Quantitative Analysis of the Benefits and Risk of Thyroid Nodule Evaluation in Patients ≥70 Years Old

Wang, Zhihong; Vyas, Chirag M.; Benschoten, Olivia Van; Nehs, Matt A.; Moore, Francis D.; Marqusee, Ellen; Krane, Jeffrey F.; Kim, Matthew I.; Heller, Howard T.; Gawande, Atul A.; Frates, Mary C.; Doubilet, Peter M.; Doherty, Gerard M.; Cho, Nancy L.; Cibas, Edmund S.; Benson, Carol B.; Barletta, Justine A.; Zavacki, Ann Marie; Larsen, P. Reed; Alexander, Erik K.; Angell, Trevor E.

doi:10.1089/thy.2017.0655

Cited by 45 publications

(30 citation statements)

References 22 publications

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“…However, the use of clinically relevant thyroid cancer as a new outcome can help clinicians to differentiate between benign and low risk thyroid cancer and to identify those lesions that would result in important adverse outcomes to patients. No consensus exists on how to define this concept, but definitions based on high risk histopathological variants have been proposed 75. Other factors that could help to identify clinically relevant thyroid cancer include size of thyroid nodules, presence of cervical lymphadenopathy, and results of cytology and molecular markers.…”

Section: Limitations Of Diagnostic Literature For Thyroid Nodulesmentioning

confidence: 99%

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Ospina

Iñiguez-Ariza

Castro

2020

BMJ

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Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient’s values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.

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Section: Limitations Of Diagnostic Literature For Thyroid Nodulesmentioning

confidence: 99%

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Ospina

Iñiguez-Ariza

Castro

2020

BMJ

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“…12,16 This is challenging, as evidence suggests that although thyroid cancer is less common in older J o u r n a l P r e -p r o o f patients with thyroid nodules than younger patients, the prevalence of clinically significant thyroid cancer based on histological features is higher. 10,11 In a cohort of Thyroid ultrasound is the most important imaging modality in the assessment of thyroid nodules and sonographic findings are crucial for stratifying thyroid nodules according to their estimated malignancy risk and to support personalized care. 12,34 Although computed tomography (CT) has a role in evaluating patients with goiter and possible substernal extension, delineating the presence of tracheal compression in patients with positional dyspnea, and assessing select patients with thyroid cancer, it is not currently recommended for the routine assessment of thyroid nodules.…”

Section: Thyroid Nodule Evaluationmentioning

confidence: 99%

“…12,48,49 A study of 1,129 patients aged ≥70 years with thyroid nodules ≥1 cm (median size, 1.7 cm) evaluated ultrasound use and thyroid biopsy findings to guide management in older adults. 11…”

Section: Thyroid Nodule Fna Biopsy and Cytological Evaluationmentioning

confidence: 99%

“…However, if thyroid cancer is diagnosed, there is a higher likelihood of it being high-risk thyroid cancer based on histological findings. [10][11][12] Moreover, older individuals have higher risks of treatment complications and worse clinical outcomes after thyroid cancer treatment. [12][13][14][15] Thus, the evaluation and management of thyroid nodules as the population ages emerges as a challenging but common clinical scenario.…”

Section: Introductionmentioning

confidence: 99%

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Thyroid Nodule Evaluation and Management in Older Adults: A Review of Practical Considerations for Clinical Endocrinologists

Ospina

Papaleontiou

2021

Endocrine Practice

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…The chances of diagnosing asymptomatic thyroid nodules are increased by the frequent use of high-frequency ultrasound and cross-sectional imaging in routine clinical care [ 17 ]. However, while confirmed cancers in elderly patients are more likely to be aggressive [ 16 ], the risks associated with overtreatment of benign or low-risk malignant diseases should be carefully avoided in frail patients since the benefits are uncertain [ 18 ]. It is now clear that less aggressive treatment approaches are safe for low-risk thyroid malignancies [ 19 , 20 ], even if these are still relatively uncommon in real-world practice [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Sonographic Risk Stratification Systems for Thyroid Nodules as Rule-Out Tests in Older Adults

Grani

Brenta

Trimboli

et al. 2020

Cancers

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Ultrasonographic risk-stratification systems (RSS), including various Thyroid Imaging Reporting and Data Systems (TIRADS), were proposed to improve reporting and reduce the number of fine-needle aspiration biopsies. However, age might be a confounder since some suspicious ultrasonographic features lack specificity in elderly patients. We aimed to investigate whether the diagnostic performance of the RSS varied between age groups. All patients consecutively referred for thyroid biopsy between November 1, 2015, and March 10, 2020, were included. The malignancy risk of each nodule was estimated according to five RSS: the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines, the American College of Radiology (ACR) TIRADS, the American Thyroid Association guidelines, the European TIRADS, and the Korean TIRADS. Overall, 818 nodules (57 malignant) were evaluated. The malignancy rate was higher in patients ≤ 65 years (8.1%) than in patients > 65 years (3.8%; p = 0.02). All RSS confirmed a significant discriminative performance in both age groups, with a negative predictive value of 100% in patients > 65 years, although specificity was lower in older patients. The ACR TIRADS was the best performing in both age groups. RSS could avoid a sizable number of biopsies when applied as rule-out tests in elderly patients.

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Quantitative Analysis of the Benefits and Risk of Thyroid Nodule Evaluation in Patients ≥70 Years Old

Abstract: For patients ≥70 years old, US and FNA are safe and prove helpful in identifying SRTC and benign cytology. However, the surgical management of patients ≥70 years old presenting without high-risk findings should be tempered, especially when comorbid illness is identified.

Cited by 45 publications

References 22 publications

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Thyroid Nodule Evaluation and Management in Older Adults: A Review of Practical Considerations for Clinical Endocrinologists

Sonographic Risk Stratification Systems for Thyroid Nodules as Rule-Out Tests in Older Adults

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