US-based risk stratification "guidelines" for thyroid nodules: Quō Vādis?

Abstract

Purpose: This rapid scoping review addresses the commentary titled the ACR TI-RADS™: An Advance in the Management of Thyroid Nodules or Pandora's Box of Surveillance? suggesting that the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS™-2017) adds to a plethora of existing guidelines, incorporates an inconsistent lexicon, and potentially contradicts recommendations.

Materials and methods: The author performed a rapid scoping review using a combination of English keywords to identify and review peer reviewed articles contained in electronic databases (e-databases) comparing 2 or more guidelines for managing adult thyroid nodules (GMTNs) with (UGMTNs) and without (non-UGMTNs) ultrasound. E-databases included Medline (PubMed), EBSCO, Google, and Google Scholar published (2010-2019).

Results: The search returned 28 articles, where the author identified 12 different guidelines. Most articles evaluated diagnostic performance (N = 26), not quality (N = 2) measures. The most commonly reviewed UGMTNs were in descending order ATA-2015, ACR TI-RADS™-2017, South Korean, and EU TI-RADS. No article reviewed all GMTNs or identified a generally accepted UGMTNs or non-UGMTNs. Primary origin continents were: North America (U.S.A), Asia (Japan, South Korea, Thailand), Europe (France, Italy, U.K.), and South America (Chile).

Conclusion: A plethora of UGMTNs may exist. No guideline enjoys general acceptance and evaluations of performance and quality vary.

Keywords: guideline; nodule; risk; stratification; thyroid; ultrasound.