nodules that warranted biopsy, and 16 of 95 biopsies were performed unnecessarily. On the basis of the three clinical specialists’ interpretation, 10, 31, and 33 reports were considered too incomplete to assign a grade; 40, 10, and four biopsies would have been unnecessarily ordered; and zero, three, and four cancers would have been missed. CONCLUSION. There is widespread underreporting of established elements in thyroid US reports, and this causes confusion and discrepancy among clinical specialists regarding the risk of malignancy and the need for biopsy.