Trends in imaging after diagnosis of thyroid cancer

Abstract

Background The largest growth in differentiated thyroid cancer (DTC) diagnosis is in low-risk cancers. Trends in imaging after DTC diagnosis are understudied. Hypothesizing a reduction in imaging utilization due to rising low-risk disease, we evaluated post-diagnosis imaging patterns over time and patient characteristics that are associated with likelihood of imaging. Methods Using the Surveillance Epidemiology and End Results-Medicare database, we identified patients diagnosed with localized, regional or distant DTC between 1991 and 2009. We reviewed Medicare claims for neck ultrasound, I-131 scan, or PET scan within 3 years post-diagnosis. Using regression analyses we evaluated trends of imaging utilization. Multivariable logistic regression was used to estimate the likelihood of imaging based on patient characteristics. Results 23,669 patients were included. Patients diagnosed during 2001-2009, compared to 1991-2000, were more likely to have localized disease (p<0.001) and tumors less than 1cm (p<0.001). Use of neck ultrasound and I-131 scan increased in patients with localized disease (p=<0.001 and p=0.003, respectively), regional disease (p<0.001 and p<0.001), and distant metastasis (p=0.001 and p=0.015). Patients diagnosed after 2000 were more likely to undergo neck ultrasound (OR 2.15, 95% CI 2.02-2.28) and I-131 scan (OR 1.44, 95% CI 1.35-1.54). PET scan use from 2005-2009, compared to 1996-2004, increased 32.4-fold (p=<0.001) in localized patients, 13.1-fold (p<0.001) in regional disease patients, and 33.4-fold (p<0.001) in patients with distant DTC. Conclusion Despite a rise in low-risk disease, the use of post-diagnosis imaging increased in all stages of disease. The largest growth was in use of PET scan after 2004.

Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer

“…Unnecessary diagnosis and intervention of low-risk and clinically non-significant disease remain a legitimate concern [34]. However, it is important to note that the imaging results analyzed in this study influenced patient management in over 50 % of patients, of whom 17 (37 %) were operated.…”

“…The rise in use of diagnostic imaging, especially of FDG-PET(/CT) in TC follow-up, leads to increased radiation exposure and associated health costs [32–34]. Unnecessary diagnosis and intervention of low-risk and clinically non-significant disease remain a legitimate concern [34].…”

Cost‐effectiveness analysis of papillary thyroid cancer surveillance

“…A recent Surveillance, Epidemiology, and End Results Medicare database study demonstrated a trend toward increased use of postdiagnostic imaging modalities across all risk categories over recent decades. 13 Although thyroid cancer is a disease with a relatively low clinical recurrence and death burden, the economic burden of the disease is not insignificant and continues to grow. A review of surveillance practices to improve cost-effectiveness in low-risk PTC could significantly curb the rising costs of thyroid cancer management.…”

Ions doped melanin nanoparticle as a multiple imaging agent

“…Directly ionizing gamma-radiation from radioisotopes such as 99m Tc can also provide real-time information during minimally invasive surgeries using a portable detector such as Geiger–Müller devices [ 18 ]. Furthermore, both beta and gamma-ray irradiation radionuclides like 131 I can be simultaneously applied for radiotherapy by beta-ray irradiation and for conducting imaging diagnosis using the beta or gamma-ray by SPECT, gamma camera, or PET [ 19 – 21 ].…”