Title:American Association of Clinical Endocrinology And Associazione Medici Endocrinologi Thyroid Nodule Algorithmic Tool
Volume: 21
Issue: 11
Author(s): Jeffrey R. Garber*, Enrico Papini, Andrea Frasoldati, Mark A. Lupo, R. Mack Harrell, Sareh Parangi, Vivek Patkar, Zubair W. Baloch, Rachel Pessah-Pollack, Laszlo Hegedus, Anna Crescenzi, Carrie C. Lubitz, Ralf Paschke, Gregory W. Randolph, Rinaldo Guglielmi, Celestino P. Lombardi and Hossein Gharib
Affiliation:
- Endocrine Division, Harvard Vanguard Medical Associates, Boston, Massachusetts,United States
Keywords:
algorithms, diagnostic techniques, fine-needle aspiration, internet, practice guidelines
Abstract:
Objective: The first edition of the American Association of Clinical Endocrinology/American College of
Endocrinology/Associazione Medici Endocrinologi Guidelines for the Diagnosis and Management
of Thyroid Nodules was published in 2006 and updated in 2010 and 2016. The American Association of
Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi multidisciplinary
thyroid nodules task force was charged with developing a novel interactive electronic
algorithmic tool to evaluate thyroid nodules.
Methods: The Thyroid Nodule App (termed TNAPP) was based on the updated 2016 clinical practice
guideline recommendations while incorporating recent scientific evidence and avoiding unnecessary
diagnostic procedures and surgical overtreatment. This manuscript describes the algorithmic tool
development, its data requirements, and its basis for decision making. It provides links to the web-based
algorithmic tool and a tutorial.
Results: TNAPP and TI-RADS were cross-checked on 95 thyroid nodules with histology-proven diagnoses.
Conclusion: TNAPP is a novel interactive web-based tool that uses clinical, imaging, cytologic, and molecular
marker data to guide clinical decision making to evaluate and manage thyroid nodules. It may be
used as a heuristic tool for evaluating and managing patients with thyroid nodules. It can be adapted to
create registries for solo practices, large multispecialty delivery systems, regional and national databases,
and research consortiums. Prospective studies are underway to validate TNAPP to determine how it
compares with other ultrasound-based classification systems and whether it can improve the care of
patients with clinically significant thyroid nodules while reducing the substantial burden incurred by
those who do not benefit from further evaluation and treatment.
