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. 2019 Dec 1;104(12):6060-6068.
doi: 10.1210/jc.2019-01219.

Factors Associated With Diagnosis and Treatment of Thyroid Microcarcinomas

Nazanene H Esfandiari  1 , David T Hughes  2 , David Reyes-Gastelum  1 , Kevin C Ward  3 , Ann S Hamilton  4 , Megan R Haymart  1
Affiliations

Factors Associated With Diagnosis and Treatment of Thyroid Microcarcinomas

Nazanene H Esfandiari et al. J Clin Endocrinol Metab. .

Abstract

Context: Nearly one-third of all thyroid cancers are ≤1 cm.

Objective: To determine diagnostic pathways for microcarcinomas vs larger cancers.

Design/setting/participants: Patients from Georgia and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries with differentiated thyroid cancer diagnosed in 2014 or 2015 were surveyed. Survey data were linked to SEER data on tumor and treatment characteristics. Multivariable logistic regression analysis was performed.

Main outcome measures: Method of nodule discovery; reason for thyroid surgery.

Results: Of patients who underwent surgery, 975 (38.2%) had cancers ≤1 cm, and 1588 cancers (61.8%) were >1 cm. The reported method of nodule discovery differed significantly between patients with cancers ≤1 cm and those with cancers >1 cm (P < 0.001). Cancer ≤1 cm was associated with nodule discovery on thyroid ultrasound (compared with other imaging, OR, 1.59; 95% CI, 1.21 to 2.10), older patient age (45 to 54 years vs ≤44, OR, 1.45; 95% CI, 1.16 to 1.82), and female sex (OR, 1.51; 95% CI, 1.22 to 1.87). Hispanic ethnicity (OR, 0.71; 95% CI, 0.57 to 0.89) and Asian race (OR, 0.67; 95% CI, 0.49 to 0.92) were negative correlates. Cancers ≤1 cm were associated with lower likelihood of surgery for a nodule suspicious or consistent with cancer (OR, 0.48; 95% CI, 0.40 to 0.57).

Conclusion: Thyroid microcarcinomas are more likely to be detected by ultrasound and less likely to be associated with surgery scheduled for known thyroid cancer. Understanding diagnostic pathways allows for targeted interventions to decrease overdiagnosis and overtreatment.

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Figures

Figure 1.
Figure 1.
Flow diagram illustrating cohort selection. AJCC, American Joint Committee on Cancer; LA, Los Angeles
Figure 2.
Figure 2.
Patient-reported method of initial nodule discovery. χ2P < 0.001. Of the patients who reported having their nodule found with “other imaging,” 159 of 188 patients (86.6%) with cancers ≤1 cm and 254 of 303 patients (85.2%) with cancers >1 cm reported that this imaging test was ordered for another, unrelated medical problem.
Figure 3.
Figure 3.
Multivariable analysis comparing factors associated with diagnosing microcarcinomas as compared with larger cancers. ref, reference; US, ultrasound.
Figure 4.
Figure 4.
Multivariable analysis evaluating the characteristics associated with patient report of thyroid ultrasound leading to their nodule discovery. PCP, primary care physician; ref, reference; US, ultrasound.
Figure 5.
Figure 5.
Patient-reported reason for thyroid surgery. The categories are not exclusive. χ2P values are < 0.001, = 0.016, = 0.002, < 0.001, as respectively shown in the figure. These tests were significant after adjusting for multiple testing.
See this image and copyright information in PMC

Comment in

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