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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: 1] [Impact Index Per Article: 0.3] [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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Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinics. J Clin Med 2019; 8:jcm8122172. [PMID: 31818026 PMCID: PMC6947274 DOI: 10.3390/jcm8122172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Thyroid nodules are a common finding. A high-resolution thyroid nodule clinic (HR-TNC) condenses all tests required for the evaluation of thyroid nodules into a single appointment. We aimed to evaluate the clinical outcomes at HR-TNCs. DESIGN AND METHODS A retrospective cross-sectional multicenter study including data from four HR-TNCs in Spain. We evaluated fine-needle aspiration (FNA) indications and the association between clinical and ultrasound characteristics with cytological and histopathological outcomes. RESULTS A total of 2809 thyroid nodules were included; FNA was performed in 82.1%. Thyroid nodules that underwent FNA were more likely larger, isoechoic, with microcalcifications, and in younger subjects. The rate of nondiagnostic FNA was 4.3%. A solid component, irregular margins or microcalcifications, significantly increased the odds of Bethesda IV-V-VI (vs. Bethesda II). Irregular margins and a solid component were independently associated with increased odds of malignancy. Thyroid nodules <20 mm and ≥20-<40 mm had a 6.5-fold and 3.3-fold increased risk for malignancy respectively in comparison with those ≥40 mm. CONCLUSION In this large multicenter study, we found that the presence of a solid component and irregular margins are factors independently related to malignancy in thyroid nodules. Since nodule size ≥40 mm was associated with the lowest odds of malignancy, this cut-off should not be a factor leading to indicate thyroid surgery. HR-TNCs were associated with a low rate of nondiagnostic FNA.
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García Pascual L, Surralles ML, Morlius X, González Mínguez C, Viscasillas G, Lao X. Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination: Diagnostic efficacy, prevalence, and factors predicting for Bethesda category I results. ACTA ACUST UNITED AC 2019; 66:495-501. [PMID: 30858021 DOI: 10.1016/j.endinu.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/14/2018] [Accepted: 12/21/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination may decrease the number of Bethesda categoryI cytologies. The study objective was to evaluate our second-year experience with this procedure to analyze diagnostic efficacy, prevalence, and factors predicting for Bethesda categoryI results. PATIENTS AND METHOD A retrospective study was conducted of 279 nodules from 233 patients. Ultrasound -guided fine needle aspiration was performed according to the 2015 criteria of the American Thyroid Association. A specimen of each aspiration was air-fixed on site before Diff-Quik staining and microscopic examination to assess its suitability; otherwise, nodule aspiration was repeated up to 5times. Diagnostic efficacy was assessed based on sensitivity and specificity on the cytological categories BethesdaII and BethesdaVI. RESULTS Diagnostic sensitivity and specificity were both 100%, 5.4% Bethesda categoryI results were obtained, and variables independently associated were age (4.7% increase per year of life) and nodule volume (2.3% increase per each 1mL of volume). CONCLUSIONS Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination allows for a high diagnostic efficacy and has been shown to be a highly relevant procedure because it has a very low rate of cytological results of Bethesda categoryI, whose risk has been higher in older subjects and with larger nodules.
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Affiliation(s)
- Luis García Pascual
- Servicio de Endocrinología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.
| | - Maria Lluïsa Surralles
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Xavier Morlius
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Clarisa González Mínguez
- Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Guillem Viscasillas
- Servicio de Otorrinolaringología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Xavier Lao
- Servicio de Otorrinolaringología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, 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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Zambrana-García JL, Torres-Jiménez M, Rubio-Sánchez JM, Montijano-Cabrera A, Peña-Ojeda JA, Velasco-Malagón MJ. [Clinical processes in a high resolution clinic of specialist outpatient clinics]. ACTA ACUST UNITED AC 2016; 32:82-88. [PMID: 27793461 DOI: 10.1016/j.cali.2016.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 06/23/2016] [Accepted: 09/01/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The high resolution clinic (HRC) is an outpatient care process by which treatment and diagnosis are established, recorded, and completed in a single day. The aim of this study was to assess the extent to which patients with medical conditions may benefit from a single consultation system. MATERIAL AND METHODS A descriptive study of 795 first visit events, randomly selected as high-resolution consultations in cardiology, gastroenterology, internal medicine, and chest diseases. A discussion is presented on the percentage of patients who benefited from HRC and the complementary tests performed. RESULTS A total of 559 (70%, 95% CI: 67-73%) of all first visits became HRCs, and 483 (61%, 95% CI: 57%-64%) required a diagnostic test that was reviewed on the same day. There were differences between medical consultations (86% in cardiology versus 44% in gastroenterology consultations, P<.001). Performing a test on the same day significantly increased the percentage of HRCs (49 versus 22%, P<.001). Ischaemic heart disease, dyspepsia, headache, and asthma were the conditions most commonly leading to HRC. The most common tests were cranial tomography, blood analysis, and ultrasound. CONCLUSIONS Medical consultations may largely benefit from an HRC system, only requiring some organisational changes and no additional costs.
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Affiliation(s)
- J L Zambrana-García
- Línea de Procesos Médicos, Hospital de Montilla, Montilla (Córdoba), España.
| | - M Torres-Jiménez
- Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, España
| | - J M Rubio-Sánchez
- Línea de Procesos Médicos, Hospital de Montilla, Montilla (Córdoba), España
| | | | - J A Peña-Ojeda
- Línea de Procesos Médicos, Hospital de Montilla, Montilla (Córdoba), España
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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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Carral F, Ayala MDC, Jiménez AI, García C. Impacto asistencial y económico de la ecografía tiroidea en acto único en consultas de endocrinología (estudio ETIEN 1). ACTA ACUST UNITED AC 2016; 63:64-9. [DOI: 10.1016/j.endonu.2015.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/27/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
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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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López Vázquez Y, Penín Álvarez M, San Miguel Fraile P, Barragáns Pérez M. Risk of malignancy in thyroid nodules with atipia of undetermined significance. ACTA ACUST UNITED AC 2015; 62:507-10. [PMID: 26526719 DOI: 10.1016/j.endonu.2015.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Prevalence of malignancy among cytologies with atypia of undetermined significance (Bethesda category III) is variable, ranging from 5%-37% in the different studies. There is thus no agreement on whether FNA should be repeated or surgery should be performed in these cases. The aim of this paper was to analyze the risk of malignancy in order to establish the most adequate clinical approach. MATERIAL AND METHODS We analyzed 431 thyroid cytologies performed at our hospital since the introduction of Bethesda System (from January 2011 to September 2014), of which 32 (7.1%) were labeled as category III. The second FNA, when performed, and the histological results after surgery were reviewed. RESULTS Twenty-three patients (82.1%) underwent thyroidectomy, while repeat FNA was performed in the remaining 5 patients (17.9%). Cytology was reported as benign (category II) in 3 (60%) and as unsatisfactory (category I) in 2 (40%), who underwent thyroidectomy. Thirteen of the 25 (52%) surgical thyroid specimens showed no malignancy, while differentiated thyroid carcinomas were found in 12 (48%): papillary cancer in 10 (83.3%), follicular cancer in 1 (8.3%), and papillary cancer with follicular areas in 1 (8.3%). The risk of malignancy of Bethesda category III in our patients was 42.9%-48.0%. CONCLUSION We recommend thyroidectomy for all patients with of cytological Bethesda category III.
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Affiliation(s)
- Yolanda López Vázquez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Vigo (EOXI Vigo), Hospital Meixoeiro, Vigo, Pontevedra, España.
| | - Manuel Penín Álvarez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Vigo (EOXI Vigo), Hospital Meixoeiro, Vigo, Pontevedra, España
| | - Pilar San Miguel Fraile
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Vigo (EOXI Vigo), Hospital Meixoeiro, Vigo, Pontevedra, España
| | - María Barragáns Pérez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Vigo (EOXI Vigo), Hospital Meixoeiro, Vigo, Pontevedra, España
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Reply to: diagnostic and functional structure of a high-resolution thyroid nodule clinic: an efficiency model. ACTA ACUST UNITED AC 2014; 61:553-4. [PMID: 25444979 DOI: 10.1016/j.endonu.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 11/23/2022]
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Díaz-Soto G, Torres B, López JJ, de Luis D. Estructura diagnóstica y funcional de una consulta de alta resolución de nódulo tiroideo: un modelo de eficiencia económica. ACTA ACUST UNITED AC 2014; 61:552-3. [DOI: 10.1016/j.endonu.2014.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/24/2014] [Indexed: 11/24/2022]
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