Cost-effectiveness of fine-needle aspiration cytology (FNAC) and watchful observation for incidental thyroid nodules

Wong, Carlos King Ho; Liu, X.; Lang, Brian Hung‐Hin

doi:10.1007/s40618-020-01254-0

Cited by 14 publications

(7 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 9 , 13 – 15 Thyroid FNAC management was cost-effective compared with watchful management. 16 Several factors – such as age, 17 female sex, 18 thyroid status, thyroid hormone level, 19 thyroid autoantibodies, 20 metabolic syndrome components, 21 , 22 smoking and alcohol consumption, 23 environmental factors, 18 , 24 diet and nutritional pattern, 25 and genetic factors 26 – have been reported as risk factors associated with thyroid nodular diseases and cancers.…”

Section: Introductionmentioning

confidence: 99%

The prevalence and associated predictors for Bethesda III–VI for reporting thyroid cytopathology in Royal Commission Hospital, Kingdom of Saudi Arabia

Alyousif

Adam

Alamin

et al. 2022

Therapeutic Advances in Endocrinology

View full text Add to dashboard Cite

Background: Thyroid cancer is increasing globally and is currently the most prevalent endocrine malignancy. Recent data show an increase in the incidence of thyroid cancer in the Kingdom of Saudi Arabia (KSA). Thyroid ultrasound and fine-needle aspiration cytology (FNAC) are the cornerstones in managing thyroid nodules. We conducted this study to evaluate the prevalence and the associated predictors for thyroid nodule Bethesda III–VI in eastern KSA. Methods: A retrospective study was conducted between January 2015 and 31 August 2021. The participants were recruited patients who received a thyroid ultrasound and ultrasound-guided thyroid FNAC, using the thyroid imaging reporting and data system (TI-RADS) and the Bethesda Classification, respectively. Result: Three hundred and ten patients who underwent thyroid FNAC were enrolled in the study. The median (interquartile, IQR) age was 47.0 (20.0) years, and 266 (85.8%) of them were females. The median (IQR) body mass index was 30.2 (7.6) kg/m2. Out of these participants, 64.8% were euthyroid, 27.4% had hypothyroidism and 7.7% had hyperthyroidism. The ACR TI-RADS-3, 4 and 5 were 51.3%, 46.1% and 2.6%, respectively. The Bethesda outcome of thyroid FNAC I–VI was 5.2%, 63.9%, 15.5%, 5.8%, 3.5% and 6.1%, respectively. The risk for malignancy (Bethesda III–VI) was documented in 31.0% and atypia of undetermined significance was most prevalent (15.5%). A higher ACR TI-RADS score was associated with a higher risk of malignancy: ACR TI-RADS-3 (20.8%), ACR TI-RADS-4 (39.2%) and ACR TI-RADS-5 (87.5%). In a multivariate analysis, only the ACR TI-RADS score was significantly associated with the outcome of thyroid FNAC: ACR TI-RADS-4 [OR = 2.59 (95% CI = 1.54–4.36)] and ACR TI-RADS-5 [OR = 29.03 (95% CI = 3.44–245.07)]. Conclusion: There was a high prevalence of Bethesda III–VI and atypia of undetermined significance was most prevalent. A thyroid ultrasound report for TI-RADS was significantly associated with the outcome of thyroid FNAC and is a reliable tool in the absence of molecular testing for thyroid cancer.

show abstract

Section: Introductionmentioning

confidence: 99%

The prevalence and associated predictors for Bethesda III–VI for reporting thyroid cytopathology in Royal Commission Hospital, Kingdom of Saudi Arabia

Alyousif

Adam

Alamin

et al. 2022

Therapeutic Advances in Endocrinology

View full text Add to dashboard Cite

show abstract

“…Although 85% to 98% of thyroid nodules are benign, the potential for malignant neoplasms is associated with increased unnecessary workup in the form of imaging, fine-needle aspiration (FNA), and diagnostic surgery . This presents the well-described dilemma of overinvestigation, which is potentially associated with increased patient morbidity without improving mortality rates from thyroid cancer, coupled with an increased systemwide cost burden . To address this dilemma, many organizations have described systems to facilitate communication and decision-making around thyroid nodule workup, based on ultrasonographic findings.…”

Section: Introductionmentioning

confidence: 99%

Association of the Implementation of a Standardized Thyroid Ultrasonography Reporting Program With Documentation of Nodule Characteristics

Hamour

Yang

Lee

et al. 2021

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

IMPORTANCEAlthough most thyroid nodules are benign, the potential for malignant neoplasms is associated with unnecessary workup in the form of imaging, fine-needle aspiration, and diagnostic surgery. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is commonly used to assess the malignant neoplasm risk potential of thyroid nodules imaged by ultrasonography. However, standardized reporting of ACR TI-RADS descriptors is inconsistent.OBJECTIVE To increase the documentation rate of ACR TI-RADS thyroid nodule characteristics to 80% in 18 months. DESIGN, SETTING, AND PARTICIPANTSThis prospective interrupted time series quality improvement study was conducted from December 1, 2018, to March 31, 2020, at a tertiary outpatient head and neck clinic among 229 patients who had at least 1 documented thyroid nodule identified on bedside clinic ultrasonography. Data analysis was performed throughout the entire study period because this was a quality improvement study with iterative small cycle changes; final analysis of the data was performed in April 2020. MAIN OUTCOMES AND MEASURESThe primary outcome was the documentation rates of 6 ACR TI-RADS ultrasonographic descriptors. Secondary outcomes included nodule fine-needle aspiration biopsy rate and physician-reported clinic flow efficiency.RESULTS A total of 229 patients had at least 1 documented thyroid nodule and were included in the analysis. Size was the most frequently documented nodule characteristic (72 of 74 [97.3%]) at baseline, followed by echogenic foci (31 of 74 [41.9%]), composition (23 of 74 [31.1%]), echogenicity (17 of 74 [23.0%]), margin (6 of 74 [8.1%]), and shape (1 of 74 [1.4%]). After 3 Plan, Do, Study, Act (PDSA) cycles, the final intervention consisted of a standardized ultrasonography reporting form and educational initiatives for surgical trainees. After the third PDSA cycle (n = 36), reporting of nodule size, echogenic foci, and composition increased to 100%. Similarly, reporting of echogenicity (34 of 36 [94.4%]), shape (28 of 36 [77.8%]), and margin (25 of 36 [69.4%]) all increased. This represented a cumulative 90.3% documentation rate (195 of 216), a 56.5% increase from baseline (95% CI, 50.0%-61.9%). The standardized reporting form was used in 83.3% of eligible thyroid ultrasonography cases (30 of 36) after PDSA cycle 3, demonstrating good fidelity of implementation. There were no unintended consequences associated with clinic workflow, as a balancing measure, reported by staff surgeons.CONCLUSIONS AND RELEVANCE This study suggests that implementation of an ACR TI-RADS-based reporting form in conjunction with educational initiatives improved documentation of ultrasonographic thyroid nodule characteristics, potentially allowing for improved bedside risk stratification and communication among clinicians.

show abstract

“…American Thyroid Association (ATA) guidelines suggest that FNA is the most cost-effective method for evaluating thyroid nodules and further recommends ultrasound guidance, which has been shown to achieve better diagnostic accuracy than palpation alone (24)(25)(26). For incidental thyroid nodules that are less than 2 centimeters, the costeffectiveness of FNA appears poor compared to observation ($542 vs. $412 in direct costs) (27).…”

Section: Economic Burden Of Thyroid Nodule Carementioning

confidence: 99%

Thyroid nodules: Global, economic, and personal burdens

2023

View full text Add to dashboard Cite

Thyroid nodules have garnered attention due to changes in population surveillance systems and rising concerns about the associated financial burden on healthcare systems, payers, and patients. In this review, we find that prevalence rates vary widely based on method of detection and may particularly pronounced in asymptomatic patients undergoing routine screening. Incidence rates may be particularly rising in lower-income and middle-income countries and may be declining in higher-income countries. Despite high incidence rates, survival rates continue to be as high as 97% for papillary thyroid cancer. Over the last few decades, thyroid nodule workup and management has grown more sophisticated with the advent of fine-needle aspiration biopsy, specialized biomarkers, and molecular testing. However, gaps remain in risk stratification that can lead to substantial costs of care. Certain molecular tests, such as the Afirma Gene Sequencing Classifier can lead to a cost per diagnosis of $17,873 while achieving only mild decreases in diagnostic lobectomies for patients (11.6% to 9.7% in one study). Out-of-pocket costs associated with thyroid nodule management continue to drive significant financial toxicity for patients, especially for individuals with thyroid cancer. Financial toxicity has been defined as a term that describes how direct and indirect medical costs of cancer care strain patients and households via decreased income, assets, and spending on basic necessities. Recent studies suggest that such toxicity can lead to adverse financial outcomes, such as foreclosure and bankruptcy. Additional cost-effectiveness analyses are needed to improve existing thyroid nodule management systems and new clinical tools are needed to avoid unnecessary workup and management.

show abstract

Cost-effectiveness of fine-needle aspiration cytology (FNAC) and watchful observation for incidental thyroid nodules

Cited by 14 publications

References 30 publications

The prevalence and associated predictors for Bethesda III–VI for reporting thyroid cytopathology in Royal Commission Hospital, Kingdom of Saudi Arabia

The prevalence and associated predictors for Bethesda III–VI for reporting thyroid cytopathology in Royal Commission Hospital, Kingdom of Saudi Arabia

Association of the Implementation of a Standardized Thyroid Ultrasonography Reporting Program With Documentation of Nodule Characteristics

Thyroid nodules: Global, economic, and personal burdens

Contact Info

Product

Resources

About