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Impact of Report Recommendation on Follow-up Ultrasound Studies in the Work-Up of Incidental Thyroid Nodules

Dennis Wulfeck*, Jay Bronner, Thomas Jay Crawford, Madison Kocher, Kit Simpson

The workup of Incidental Thyroid Nodules (ITNs) is costly for both patient and the associated health care system, and there have been no studies to date demonstrating the value of building a best practice model for ITN evaluation. The purpose of the study is to evaluate the impact of adding the following statement to a Computed Tomography (CT) report when an ITN has been discovered: “No further follow up is indicated for the ITN”. A tertiary multicentre clinical decision analysis study was performed where the primary outcome measured was the adherence to the best practice of including the statement when indicated. Data was collected from eight radiology practices for a preintervention six-month period from February to July 2015 including 1936 CT scans, and a post-intervention period from July to December 2015 including 2121 CT scans. Nodules were reported according to best practice 30.81% during the pre-intervention period, and 84.35% during the post-intervention period. Using a clinical decision analysis tree and previous Medicare data, there was a predicted cost savings of approximately $23,057,208. At the same time, an estimated 7,592 negative fine needle aspirations were avoided and 750 additional thyroid cancers were estimated to be detected. Significant cost control and universal health benefit can be achieved if referring physicians adhere to the best practice of not following-up ITNs that meet criteria.