Overdiagnosis of Thyroid Cancer: Is This Not an Ethical Issue for Pathologists As Well As Radiologists and Clinicians?

Schnadig, Vicki J.

doi:10.5858/arpa.2017-0510-ed

Cited by 28 publications

(28 citation statements)

References 36 publications

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“…However, genetic tests have not been used in thyroid practice or included in the health insurance system in some areas of China and other countries. Meanwhile, when we emphasize molecular testing in the diagnosis of thyroid carcinoma, being mindful of expenses to the patient and health care costs to society were considered because it is equally important to avoid overuse of molecular tests . Another study concluded that clinical features, such as gender, nodule size, and age, should be considered in patients with undetermined thyroid nodule .…”

Section: Resultsmentioning

confidence: 99%

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Pan

et al. 2019

Diagnostic Cytopathology

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Background This study was designed to explore whether ultrasound of thyroid nodules facilitates the interpretation of the malignant risk of Bethesda III/IV thyroid nodules to inform further therapies. Methods We reviewed patient records in which the results of ultrasound‐guided fine‐needle aspiration (US‐FNA) were classified by the Bethesda III/IV in our institution between January 2016 and June 2018. Studies were retrieved from PubMed, Cochrane Central Register of Controlled Trials, ISI Web of Science, Science Direct, Wiley Online Library, EMBASE, China National Knowledge Infrastructure, WanFang, and Chinese VIP. The odds ratio (OR) was used to measure associations between risk factors and thyroid nodule malignancy. Results Fifty‐nine cases of Bethesda III/IV with corresponding surgeries were included, and the malignancy risk was 54.2%. Meta‐analysis revealed irregular borders, solitary nodules, hypoechogenicity, microcalcifications, and being taller than wide, all of which increased the malignancy risk of thyroid nodules. Combined ORs for these factors were 4.08 (95% CI: 2.34‐7.14, P < .001), 2.18 (95% CI: 1.39‐3.42, P = .001), 2.02 (95% CI: 1.35‐3.01, P = .001), 3.21 (95% CI: 2.26‐4.56, P < .001), and 4.35 (95% CI: 3.07‐6.15, P < .001), respectively. Conclusion As the risk of malignancy for papillary thyroid carcinoma (PTC) is high, when any one of the five ultrasound features of malignancy were confirmed, repeated FNA is recommended to confirm PTC‐type malignancy, even though nodules were Bethesda III/IV classification. However, repeated FNA should be avoided when none of these ultrasound features are identified because repeated FNA does not contribute to identifying non‐PTC type malignancies, such as follicular thyroid carcinoma and poorly differentiated thyroid carcinoma.

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Section: Resultsmentioning

confidence: 99%

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Pan

et al. 2019

Diagnostic Cytopathology

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“…As occurred in Korea and the United States, overdiagnosis always accompanies some problems with medical ethics [48][49][50][51]. As described above, thyroid screening is likely to do more harm than good for children.…”

Section: Ethical Concerns About the Thyroid Screening Programmentioning

confidence: 99%

Overdiagnosis of Juvenile Thyroid Cancer

Takano

2019

Eur Thyroid J

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Overdiagnosis is the detection of a disease that does not do any harm to the patient throughout the lifetime. Thyroid cancer in children is a rare disease; however, since 2011, many children in Fukushima, Japan, have been diagnosed with it, and the number has shown a steady increase to over 200 cases at present. Some experts have stated that this phenomenon is due to overdiagnosis caused by thyroid ultrasound (US)-based thyroid screening detecting self-limiting thyroid cancer, which will not lead to clinical symptoms in the future. Harm caused by overdiagnosis of thyroid cancer is more serious in the young, since it is difficult to perform active surveillance and children diagnosed with cancer are likely to suffer from stigma. Thus, overdiagnosis of thyroid cancer in the young is not only a health problem but also a problem of human rights. Conflicts of interest among people related to screening programs and some experts with incomplete knowledge on overdiagnosis help to spread misleading opinions together with fear of radiation exposure among residents, which has led to their erroneous understanding of the nature of US-based thyroid screening. Scien-tific and honest discussions among experts to enhance education of residents and consideration of medical ethics are crucial to prevent the expansion of overdiagnosis.

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“…Recent reports have suggested that the risk of malignancy (ROM) for thyroid fine‐needle aspirations may be misleading and should not be reported . We strongly disagree with this position .…”

Section: Cytologic Diagnoses At Baptist Hospital January 1998 To Augmentioning

confidence: 71%

“…Recent reports have suggested that the risk of malignancy (ROM) for thyroid fine-needle aspirations may be misleading and should not be reported. 1 We strongly disagree with this position. 2 Our position has always been to provide clinicians and patients with as much relevant information as possible to help them make the best decision regarding further therapy.…”

mentioning

confidence: 91%

Risk of death due to disease for thyroid fine‐needle aspirations of well‐differentiated thyroid carcinomas

Renshaw

Gould

2019

Diagnostic Cytopathology

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The risk of malignancy for some diagnoses in thyroid fine‐needle aspirations is higher than the actual risk of clinical progression. Other measures of prognosis may be helpful in managing patients with indeterminate thyroid fine‐needle aspiration diagnoses. We estimated the risk of death due to disease (RDDD) for well‐differentiated thyroid carcinoma using a series of over 15 000 aspirates with over 2000 excisions and data from the SEER database. RDDD was low (1.3% or less for all categories). The RDDD of some indeterminate thyroid aspirates was higher than for malignant aspirates. The RDDD may provide additional information for patients and clinicians seeking to manage patients with indeterminate thyroid fine‐needle aspirates.

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Overdiagnosis of Thyroid Cancer: Is This Not an Ethical Issue for Pathologists As Well As Radiologists and Clinicians?

Cited by 28 publications

References 36 publications

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule

Overdiagnosis of Juvenile Thyroid Cancer

Risk of death due to disease for thyroid fine‐needle aspirations of well‐differentiated thyroid carcinomas

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