A 2016 Italian Survey about Guidelines and Clinical Management of Thyroid Nodules

Roberto Negro, Roberto Attanasio, Franco Grimaldi, Andrea Frasoldati, Rinaldo Guglielmi, Enrico Papini

Research output: Contribution to journalArticle

Abstract

BACKGROUND: While thyroid nodules are frequent in endocrine clinical practice, patients are often asymptomatic and euthyroid, and death is rare in cases of malignancy.

OBJECTIVES: To evaluate the perception of current international guidelines regarding thyroid nodule management among Italian endocrinologists, and to compare daily clinical practice with suggested recommendations.

METHODS: Italian Association of Clinical Endocrinologists (AME) members were invited to participate in a Web-based survey.

RESULTS: A total of 566 physicians responded. About 50% had read the full text of the guidelines. Over half appreciated the suggested ultrasound (US) risk categories. Fine-needle aspiration (FNA) was obtained more frequently than recommended. Follow-up of a cytologically benign nodule was largely performed according to the guidelines. Molecular testing would be most commonly requested when cytology reports showed atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (TIR3A for Italian System). Iodine and/or levothyroxine were largely prescribed for cytologically benign asymptomatic nodules. Laser/radiofrequency ablation and percutaneous ethanol injection were commonly considered as alternatives to surgery (46.2 and 71.4%, respectively).

CONCLUSIONS: Efforts are needed to make the guidelines more user-friendly and to encourage the use of codified risk categories in thyroid US reports. FNA indications remain a matter of debate as FNA is obtained in clinical practice more often than is recommended. Current US follow-up modalities for a benign nodule are correct, but probably could be performed less frequently without any harm. Molecular testing, if accessible, would be helpful in guiding clinicians' strategies in cases of AUS/FLUS-TIR3A cytologic results. Nonsurgical procedures are favorably embraced.

Original languageEnglish
Pages (from-to)75-81
Number of pages7
JournalEuropean Thyroid Journal
Volume6
Issue number2
DOIs
Publication statusPublished - Apr 2017

Fingerprint

Thyroid Nodule
Fine Needle Biopsy
Guidelines
Laser Therapy
Thyroxine
Iodine
Cell Biology
Thyroid Gland
Ethanol
Physicians
Injections
Surveys and Questionnaires
Neoplasms
Endocrinologists

Cite this

A 2016 Italian Survey about Guidelines and Clinical Management of Thyroid Nodules. / Negro, Roberto; Attanasio, Roberto; Grimaldi, Franco; Frasoldati, Andrea; Guglielmi, Rinaldo; Papini, Enrico.

In: European Thyroid Journal, Vol. 6, No. 2, 04.2017, p. 75-81.

Research output: Contribution to journalArticle

Negro, Roberto ; Attanasio, Roberto ; Grimaldi, Franco ; Frasoldati, Andrea ; Guglielmi, Rinaldo ; Papini, Enrico. / A 2016 Italian Survey about Guidelines and Clinical Management of Thyroid Nodules. In: European Thyroid Journal. 2017 ; Vol. 6, No. 2. pp. 75-81.
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AU - Papini, Enrico

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N2 - BACKGROUND: While thyroid nodules are frequent in endocrine clinical practice, patients are often asymptomatic and euthyroid, and death is rare in cases of malignancy.OBJECTIVES: To evaluate the perception of current international guidelines regarding thyroid nodule management among Italian endocrinologists, and to compare daily clinical practice with suggested recommendations.METHODS: Italian Association of Clinical Endocrinologists (AME) members were invited to participate in a Web-based survey.RESULTS: A total of 566 physicians responded. About 50% had read the full text of the guidelines. Over half appreciated the suggested ultrasound (US) risk categories. Fine-needle aspiration (FNA) was obtained more frequently than recommended. Follow-up of a cytologically benign nodule was largely performed according to the guidelines. Molecular testing would be most commonly requested when cytology reports showed atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (TIR3A for Italian System). Iodine and/or levothyroxine were largely prescribed for cytologically benign asymptomatic nodules. Laser/radiofrequency ablation and percutaneous ethanol injection were commonly considered as alternatives to surgery (46.2 and 71.4%, respectively).CONCLUSIONS: Efforts are needed to make the guidelines more user-friendly and to encourage the use of codified risk categories in thyroid US reports. FNA indications remain a matter of debate as FNA is obtained in clinical practice more often than is recommended. Current US follow-up modalities for a benign nodule are correct, but probably could be performed less frequently without any harm. Molecular testing, if accessible, would be helpful in guiding clinicians' strategies in cases of AUS/FLUS-TIR3A cytologic results. Nonsurgical procedures are favorably embraced.

AB - BACKGROUND: While thyroid nodules are frequent in endocrine clinical practice, patients are often asymptomatic and euthyroid, and death is rare in cases of malignancy.OBJECTIVES: To evaluate the perception of current international guidelines regarding thyroid nodule management among Italian endocrinologists, and to compare daily clinical practice with suggested recommendations.METHODS: Italian Association of Clinical Endocrinologists (AME) members were invited to participate in a Web-based survey.RESULTS: A total of 566 physicians responded. About 50% had read the full text of the guidelines. Over half appreciated the suggested ultrasound (US) risk categories. Fine-needle aspiration (FNA) was obtained more frequently than recommended. Follow-up of a cytologically benign nodule was largely performed according to the guidelines. Molecular testing would be most commonly requested when cytology reports showed atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (TIR3A for Italian System). Iodine and/or levothyroxine were largely prescribed for cytologically benign asymptomatic nodules. Laser/radiofrequency ablation and percutaneous ethanol injection were commonly considered as alternatives to surgery (46.2 and 71.4%, respectively).CONCLUSIONS: Efforts are needed to make the guidelines more user-friendly and to encourage the use of codified risk categories in thyroid US reports. FNA indications remain a matter of debate as FNA is obtained in clinical practice more often than is recommended. Current US follow-up modalities for a benign nodule are correct, but probably could be performed less frequently without any harm. Molecular testing, if accessible, would be helpful in guiding clinicians' strategies in cases of AUS/FLUS-TIR3A cytologic results. Nonsurgical procedures are favorably embraced.

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