Most Docs Lack Confidence in Using Ultrasound for Thyroid Cancer Surveillance

By Anne Harding

January 06, 2021

NEW YORK (Reuters Health) - Just one in five physicians who monitor patients for recurrence of differentiated thyroid cancer (DTC) has high confidence in their ability to use ultrasound for surveillance, new research shows.

"Ideally all patients should receive guideline-concordant surveillance that is tailored to disease severity," Dr. Megan R. Haymart of the University of Michigan, in Ann Arbor, told Reuters Health by email.

"In experienced hands, neck ultrasound is a valuable tool, and the current clinical guidelines recommend its use as a means of detecting recurrence," she added. "However, our data suggest that in a 'real-world' setting, not all physicians are equally confident in their ability (or radiologist's ability) to detect recurrence with ultrasound. This is a barrier to standardizing long-term thyroid-cancer surveillance practices."

Dr. Haymart and her team surveyed 320 physicians involved in surveillance for DTC identified through patients in the Surveillance, Epidemiology, and End Results Program registries for the state of Georgia and Los Angeles County. Fifty-six percent were endocrinologists, 21% were general surgeons and 23% were otolaryngologists.

Eighty-four (27%) of the survey respondents performed bedside ultrasonography, and 57 (20%) said they were "quite" or "extremely" confident in their ability to detect potentially cancerous lymph nodes with ultrasound. Thirty-three percent didn't have high confidence in their own or a radiologist's ability to use ultrasound to monitor for DTC recurrence.

General surgeons were significantly more likely than endocrinologists to be highly confident in their ability, and physicians who treated more patients were more confident than those who treated fewer, the researchers report in JAMA Otolaryngology-Head and Neck Surgery.

"Ideally physicians who treat thyroid cancer are either confident in their own skills or the radiologist's skills. It is optimal if the physician is both confident and skilled," Dr. Haymart said. "However, we don't know how well physician confidence correlates with skill level. In addition, we also don't know if lack of physician confidence leads to additional cross-sectional imaging, additional clinic visits, and/or missed cancer recurrence. However, this study is the foundation for future studies exploring both thyroid-cancer recurrence and barriers to guideline-concordant care."

Dr. Javad Azadi, ultrasound section chief and an assistant professor at Johns Hopkins Hospital, in Baltimore, Maryland, co-authored an editorial accompanying the study.

"Physicians who opt to perform these scans themselves can save their patients time in the work-up," he noted in an email to Reuters Health. "For example, a physician can perform an in-office ultrasound exam using the appropriate equipment at the same time as the patient's routine clinical follow-up to save the patient an additional appointment. If an abnormal or indeterminate lymph node is identified, it could even be sampled during the same visit saving the patient time and travel to two additional appointments (ultrasound with radiology followed by another appointment for fine needle aspiration of the lymph node in question). This can be very helpful for patients who have limited access to transportation or in areas with limited radiology resources."

Physicians who lack confidence in their own or their radiologist's ability to detect DTC recurrence with ultrasound "should determine if these perceptions are valid by reviewing their own and their radiologists' protocols for image acquisition and interpretation," Dr. Azadi concluded.

SOURCE: and JAMA Otolaryngology-Head and Neck Surgery, online December 23, 2020.