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Sajisevi M, Caulley L, Eskander A, Du Y(J, Auh E, Karabachev A, Callas P, Conradie W, Martin L, Pasternak J, Golbon B, Rolighed L, Abdelhamid Ahmed AH, Badhey A, Cheung AY, Corsten M, Forner D, Liu JC, Mavedatnia D, Meltzer C, Noel JE, Patel V, Sharma A, Tang AL, Tsao G, Venkatramani M, Williams M, Wrenn SM, Zafereo M, Stack BC, Randolph GW, Davies L. Evaluating the Rising Incidence of Thyroid Cancer and Thyroid Nodule Detection Modes: A Multinational, Multi-institutional Analysis. JAMA Otolaryngol Head Neck Surg 2022; 148:811-818. [PMID: 35834240 PMCID: PMC9284406 DOI: 10.1001/jamaoto.2022.1743] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance There is epidemiologic evidence that the increasing incidence of thyroid cancer is associated with subclinical disease detection. Evidence for a true increase in thyroid cancer incidence has also been identified. However, a true increase in disease would likely be heralded by an increased incidence of thyroid-referable symptoms in patients presenting with disease. Objectives To evaluate whether modes of detection (MODs) used to identify thyroid nodules for surgical removal have changed compared with historic data and to determine if MODs vary by geographic location. Design, Setting, and Participants This was a retrospective analysis of pathology and medical records of 1328 patients who underwent thyroid-directed surgery in 16 centers in 4 countries: 4 centers in Canada, 1 in Denmark, 1 in South Africa, and 12 in the US. The participants were the first 100 patients (or the largest number available) at each center who had thyroid surgery in 2019. The MOD of the thyroid finding that required surgery was classified using an updated version of a previously validated tool as endocrine condition, symptomatic thyroid, surveillance, or without thyroid-referable symptoms (asymptomatic). If asymptomatic, the MOD was further classified as clinician screening examination, patient-requested screening, radiologic serendipity, or diagnostic cascade. Main Outcomes and Measures The MOD of thyroid nodules that were surgically removed, by geographic variation; and the proportion and size of thyroid cancers discovered in patients without thyroid-referable symptoms compared with symptomatic detection. Data analyses were performed from April 2021 to February 2022. Results Of the 1328 patients (mean [SD] age, 52 [15] years; 993 [75%] women; race/ethnicity data were not collected) who underwent thyroid surgery that met inclusion criteria, 34% (448) of the surgeries were for patients with thyroid-related symptoms, 41% (542) for thyroid findings discovered without thyroid-referable symptoms, 14% (184) for endocrine conditions, and 12% (154) for nodules with original MOD unknown (under surveillance). Cancer was detected in 613 (46%) patients; of these, 30% (183 patients) were symptomatic and 51% (310 patients) had no thyroid-referable symptoms. The mean (SD) size of the cancers identified in the symptomatic group was 3.2 (2.1) cm (median [range] cm, 2.6 [0.2-10.5]; 95% CI, 2.91-3.52) and in the asymptomatic group, 2.1 (1.4) cm (median [range] cm, 1.7 [0.05-8.8]; 95% CI, 1.92-2.23). The MOD patterns were significantly different among all participating countries. Conclusions and Relevance This retrospective analysis found that most thyroid cancers were discovered in patients who had no thyroid-referable symptoms; on average, these cancers were smaller than symptomatic thyroid cancers. Still, some asymptomatic cancers were large, consistent with historic data. The substantial difference in MOD patterns among the 4 countries suggests extensive variations in practice.
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Affiliation(s)
- Mirabelle Sajisevi
- Department of Surgery, Division of Otolaryngology, University of Vermont Medical Center, Burlington
| | - Lisa Caulley
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Canada,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Yue (Jennifer) Du
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Ontario, Canada
| | - Edel Auh
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Alexander Karabachev
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Peter Callas
- Larner College of Medicine, University of Vermont, Burlington
| | - Wilhelmina Conradie
- Division of Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Cape Town, South Africa,Breast and Endocrine Unit, Tygerberg Hospital, Cape Town, South Africa
| | - Lindi Martin
- Division of Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jesse Pasternak
- Department of Surgery, University of Toronto, Ontario, Canada
| | - Bahar Golbon
- Department of Surgery, University of Toronto, Ontario, Canada
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Amr H. Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Arvind Badhey
- Department of Otolaryngology, University of Massachusetts, Worcester
| | - Anthony Y. Cheung
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Martin Corsten
- Division of Otolaryngology–Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Forner
- Division of Otolaryngology–Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey C. Liu
- Department of Otolaryngology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania,Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | | | - Julia E. Noel
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Vishaal Patel
- Department of Otolaryngology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Arun Sharma
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Alice L. Tang
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gabriel Tsao
- The Permanente Medical Group, Fremont, California
| | | | - Michelle Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sean M. Wrenn
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Brendan C. Stack
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Louise Davies
- Veterans Affairs Outcomes Group, White River Junction, Vermont,Section of Otolaryngology–Head & Neck Surgery, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire,Associate Editor, JAMA Otolaryngology−Head & Neck Surgery
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Jochum SB, Venkatramani M, Ritz EM, Favuzza J, Hayden DM, Saclarides TJ, Bhama AR. Surgical Residents' Perspective on Informed Consent-How Does It Compare With Attending Surgeons? J Surg Res 2020; 260:88-94. [PMID: 33333384 DOI: 10.1016/j.jss.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/27/2020] [Accepted: 10/31/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The informed consent discussion (ICD) is a compulsory element of clinical practice. Surgical residents are often tasked with obtaining informed consent, but formal instruction is not included in standard curricula. This study aims to examine attitudes of surgeons and residents concerning ICD. MATERIALS AND METHODS A survey regarding ICD was administered to residents and attending surgeons at an academic medical center with an Accreditation Council for Graduate Medical Education-accredited general surgery residency. RESULTS In total, 44 of 64 (68.75%) residents and 37 of 50 (72%) attending surgeons participated. Most residents felt comfortable consenting for elective (93%) and emergent (82%) cases, but attending surgeons were less comfortable with resident-led ICD (51% elective, 73% emergent). Resident comfort increased with postgraduate year (PGY) (PGY1 = 39%, PGY5 = 85%). A majority of participants (80% attending surgeons, 73% residents) believed resident ICD skills should be formally evaluated, and most residents in PGY1 (61%) requested formal instruction. High percentages of residents (86%) and attendings (100%) believed that ICD skills were best learned from direct observation of attending surgeons. CONCLUSIONS Resident comfort with ICD increases as residents advance through training. Residents acknowledge the importance of their participation in this process, and in particular, junior residents believe formal instruction is important. Attending surgeons are not universally comfortable with resident-led ICDs, particularly for elective surgeries. Efforts for improving ICD education including direct observation between attending surgeons and residents and formal evaluation may benefit the residency curriculum.
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Affiliation(s)
- Sarah B Jochum
- Rush University Medical Center, Department of Surgery, Chicago, Illinois
| | | | - Ethan M Ritz
- Rush University Medical Center, Bioinformatics and Biostatistics Core, Chicago, Illinois
| | - Joanne Favuzza
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois
| | - Dana M Hayden
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois
| | - Theodore J Saclarides
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois
| | - Anuradha R Bhama
- Rush University Medical Center, Division of Colon and Rectal Surgery, Department of Surgery, Chicago, Illinois.
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