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J Clin Endocrinol Metab. 2019 Aug 15. pii: jc.2019-01219. doi: 10.1210/jc.2019-01219. [Epub ahead of print]

Factors Associated with Diagnosis and Treatment of Thyroid Microcarcinomas.

Author information

1
University of Michigan, Division of Metabolism, Endocrinology, and Diabetes.
2
University of Michigan, Department of Surgery, Division of Endocrine Surgery.
3
Emory University, Rollins School of Public Health, Department of Epidemiology.
4
Keck School of Medicine, University of Southern California, Department of Preventive Medicine.

Abstract

CONTEXT:

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

OBJECTIVE:

Determine diagnostic pathways for microcarcinomas versus larger cancers.

DESIGN/SETTING/PATIENT PARTICIPANTS:

Patients from Georgia and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries with differentiated thyroid cancer diagnosed in 2014-2015 were surveyed (response rate 63%). 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 (61.8%) were > 1 cm. The reported method of nodule discovery differed significantly between patients with cancer ≤ 1 cm versus > 1 cm (p<0.001). Diagnosis of cancer ≤ 1 cm was associated with nodule discovery with thyroid ultrasound (compared to other imaging, OR 1.59, 95% CI 1.21-2.10), older patient age (e.g., 45-54 versus ≤ 44 OR 1.45, 95% CI 1.16-1.82), and female sex (OR 1.51, 95% CI 1.22-1.87). Hispanic ethnicity and Asian race were negative correlates (OR 0.71, 95% CI 0.57-0.89, OR 0.67, 95% CI 0.49-0.92, respectively). Cancers ≤ 1 cm were associated with lower likelihood of surgery being scheduled for a nodule suspicious or consistent with cancer (OR 0.48, 95% CI 0.40-0.57).

CONCLUSIONS:

Thyroid microcarcinomas are more likely to be detected by ultrasound and less likely to be associated with surgery scheduled for known thyroid cancer. Since females and older adults are especially at risk, understanding diagnostic pathways allows for targeted interventions to decrease overdiagnosis and overtreatment.

PMID:
31415089
DOI:
10.1210/jc.2019-01219

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