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Thyroid
Thyroid Cancer Screening
Cost-Utility Analysis of Early Detection with Ultrasonography of Differentiated Thyroid Cancer: A Retrospective Study on a Korean Population
Han-Sang Baek, Jeonghoon Ha, Kwangsoon Kim, Ja Seong Bae, Jeong Soo Kim, Sungju Kim, Dong-Jun Lim, Chul-Min Kim
Endocrinol Metab. 2024;39(2):310-323.   Published online April 9, 2024
DOI: https://doi.org/10.3803/EnM.2023.1870
  • 1,456 View
  • 42 Download
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
There is debate about ultrasonography screening for thyroid cancer and its cost-effectiveness. This study aimed to evaluate the cost-effectiveness of early screening (ES) versus symptomatic detection (SD) for differentiated thyroid cancer (DTC) in Korea.
Methods
A Markov decision analysis model was constructed to compare the cost-effectiveness of ES and SD. The model considered direct medical costs, health outcomes, and different diagnostic and treatment pathways. Input data were derived from literature and Korean population studies. Incremental cost-effectiveness ratio (ICER) was calculated. Willingness-to-pay (WTP) threshold was set at USD 100,000 or 20,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address uncertainties of the model’s variables.
Results
In a base case scenario with 50 years of follow-up, ES was found to be cost-effective compared to SD, with an ICER of $2,852 per QALY. With WTP set at $100,000, in the case with follow-up less than 10 years, the SD was cost-effective. Sensitivity analysis showed that variables such as lobectomy probability, age, mortality, and utility scores significantly influenced the ICER. Despite variations in costs and other factors, all ICER values remained below the WTP threshold.
Conclusion
Findings of this study indicate that ES is a cost-effective strategy for DTC screening in the Korean medical system. Early detection and subsequent lobectomy contribute to the cost-effectiveness of ES, while SD at an advanced stage makes ES more cost-effective. Expected follow-up duration should be considered to determine an optimal strategy for DTC screening.
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Thyroid
Thyroid Cancer Screening
Diagnostic Performance of Ultrasound-Based Risk Stratification Systems for Thyroid Nodules: A Systematic Review and Meta-Analysis
Leehi Joo, Min Kyoung Lee, Ji Ye Lee, Eun Ju Ha, Dong Gyu Na
Endocrinol Metab. 2023;38(1):117-128.   Published online February 27, 2023
DOI: https://doi.org/10.3803/EnM.2023.1670
  • 2,614 View
  • 177 Download
  • 4 Web of Science
  • 7 Crossref
AbstractAbstract PDFPubReader   ePub   
Background
This study investigated the diagnostic performance of biopsy criteria in four society ultrasonography risk stratification systems (RSSs) for thyroid nodules, including the 2021 Korean (K)-Thyroid Imaging Reporting and Data System (TIRADS).
Methods
The Ovid-MEDLINE, Embase, Cochrane, and KoreaMed databases were searched and a manual search was conducted to identify original articles investigating the diagnostic performance of biopsy criteria for thyroid nodules (≥1 cm) in four widely used society RSSs.
Results
Eleven articles were included. The pooled sensitivity and specificity were 82% (95% confidence interval [CI], 74% to 87%) and 60% (95% CI, 52% to 67%) for the American College of Radiology (ACR)-TIRADS, 89% (95% CI, 85% to 93%) and 34% (95% CI, 26% to 42%) for the American Thyroid Association (ATA) system, 88% (95% CI, 81% to 92%) and 42% (95% CI, 22% to 67%) for the European (EU)-TIRADS, and 96% (95% CI, 94% to 97%) and 21% (95% CI, 17% to 25%) for the 2016 K-TIRADS. The sensitivity and specificity were 76% (95% CI, 74% to 79%) and 50% (95% CI, 49% to 52%) for the 2021 K-TIRADS1.5 (1.5-cm size cut-off for intermediate-suspicion nodules). The pooled unnecessary biopsy rates of the ACR-TIRADS, ATA system, EU-TIRADS, and 2016 K-TIRADS were 41% (95% CI, 32% to 49%), 65% (95% CI, 56% to 74%), 68% (95% CI, 60% to 75%), and 79% (95% CI, 74% to 83%), respectively. The unnecessary biopsy rate was 50% (95% CI, 47% to 53%) for the 2021 K-TIRADS1.5.
Conclusion
The unnecessary biopsy rate of the 2021 K-TIRADS1.5 was substantially lower than that of the 2016 K-TIRADS and comparable to that of the ACR-TIRADS. The 2021 K-TIRADS may help reduce potential harm due to unnecessary biopsies.

Citations

Citations to this article as recorded by  
  • Accuracy of ultrasound in predicting thyroid malignancy: a comparative analysis of the ACR TI-RADS and ATA risk stratification systems
    Shaza Samargandy, Aliaa H. Ghoneim
    Archives of Endocrinology and Metabolism.2024;[Epub]     CrossRef
  • Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules 2024
    Young Joo Park, Eun Kyung Lee, Young Shin Song, Su Hwan Kang, Bon Seok Koo, Sun Wook Kim, Dong Gyu Na, Seung-Kuk Baek, So Won Oh, Min Kyoung Lee, Sang-Woo Lee, Young Ah Lee, Yong Sang Lee, Ji Ye Lee, Dong-Jun Lim, Leehi Joo, Yuh-Seog Jung, Chan Kwon Jung,
    International Journal of Thyroidology.2024; 17(1): 208.     CrossRef
  • To Screen or Not to Screen?
    Do Joon Park
    Endocrinology and Metabolism.2023; 38(1): 69.     CrossRef
  • The 2017 United States Preventive Services Task Force Recommendation for Thyroid Cancer Screening Is No Longer the Gold Standard
    Ka Hee Yi
    Endocrinology and Metabolism.2023; 38(1): 72.     CrossRef
  • Thyroid Cancer Screening: How to Maximize Its Benefits and Minimize Its Harms
    Jung Hwan Baek
    Endocrinology and Metabolism.2023; 38(1): 75.     CrossRef
  • 2023 Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules
    Young Joo Park, Eun Kyung Lee, Young Shin Song, Soo Hwan Kang, Bon Seok Koo, Sun Wook Kim, Dong Gyu Na, Seung-Kuk Baek, So Won Oh, Min Kyoung Lee, Sang-Woo Lee, Young Ah Lee, Yong Sang Lee, Ji Ye Lee, Dong-Jun Lim, Leehi Joo, Yuh-Seog Jung, Chan Kwon Jung
    International Journal of Thyroidology.2023; 16(1): 1.     CrossRef
  • Evaluation of the Appropriateness of Thyroid Fine-Needle Aspiration
    Lairce Cristina Ribeiro Brito, Iara Beatriz De Carvalho Botêlho, Lanna Matos Silva Fernandes, Nayze Lucena Sangreman Aldeman, Uziel Nunes Silva
    International Journal for Innovation Education and Research.2023; 11(6): 8.     CrossRef
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Thyroid
Thyroid Cancer Screening
A Comprehensive Assessment of the Harms of Fine-Needle Aspiration Biopsy for Thyroid Nodules: A Systematic Review
Ji Yong Park, Wonsuk Choi, A Ram Hong, Jee Hee Yoon, Hee Kyung Kim, Ho-Cheol Kang
Endocrinol Metab. 2023;38(1):104-116.   Published online February 27, 2023
DOI: https://doi.org/10.3803/EnM.2023.1669
  • 4,459 View
  • 177 Download
  • 4 Web of Science
  • 7 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of FNAB.
Methods
Studies related with the harms of FNAB were searched on MEDLINE, Embase, Cochrane library, and KoreaMed from 2012 to 2022. Also, studies reviewed in the previous systematic reviews were evaluated. Included clinical complications were postprocedural pain, bleeding events, neurological symptoms, tracheal puncture, infections, post-FNAB thyrotoxicosis, and needle tract implantation of thyroid cancers.
Results
Twenty-three cohort studies were included in this review. Nine studies which were related with FNAB-related pain showed that most of the subjects had no or mild discomfort. The 0% to 6.4% of the patients had hematoma or hemorrhage after FNAB, according to 15 studies. Vasovagal reaction, vocal cord palsy, and tracheal puncture have rarely described in the included studies. Needle tract implantation of thyroid malignancies was described in three studies reporting 0.02% to 0.19% of the incidence rate.
Conclusion
FNAB is considered to be a safe diagnostic procedure with rare complications, which are mainly minor events. Thorough assessement of the patients’ medical condition when deciding to perform FNABs would be advisable to lower potential complications.

Citations

Citations to this article as recorded by  
  • A Narrative Review of the 2023 Korean Thyroid Association Management Guideline for Patients with Thyroid Nodules
    Eun Kyung Lee, Young Joo Park, Chan Kwon Jung, Dong Gyu Na
    Endocrinology and Metabolism.2024; 39(1): 61.     CrossRef
  • Fine-needle aspiration cytology for neck lesions in patients with antithrombotic/anticoagulant medications: systematic review and meta-analysis
    Dongbin Ahn, Ji Hye Kwak, Gill Joon Lee, Jin Ho Sohn
    European Radiology.2024;[Epub]     CrossRef
  • 2023 Update of the Korean Thyroid Association Guidelines for the Management of Thyroid Nodules
    Eun Kyung Lee, Young Joo Park
    Clinical Thyroidology®.2024; 36(4): 153.     CrossRef
  • Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part II. Follow-up Surveillance after Initial Treatment 2024
    Mijin Kim, Ji-In Bang, Ho-Cheol Kang, Sun Wook Kim, Dong Gyu Na, Young Joo Park, Youngduk Seo, Young Shin Song, So Won Oh, Sang-Woo Lee, Eun Kyung Lee, Ji Ye Lee, Dong-Jun Lim, Ari Chong, Yun Jae Chung, Chae Moon Hong, Min Kyoung Lee, Bo Hyun Kim
    International Journal of Thyroidology.2024; 17(1): 115.     CrossRef
  • To Screen or Not to Screen?
    Do Joon Park
    Endocrinology and Metabolism.2023; 38(1): 69.     CrossRef
  • Thyroid Cancer Screening: How to Maximize Its Benefits and Minimize Its Harms
    Jung Hwan Baek
    Endocrinology and Metabolism.2023; 38(1): 75.     CrossRef
  • Evaluation of the Appropriateness of Thyroid Fine-Needle Aspiration
    Lairce Cristina Ribeiro Brito, Iara Beatriz De Carvalho Botêlho, Lanna Matos Silva Fernandes, Nayze Lucena Sangreman Aldeman, Uziel Nunes Silva
    International Journal for Innovation Education and Research.2023; 11(6): 8.     CrossRef
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Thyroid
Thyroid Cancer Screening
Lower Thyroid Cancer Mortality in Patients Detected by Screening: A Meta-Analysis
Shinje Moon, Young Shin Song, Kyong Yeun Jung, Eun Kyung Lee, Young Joo Park
Endocrinol Metab. 2023;38(1):93-103.   Published online February 27, 2023
DOI: https://doi.org/10.3803/EnM.2023.1667
  • 2,556 View
  • 129 Download
  • 3 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Thyroid cancer screening has contributed to the skyrocketing prevalence of thyroid cancer. However, the true benefit of thyroid cancer screening is not fully understood. This study aimed to evaluate the impact of screening on the clinical outcomes of thyroid cancer by comparing incidental thyroid cancer (ITC) with non-incidental thyroid cancer (NITC) through a meta-analysis.
Methods
PubMed and Embase were searched from inception to September 2022. We estimated and compared the prevalence of high-risk features (aggressive histology of thyroid cancer, extrathyroidal extension, metastasis to regional lymph nodes or distant organs, and advanced tumor-node-metastasis [TNM] stage), thyroid cancer-specific death, and recurrence in the ITC and NITC groups. We also calculated pooled risks and 95% confidence intervals (CIs) of the outcomes derived from these two groups.
Results
From 1,078 studies screened, 14 were included. In comparison to NITC, the ITC group had a lower incidence of aggressive histology (odds ratio [OR], 0.46; 95% CI, 0.31 to 0.7), smaller tumors (mean difference, −7.9 mm; 95% CI, −10.2 to −5.6), lymph node metastasis (OR, 0.64; 95% CI, 0.48 to 0.86), and distant metastasis (OR, 0.42; 95% CI, 0.23 to 0.77). The risks of recurrence and thyroid cancer-specific mortality were also lower in the ITC group (OR, 0.42; 95% CI, 0.25 to 0.71 and OR, 0.46; 95% CI, 0.28 to 0.74) than in the NITC group.
Conclusion
Our findings provide important evidence of a survival benefit from the early detection of thyroid cancer compared to symptomatic thyroid cancer.

Citations

Citations to this article as recorded by  
  • Cost-Utility Analysis of Early Detection with Ultrasonography of Differentiated Thyroid Cancer: A Retrospective Study on a Korean Population
    Han-Sang Baek, Jeonghoon Ha, Kwangsoon Kim, Ja Seong Bae, Jeong Soo Kim, Sungju Kim, Dong-Jun Lim, Chul-Min Kim
    Endocrinology and Metabolism.2024; 39(2): 310.     CrossRef
  • To Screen or Not to Screen?
    Do Joon Park
    Endocrinology and Metabolism.2023; 38(1): 69.     CrossRef
  • The 2017 United States Preventive Services Task Force Recommendation for Thyroid Cancer Screening Is No Longer the Gold Standard
    Ka Hee Yi
    Endocrinology and Metabolism.2023; 38(1): 72.     CrossRef
  • Thyroid Cancer Screening: How to Maximize Its Benefits and Minimize Its Harms
    Jung Hwan Baek
    Endocrinology and Metabolism.2023; 38(1): 75.     CrossRef
  • Delayed Surgery for and Outcomes of Papillary Thyroid Cancer: Is the Pendulum Still Swinging?
    Giorgio Grani
    Clinical Thyroidology.2023; 35(5): 192.     CrossRef
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Thyroid
Thyroid Cancer Screening
Survival Comparison of Incidentally Found versus Clinically Detected Thyroid Cancers: An Analysis of a Nationwide Cohort Study
Shinje Moon, Eun Kyung Lee, Hoonsung Choi, Sue K. Park, Young Joo Park
Endocrinol Metab. 2023;38(1):81-92.   Published online February 27, 2023
DOI: https://doi.org/10.3803/EnM.2023.1668
  • 2,050 View
  • 161 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract PDFPubReader   ePub   
Background
The true benefit of thyroid cancer screening is incompletely understood. This study investigated the impact of ultrasound screening on thyroid cancer outcomes through a comparison with symptomatic thyroid cancer using data from a nationwide cohort study in Korea.
Methods
Cox regression analysis was performed to assess the hazard ratios (HRs) for all-cause and thyroid cancer-specific mortality. Considering the possible bias arising from age, sex, year of thyroid cancer registration, and confounding factors for mortality (including smoking/drinking status, diabetes, and hypertension), all analyses were conducted with stabilized inverse probability of treatment weighting (IPTW) according to the route of detection.
Results
Of 5,796 patients with thyroid cancer, 4,145 were included and 1,651 were excluded due to insufficient data. In comparison with the screening group, the clinical suspicion group was associated with large tumors (17.2±14.6 mm vs. 10.4±7.9 mm), advanced T stage (3–4) (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09 to 1.41), extrathyroidal extension (OR, 1.16; 95% CI, 1.02 to 1.32), and advanced stage (III–IV) (OR, 1.16; 95% CI, 1.00 to 1.35). In IPTW-adjusted Cox regression analysis, the clinical suspicion group had significantly higher risks of all-cause mortality (HR, 1.43; 95% CI, 1.14 to 1.80) and thyroid cancer-specific mortality (HR, 3.07; 95% CI, 1.77 to 5.29). Mediation analysis showed that the presence of thyroid-specific symptoms was directly associated with a higher risk of cancer-specific mortality. Thyroid-specific symptoms also indirectly affected thyroid cancer-specific mortality, mediated by tumor size and advanced clinicopathologic status.
Conclusion
Our findings provide important evidence for the survival benefit of early detection of thyroid cancer compared to symptomatic thyroid cancer.

Citations

Citations to this article as recorded by  
  • Cost-Utility Analysis of Early Detection with Ultrasonography of Differentiated Thyroid Cancer: A Retrospective Study on a Korean Population
    Han-Sang Baek, Jeonghoon Ha, Kwangsoon Kim, Ja Seong Bae, Jeong Soo Kim, Sungju Kim, Dong-Jun Lim, Chul-Min Kim
    Endocrinology and Metabolism.2024; 39(2): 310.     CrossRef
  • Clinical Characteristics, Diagnostic Approach and Outcome of Thyroid Incidental Findings vs. Clinically Overt Thyroid Nodules: An Observational Single-Centre Study
    Tom Jansen, Nike Stikkelbroeck, Annenienke van de Ven, Ilse van Engen-van Grunsven, Marcel Janssen, Han Bonenkamp, Martin Gotthardt, Romana T. Netea-Maier
    Cancers.2023; 15(8): 2350.     CrossRef
  • Lower Thyroid Cancer Mortality in Patients Detected by Screening: A Meta-Analysis
    Shinje Moon, Young Shin Song, Kyong Yeun Jung, Eun Kyung Lee, Young Joo Park
    Endocrinology and Metabolism.2023; 38(1): 93.     CrossRef
  • To Screen or Not to Screen?
    Do Joon Park
    Endocrinology and Metabolism.2023; 38(1): 69.     CrossRef
  • The 2017 United States Preventive Services Task Force Recommendation for Thyroid Cancer Screening Is No Longer the Gold Standard
    Ka Hee Yi
    Endocrinology and Metabolism.2023; 38(1): 72.     CrossRef
  • Thyroid Cancer Screening: How to Maximize Its Benefits and Minimize Its Harms
    Jung Hwan Baek
    Endocrinology and Metabolism.2023; 38(1): 75.     CrossRef
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Editorials
Thyroid
Thyroid Cancer Screening
Thyroid Cancer Screening: How to Maximize Its Benefits and Minimize Its Harms
Jung Hwan Baek
Endocrinol Metab. 2023;38(1):75-77.   Published online February 27, 2023
DOI: https://doi.org/10.3803/EnM.2023.105
  • 1,492 View
  • 116 Download
  • 1 Web of Science
  • 2 Crossref
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Citations

Citations to this article as recorded by  
  • Multidimensional Prediction Method for Thyroid Cancer Based on Spatiotemporally Imbalanced Distribution Data
    Zhiwei Jia, Yuqi Huang, Yanhui Lin, Min Fu, Chenhao Sun
    IEEE Access.2024; 12: 4674.     CrossRef
  • Cost-Utility Analysis of Early Detection with Ultrasonography of Differentiated Thyroid Cancer: A Retrospective Study on a Korean Population
    Han-Sang Baek, Jeonghoon Ha, Kwangsoon Kim, Ja Seong Bae, Jeong Soo Kim, Sungju Kim, Dong-Jun Lim, Chul-Min Kim
    Endocrinology and Metabolism.2024; 39(2): 310.     CrossRef
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Thyroid
Thyroid Cancer Screening
The 2017 United States Preventive Services Task Force Recommendation for Thyroid Cancer Screening Is No Longer the Gold Standard
Ka Hee Yi
Endocrinol Metab. 2023;38(1):72-74.   Published online February 27, 2023
DOI: https://doi.org/10.3803/EnM.2023.106
  • 1,175 View
  • 87 Download
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Thyroid
Thyroid Cancer Screening
To Screen or Not to Screen?
Do Joon Park
Endocrinol Metab. 2023;38(1):69-71.   Published online February 27, 2023
DOI: https://doi.org/10.3803/EnM.2023.104
  • 1,022 View
  • 100 Download
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