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Tessler Heads International Effort to Standardize Thyroid Nodule Guidelines

Franklin TesslerFranklin Tessler, MD, CM, professor of Radiology, is leading an international initiative to create a universal system to guide thyroid nodule management based on ultrasound.

The International Thyroid Nodule Ultrasound Working Group includes radiologists, endocrinologists, and surgeons with expertise in thyroid ultrasound from four continents. Dr. Tessler also is chairing a steering committee with representatives from the United States, France, Italy, and Korea.

“I have a lot of reasons to be optimistic about this effort because people are really enthusiastic about it,” Dr. Tessler says. “This potentially will have very widespread impact. Thyroid nodules are very common; they’re present in almost seven out of 10 adults who are examined with high-resolution ultrasound. However, if we biopsied every one of them, there would be a huge cost to society as a whole. These guidelines could give us a universally accepted way to determine which nodules most warrant further attention.”

Most thyroid nodules are benign, and many of those that are cancerous are not life-threatening. Only a minority of thyroid nodules are aggressive and require treatment. Practitioners have long sought ways to determine which nodules are suspicious enough to warrant further investigation with a fine needle aspiration (FNA) biopsy, the most commonly employed diagnostic technique.

The Next Step

Multiple groups and professional organizations have formulated guidelines for classifying thyroid nodules. In 2004, Dr. Tessler participated in a consensus conference convened by the Society of Radiologists in Ultrasound that produced guidelines that were adopted by many radiologists in the United States and elsewhere. More recently, he chaired a committee for the American College of Radiology that developed the ACR TI-RADS (Thyroid Imaging, Reporting and Data System), which was published in 2017. ACR TI-RADS has been well-received, but guidelines from other organizations such as the American Thyroid Association, the European Thyroid Association, and the Korean Society of Thyroid Radiology are used as well.

While these systems have much in common, they differ in several respects. For example, a nodule that would warrant an FNA under one system might not under a different set of guidelines. Discordant recommendations have understandably led to uncertainty about how to manage thyroid nodules.

Dr. Tessler says that basing the group’s work product on solid evidence from medical literature will be a key to success. “Evidence-based practices and standardization of care will create less confusion for patients and for practitioners who seek guidance for this common problem,” he says.

During a July 31 conference call, steering committee members discussed how to proceed and mapped out a plan for the working group. Dr. Tessler expects that work will begin in earnest later this summer.