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Joshi P, Chang J, Scola WH, Shah H, Remer LF, Lew JL. Incidental Thyroid Malignancy in Surgical Patients With Benign Thyroid Disease. J Surg Res 2024; 302:778-783. [PMID: 39216460 DOI: 10.1016/j.jss.2024.07.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/14/2024] [Accepted: 07/27/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION The rate of incidental thyroid malignancy (ITM) has increased in recent decades. However, the factors associated with ITM remain uncertain. This study analyzes the rate of ITM in patients after surgical resection for benign thyroid disease (BTD) without preoperative suspicion of thyroid malignancy and its associated sociodemographic factors. MATERIALS AND METHODS A retrospective study of prospectively collected data reviewed data from 2528 patients who underwent initial thyroidectomy for BTD at a tertiary academic medical hospital between 2011 and 2022. Patients were excluded if they had a known history of thyroid cancer, radiation exposure, suspicious thyroid ultrasound features, and/or fine needle aspiration results. ITM rate was analyzed along with patient demographics, body mass index (BMI), tumor size, and invasive features. RESULTS Among 345 patients with BTD (mean 53.6 y, SD = 14.5), 22.9% (79/345) had ITM on final histopathology. Most patients were women (87.0%), White (87.0%), and Hispanic (56.8%), with an average BMI of 29.6 (SD = 6.56). BTD type was associated with ITM (P < 0.001), with nontoxic multinodular goiter exhibiting the highest incidence (36.0%). Higher BMI emerged as a predictor of higher rate of ITM (OR = 1.057, P = 0.007). Other sociodemographic variables did not show significant associations. CONCLUSIONS The study identified a higher rate of ITM than previously reported as well as an association between higher BMI and increased rate of ITM. This highlights a potential link between obesity and ITM not previously identified. Patients with higher BMI and BTD may benefit from further surveillance.
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Affiliation(s)
- Priyashma Joshi
- Weill Cornell Medicine Department of Surgery, New York, New York; University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
| | - Jonathan Chang
- University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - William H Scola
- Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Hana Shah
- Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Lindsay F Remer
- Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - John L Lew
- Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Chooi JE, Ravindiran A, Balasubramanian SP. The influence of incidental detection of thyroid nodule on thyroid cancer risk and prognosis-A systematic review. Clin Endocrinol (Oxf) 2022; 96:246-254. [PMID: 34378225 DOI: 10.1111/cen.14575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Clinically inapparent thyroid nodules discovered serendipitously on imaging for nonthyroid indications are termed as thyroid incidentalomas. It is unclear whether these incidentalomas have a lower prevalence of malignancy or slower tumour progression compared to symptomatic nodules. The aims of this systematic review were to determine the impact of incidental detection of thyroid nodules on both the risk of malignancy and on prognosis in patients with thyroid cancer. METHOD PubMed and MEDLINE® on Web of Science databases were searched from inception to March 2020 for English language articles reporting on human studies of thyroid cancer risk and/or prognosis in incidental and nonincidental nodules. RESULTS Eighteen observational studies published between 1998 and 2020 were eligible for analysis; four studies reported on risk, nine on prognosis and five studies reported on both risk and prognosis. When comparing the incidental and nonincidental groups in the risk study, the odds of incidental detection in the cancer and benign groups ranged from 0.16 to 0.5 and 0.06 to 0.38, respectively (odds ratio [OR] = 0.64-2.86) in case-control studies (n = 6); the risk of malignancy for thyroid nodules ranged from 4% to 23.5% in the incidental and 3.8% to 28.7% in the nonincidental groups (relative risk = 0.13-6.27) in the cohort studies (n = 3). A meta-analysis of the eligible case-control studies (n = 3) showed a nonsignificant summated OR of 1.04 (95% confidence interval = 0.63-1.70; p = .88). In the prognosis study, five direct and thirteen indirect markers of prognosis were compared between the incidental and nonincidental groups. A meta-analysis was not possible but incidentally detected thyroid cancer had better progression-free and overall survival. CONCLUSION Current evidence suggests that investigation and management of thyroid nodules should not be influenced by the mode of detection.
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Affiliation(s)
- Je Ern Chooi
- The Medical School, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Abiramie Ravindiran
- The Medical School, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Saba P Balasubramanian
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, South Yorkshire, UK
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Lincango-Naranjo E, Solis-Pazmino P, El Kawkgi O, Salazar-Vega J, Garcia C, Ledesma T, Rojas T, Alvarado-Mafla B, Young G, Dy B, Ponce OJ, Brito JP. Triggers of thyroid cancer diagnosis: a systematic review and meta-analysis. Endocrine 2021; 72:644-659. [PMID: 33512656 DOI: 10.1007/s12020-020-02588-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/09/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Understanding the method of thyroid cancer detection has potential implications on interpreting incidence rates, the diagnosis and management of thyroid cancer. We conducted a systematic review of studies reporting methods of thyroid cancer detection to estimate the frequency of incidentally found cancers and classify triggers of incidental thyroid cancer diagnosis. METHODS We searched multiple bibliographic databases from inception to June 2020. A pair of reviewers, working independently and in duplicate selected studies for inclusion, extracted data, and evaluated each trial's risk of bias. Studies enrolling patients older than 18 years with thyroid cancer confirmed histologically were included. RESULTS In total, 17 cohorts and 1 cross-sectional study, conducted between 1991 and 2018, enrolling 4668 patients with thyroid cancer were included: 88% had papillary thyroid cancer and 23% had papillary thyroid microcarcinoma. The proportion of patients with non-incidental and incidental thyroid cancer was similar: 49% [95% confidence interval (CI): 40-58%]. Subgroup analysis showed that most patients with incidental thyroid cancers had tumor size <10 mm (76%; 95% CI: 56-92%), age >45 (61%; 95% CI: 56-67%), and were detected through imaging (35%; 95% CI: 26-45%), of which ultrasound was the most common modality (27%; 95% CI: 14-43%). The heterogeneity for all the effect sizes was large and significant. CONCLUSIONS About half of thyroid cancers were found incidentally through the use of imaging studies, in particular neck ultrasound. These incidentally found cancers were mostly small papillary thyroid cancer. These results highlight opportunities for interventions aimed at reducing drivers of overdiagnosis.
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Affiliation(s)
- Eddy Lincango-Naranjo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
- Universidad Central, Medical School, Quito-Ecuador, Quito, Ecuador
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
| | - Paola Solis-Pazmino
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
- Universidad Central, Medical School, Quito-Ecuador, Quito, Ecuador
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Omar El Kawkgi
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, 55905, USA
| | - Jorge Salazar-Vega
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Endocrinology Department, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Cristhian Garcia
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Surgery Department, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Tannya Ledesma
- Universidad Central, Medical School, Quito-Ecuador, Quito, Ecuador
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
| | - Tatiana Rojas
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Universidad San Francisco de Quito, Quito, Ecuador
| | | | | | - Benzon Dy
- Division of Endocrine Surgery, Mayo Clinic, Rochester, MN, USA
| | - Oscar J Ponce
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA.
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador.
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, 55905, USA.
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