Point of care ultrasonography (POCUS) for assessment and intervention of thyroid nodules in an office setting

Background: Traditionally, thyroid ultrasounds and fine-needle biopsy have been performed by trained radiologist or sonographer. More recently, portable office-based point of care ultrasound (POCUS) have been used in management of thyroid nodules. This study aims to compare the diagnostic accuracy and interventional performance of POCUS with conventional hospital-based console ultrasound in management of thyroid nodules.

Methods: This is a retrospective case study set in a large community-based Otolaryngology practice with a dedicated thyroid ultrasound clinic. All patients referred to the thyroid clinic between January 2023 and December 2024 for ultrasound-guided fine-needle biopsy were assigned American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) category in a prospective manner by the operator immediately prior to biopsy. Studies and procedures were performed utilizing a GE (General Electric Company) Healthcare Versana Active portable ultrasound with a 12 Hz linear probe (12L-RS). Hospital assigned TI-RADS categories were subsequently obtained through a retrospective chart review of the radiologist report. The performance of both the TI-RADS categories was compared. The Bethesda system for Reporting Thyroid Cytopathology (BSRTC Categories) was utilized for all cytology reports.

Results: A total of 339 nodules underwent biopsy, of which 293 had available data for both the in-office and radiologist-assigned TI-RADS. Only the nodules with cytological categories of BSRTC categories of 2 through 6 were included in the study. The POCUS TI-RADS categories yielded a sensitivity of 1.00, specificity of 0.00, positive predictive value (PPV) of 0.10, and negative predictive value (NPV) of 1.00. The hospital-based radiologist TI-RADS categories yielded a sensitivity of 0.80, specificity of 0.35, PPV of 0.12, and NPV of 0.94. Sensitivity was significantly higher with the POCUS TI-RADS categories (P=0.01), while specificity was significantly higher with the hospital-based radiologist TI-RADS categories (P<0.001).

Conclusions: In-office POCUS is a reliable diagnostic tool that offers high sensitivity in identifying malignant thyroid nodules in an in-office setting.