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Bodoque Cubas J, Fernández Sáez J, Martínez Hervás S, Gil Boix JV, Salazar González JJ, Pallarés Gasulla RM, Miret Llauradó M, Argüelles Jiménez I, Tofé Povedano S. Functional structure of a high resolution thyroid nodule unit. Economic impact and results of its implementation in an Endocrinology department. ENDOCRINOL DIAB NUTR 2024:S2530-0180(24)00085-4. [PMID: 39097482 DOI: 10.1016/j.endien.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND AND OBJECTIVE The high incidence of nodular thyroid pathology has led to growing concern about the economic impact that this pathology represents on the healthcare system. There are conclusive data about the cost-effectiveness of high-resolution units for nodular thyroid pathology; however, their implementation is not homogeneous in the Endocrinology and Nutrition services of our country. The objective of the present study was to evaluate the economic impact of the implementation of the high-resolution thyroid nodule unit (HRTNU) in our center. PATIENTS AND METHODS The present work is a prospective, observational and descriptive study carried out in 1314 patients (82% women, mean age 58 years ds = 11) evaluated at the HRTNU during the period of August 2022-August 2023. Demographic data (age and sex) were analyzed, referral center and consultation type, number of total consultations and neck ultrasound performed, number of fine needle aspiration (FNAB) performed, and cytology results were analyzed. RESULTS In the period from August 2022 to August 2023, a total of 1314 patients were evaluated (neck ultrasound and clinical consultation) and a total of 133 FNAB were performed, of which only 2.26% were non-diagnostic. Compared to the percentage of unsatisfactory FNAB from the previous year August 2021-July 2022 of 25%, a mean saving of 9931.43 euros was estimated. 84.47% of the patients evaluated for the first time by the HRTNU were discharged, estimating a mean saving of 133,200 euros. CONCLUSIONS The implementation of a HRTNU at the Endocrinology and Nutrition departments, coordinated with primary and specialized care, is a cost-effectiveness alternative, as it reduces the number of medical consultations and is accompanied by a higher rate of diagnostic FNAB.
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Affiliation(s)
| | - José Fernández Sáez
- Unitat de suport a la recerca Terres de l'Ebre, Fundació Institut Univesitari per a la recerca a l'atenció primària de la Salut Jordi Gol, Tortosa, Tarragona, Spain.
| | - Sergio Martínez Hervás
- Departament de Medicina, Universitat de València, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Sifontes-Dubón M, García-López JM, González-Ortega N, Pazos-Couselo M. Evaluation of a Clinical Pathway for Thyroid Nodular Disease: Timings and Delays in the Diagnosis and Treatment of Thyroid Cancer. J Clin Med 2021; 10:jcm10235681. [PMID: 34884383 PMCID: PMC8658455 DOI: 10.3390/jcm10235681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Due to the high prevalence of nodular thyroid disease in the general population and the need to rule out malignant tumours, a clinical pathway for nodular thyroid disease was created at our tertiary-level hospital. Our study aimed to quantify timings and delays in diagnosis and treatment in this clinical pathway, specifically for patients who were diagnosed with thyroid cancer. Methods: A retrospective review was conducted of patients who were newly diagnosed with thyroid cancer and who had been previously evaluated in the clinical pathway for nodular thyroid disease at our institution during 2015–2017. Patient demographics, previous diagnostic studies, cytological results, tumour details and key dates were analysed to identify wait times in diagnosis and treatment. Results: Forty patients with thyroid cancer were included. The diagnostic delay had a median time of 60 days, and the treatment delay was dependent on cytopathological results. The main cause for delay in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. In the treatment phase, patients with a cytological result of Bethesda III, V or VI underwent surgery at the suggested time, while those in the Bethesda II or IV category did not. Conclusions: The major delay found in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. We are not suggesting that this step must be eliminated, though the implementation of routine ultrasonography in a thyroid clinic can help identify patients who need more urgent evaluation for fine needle aspiration cytology. In our hospital, decision for surgery is based mainly on the cytopathological report. Imaging studies and/or molecular testing could be considered to reduce treatment delays.
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Affiliation(s)
- Mildred Sifontes-Dubón
- Doctoral Programme in Medicine Clinical Research, International PhD School of the University of Santiago de Compostela (EDIUS), 15782 Santiago de Compostela, Spain
- Endocrinology Department, Mateu Orfila General Hospital, 07703 Mahón, Spain
- Correspondence: or ; Tel.: +34-971487325
| | - Jose Manuel García-López
- Endocrinology Department, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | | | - Marcos Pazos-Couselo
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain;
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Gómez-Pérez AM, Fernández-García JC, Iglesias P, Díez JJ, Álvarez-Escolá C, Lecumberri B, Lucas-Martín A, Donnay S, Cabrejas-Gómez C, Menéndez-Torre E, Galofré JC. Diagnosis and treatment of thyroid nodules in Spain. Results of a national survey. ACTA ACUST UNITED AC 2020; 67:438-445. [PMID: 31926931 DOI: 10.1016/j.endinu.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Thyroid nodule (TN) is a common reason for consultation in daily practice. The purpose of this study was to evaluate the diagnosis and treatment of TNs in our environment and to assess the current status regarding the existence and structure of high-resolution TN clinics. MATERIAL AND METHODS Members of the Spanish Society of Endocrinology and Nutrition were invited in 2018 to participate in an online survey on the diagnostic and therapeutic processes of TN. RESULTS A total of 211 valid surveys were received. Of all respondents, 30.8% stated that there were high-resolution TN clinics in their environment, with the endocrinologist being the main person responsible for performing ultrasonography (87.7%) and fine needle aspiration (FNA) (69.2%). For ultrasound classification of TNs, 32.7% used the ATA criteria, 32.2% the TI-RADS criteria, and 22.7% no classification. In situ verification of sample suitability was performed in 35.5% of the cases, and molecular analysis in 8.1%. With regard to clinical discharge, 65.4% would consider it after 5 years of follow-up and with a benign FNA. In the event of a Bethesda III result, 50.2% of respondents would repeat FNA and 35.5% would opt for surgery; if a Bethesda IV result was found, 95.8% would opt for surgery. CONCLUSIONS High-resolution TN clinics are structures increasingly implemented in our environment where the endocrinologist is the main person responsible for performing ultrasonography and FNA. The standard clinical practice in our specialty is consistent with most recommendations concerning clinical practice guidelines for TNs.
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Affiliation(s)
- Ana María Gómez-Pérez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, España; Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, España
| | - José Carlos Fernández-García
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, España; Laboratorio de Investigación, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, España.
| | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid, España
| | - Juan J Díez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid, España
| | | | - Beatriz Lecumberri
- Servicio de Endocrinología y Nutrición, Hospital Universitario La Paz, Madrid, España
| | - Anna Lucas-Martín
- Servicio de Endocrinología y Nutrición, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Sergio Donnay
- Servicio de Endocrinología y Nutrición, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - Edelmiro Menéndez-Torre
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Juan Carlos Galofré
- Servicio de Endocrinología y Nutrición, Clínica Universidad de Navarra. Pamplona, Navarra, España
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Martín-Hernández T, Díez Gómez JJ, Díaz-Soto G, Torres Cuadro A, Navarro González E, Oleaga Alday A, Sambo Salas M, Reverter Calatayud JL, Argüelles Jiménez I, Mancha Doblas I, Fernández García D, Galofré JC. Criterios sobre la utilización y requerimientos técnicos de la ecografía tiroidea en los servicios de endocrinología y nutrición. ENDOCRINOL DIAB NUTR 2017; 64 Suppl 1:23-30. [DOI: 10.1016/j.endinu.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 12/19/2022]
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Impacto económico y satisfacción de la implantación de una consulta de alta resolución de patología nodular tiroidea en Endocrinología. ACTA ACUST UNITED AC 2016; 63:414-20. [DOI: 10.1016/j.endonu.2016.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/11/2016] [Accepted: 04/04/2016] [Indexed: 11/20/2022]
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Singh Ospina N, Brito JP, Maraka S, Espinosa de Ycaza AE, Rodriguez-Gutierrez R, Gionfriddo MR, Castaneda-Guarderas A, Benkhadra K, Al Nofal A, Erwin P, Morris JC, Castro MR, Montori VM. Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for thyroid malignancy: systematic review and meta-analysis. Endocrine 2016; 53:651-61. [PMID: 27071659 DOI: 10.1007/s12020-016-0921-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/09/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE To systematically appraise and summarize the available evidence about the diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy (USFNA) for thyroid malignancy, and to explore the integration of these estimates with the probability of thyroid malignancy before USFNA. METHODS A comprehensive search of multiple databases from each database's inception to August 2014 was performed. Eligible studies included those that evaluated patients with thyroid nodules who underwent USFNA and subsequent evaluation by histopathology or long-term follow-up. RESULTS We identified 32 studies at moderate risk of bias evaluating the USFNA diagnostic characteristics for the diagnosis of thyroid malignancy. Results were imprecise and inconsistent across trials. The pooled likelihood ratio (LR) of thyroid malignancy for a benign USFNA result was 0.09 (95 % CI 0.06, 0.14; I (2) = 33 %), whereas the pooled LR for a malignant result was 197 (95 % CI, 68, 569; I (2) = 77 %). In the case of a suspicious for follicular neoplasm result, the pooled LR for malignancy was 0.6 (95 % CI, 0.4, 1.0; I (2) = 84 %) and 8.3 (95 % CI, 3.6, 19.2; I (2) = 89) for a result of suspicious for malignancy. CONCLUSION The available evidence regarding the diagnostic accuracy of USFNA warrants only limited confidence due to risk of bias, imprecision, and inconsistency. However, some USFNA results (benign, malignant) are likely very helpful, by significantly changing the pre-test probability of thyroid cancer.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ana E Espinosa de Ycaza
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael R Gionfriddo
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
| | - Ana Castaneda-Guarderas
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
| | - Khalid Benkhadra
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN, USA
| | | | - John C Morris
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Regina Castro
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
- Knowledge and Evaluation Research Unit, Division of Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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[Diagnosis of nodular thyroid disease: An update]. Med Clin (Barc) 2016; 146:86-91. [PMID: 26434991 DOI: 10.1016/j.medcli.2015.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/04/2015] [Accepted: 07/07/2015] [Indexed: 11/23/2022]
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Hadjisavva IS, Dina R, Talias MA, Economides PA. Prevalence of Cancer in Patients with Thyroid Nodules in the Island of Cyprus: Predictive Value of Ultrasound Features and Thyroid Autoimmune Status. Eur Thyroid J 2015; 4:123-8. [PMID: 26279998 PMCID: PMC4521064 DOI: 10.1159/000430438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 04/11/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of thyroid carcinoma in patients who underwent ultrasound-guided fine needle aspiration biopsy (USgFNA) of thyroid nodules in the island of Cyprus. Ultrasound features as well as the presence of autoimmune thyroid disease were evaluated as risk factors for malignancy. METHODS 322 consecutively examined patients (272 females/50 males, age 13-81) underwent USgFNA of thyroid nodules in a referral endocrine clinic between July 2007 and July 2009. The ultrasonographic characteristics examined were: echogenicity, margin irregularity, composition, calcifications, presence of increased vasculature and nodule size. The presence or absence of autoimmune thyroid disease was recorded. RESULTS From the 548 nodules examined, 74 (13.6%) were classified as THY3, 4 or 5. 75 patients (123 nodules) underwent surgical resection. 46 patients (64 nodules) proved to have thyroid carcinoma by histology. There was a significant correlation of suspicious/malignant cytology with solid composition, hypoechogenicity, irregular margins and the presence of calcifications. A significant association was also noted between the presence of positive antithyroglobulin antibodies (p < 0.05) and Graves' disease (p = 0.01) with suspicious/malignant cytology. CONCLUSION The overall prevalence of thyroid cancer was 14.3%. Ultrasound characteristics were highly predictive of thyroid malignancy. Thyroid autoimmunity should be considered as a risk factor.
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Affiliation(s)
- Irini S. Hadjisavva
- Economides Nicosia Endocrinology Center, Open University of Cyprus, Nicosia, Cyprus, London, UK
| | - Roberto Dina
- Department of Cellular Pathology, Hammersmith Hospital, Imperial College Healthcare Trust, London, UK
| | - Michael A. Talias
- Healthcare Management Postgraduate Program, Open University of Cyprus, Nicosia, Cyprus, London, UK
| | - Panayiotis A. Economides
- Economides Nicosia Endocrinology Center, Open University of Cyprus, Nicosia, Cyprus, London, UK
- *Dr. Panayiotis A. Economides, MD, PhD, FACE, Economides Nicosia Endocrinology Center, 9 Iona Nicolaou, Engomi 2406, Nicosia (Cyprus), E-Mail
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Manso García S, Velasco Marcos MJ. [Review of the current value of ultrasonography in the characterization of thyroid nodules]. RADIOLOGIA 2014; 57:248-58. [PMID: 25066724 DOI: 10.1016/j.rx.2014.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 03/20/2014] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
The widespread use of medical imaging to study diseases of the neck reveals the prevalence of thyroid nodules can be as high as 67%. This is an important problem for the healthcare system because after analyzing the characteristics of the nodules a decision must be made regarding whether to perform fine-needle aspiration cytology to determine whether the lesion is malignant. In this article, we review the techniques for ultrasonographic study and fine-needle aspiration. We discuss the different guidelines for characterizing thyroid nodules and the criteria that help determine which patients need fine-needle aspiration for diagnosis and when an invasive procedure is unnecessary and can be avoided. Close collaboration with the different specialists involved in the management of thyroid nodules helps optimize resources and diagnostic performance.
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Affiliation(s)
- S Manso García
- Servicio de Radiodiagnóstico, Sección de Ecografía, Hospital Universitario Río Hortega, Valladolid, España.
| | - M J Velasco Marcos
- Servicio de Radiodiagnóstico, Sección de Ecografía, Hospital Universitario Río Hortega, Valladolid, España
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Estructura diagnóstica y funcional de una consulta de alta resolución de nódulo tiroideo. ACTA ACUST UNITED AC 2014; 61:329-34. [DOI: 10.1016/j.endonu.2013.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/28/2013] [Accepted: 09/24/2013] [Indexed: 11/21/2022]
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Argüelles I, Tofé S. Relevancia de la ecografia en un servicio de endocrinologia. ACTA ACUST UNITED AC 2013; 60:51-2. [DOI: 10.1016/j.endonu.2013.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 11/15/2022]
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Castells I, Pardo N, Videla S, Giménez G, Llargues E, Simó O, Recasens MA, Guirao X, Mira X, Serrano À, Sanmartí A. Impacto asistencial tras la introducción de la ecografía tiroidea en una unidad monográfica de atención al nódulo tiroideo. ACTA ACUST UNITED AC 2013; 60:53-9. [DOI: 10.1016/j.endonu.2012.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 05/08/2012] [Accepted: 05/09/2012] [Indexed: 11/26/2022]
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