Table 6. Recommendation Matrix of Existing Guidelines (Clinical Situation 1: Known or Suspected Thyroid Nodule, Initial Imaging).
| Source Guidelines | AGREE II | Recommendation | Grading of Recommendation |
|---|---|---|---|
| 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer | 72 | Thyroid sonography with survey of cervical lymph nodes should be performed in all patients with known or suspected thyroid nodules | Strong recommendation, high-quality evidence |
| AACE/AME/ETA Medical Guidelines for Clinical Practice for Diagnosis and Management of Thyroid Nodules | 72 | US evaluation is recommended for patients who are at risk for thyroid malignancy, have palpable thyroid nodules or goiter, or have neck lymphadenopathy suggestive of a malignant lesion MRI and CT are not recommended for routine thyroid nodule evaluation | Grade A; BEL 2 |
| British Thyroid Association Guidelines for the Management of Thyroid Cancer | 84 | US is extremely sensitive examination for thyroid nodules. It can be specific for diagnosis of thyroid carcinoma (particularly papillary carcinoma), and aids decision making about which nodules to perform FNA | Good practice point |
| 1) All patients being investigated for possible thyroid cancer should undergo US of neck in secondary care by appropriate, competent practitioner | |||
| MRI or CT scanning is indicated when the limits of the goiter cannot be determined clinically or for fixed tumors or in patients with hemoptysis | Not available | ||
| Gadolinium-enhanced MRI may provide useful information without compromising subsequent radioiodine uptake by any remaining thyroid tissue | |||
| US Diagnosis and Imaging-based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations | 50 | Among modern imaging modalities, high-resolution US is most sensitive diagnostic modality for detection of thyroid nodules, and it is necessary to perform US for nodules found after palpation | Not available |
| ACR Appropriateness Criteria® Thyroid Disease | 69 | US thyroid; usually appropriate | Limited |
| CT neck with IV contrast; may be appropriate | Limited | ||
| CT neck without IV contrast; may be appropriate | |||
| MRI neck without and with IV contrast; usually not appropriate | Expert consensus | ||
| MRI neck without IV contrast; usually not appropriate | |||
| Primary Imaging Test and Appropriate Biopsy Methods for Thyroid Nodules: Guidelines by Korean Society of Radiology and National Evidence-based Healthcare Collaborating Agency | We recommend neck US for the diagnosis of thyroid nodules detected by imaging other than US or in patients with suspected thyroid nodules | Recommendation grade A, evidence level II | |
| NCCN Clinical Practice Guidelines in Oncology, Thyroid Carcinoma, Version 1. 2019 | 75 | For thyroid nodules known or suspected on clinical or imaging findings, US is recommended | 2A |
| Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer | 33 | Thyroid sonography with survey of cervical lymph nodes should be performed in all patients with known or suspected thyroid nodules | 1 |
AACE/AME/ETA = American Association of Clinical Endocrinologists/Italian Association of Clinical Endocrinologists/European Thyroid Association, ACR = American College of Radiology, CT = computed tomography, FNA = fine-needle aspiration, IV = intravenous, MRI = magnetic resonance imaging, NCCN = National Comprehensive Cancer Network, US = ultrasonography