Eddy Lincango-Naranjo1,2,3, Paola Solis-Pazmino1,2,3,4, Omar El Kawkgi1,5, Jorge Salazar-Vega3,6, Cristhian Garcia3,7, Tannya Ledesma2,3, Tatiana Rojas3,8, Benjamin Alvarado-Mafla3, Geoffrey Young9, Benzon Dy10, Oscar J Ponce1,3,11, Juan P Brito12,13,14. 1. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA. 2. Universidad Central, Medical School, Quito-Ecuador, Quito, Ecuador. 3. CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador. 4. Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA. 5. Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, 55905, USA. 6. Endocrinology Department, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador. 7. Surgery Department, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador. 8. Universidad San Francisco de Quito, Quito, Ecuador. 9. Miami Cancer Institute, Miami, FL, USA. 10. Division of Endocrine Surgery, Mayo Clinic, Rochester, MN, USA. 11. Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru. 12. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA. brito.juan@mayo.edu. 13. CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador. brito.juan@mayo.edu. 14. Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, 55905, USA. brito.juan@mayo.edu.
Abstract
PURPOSE: Understanding the method of thyroid cancer detection has potential implications on interpreting incidence rates, the diagnosis and management of thyroid cancer. We conducted a systematic review of studies reporting methods of thyroid cancer detection to estimate the frequency of incidentally found cancers and classify triggers of incidental thyroid cancer diagnosis. METHODS: We searched multiple bibliographic databases from inception to June 2020. A pair of reviewers, working independently and in duplicate selected studies for inclusion, extracted data, and evaluated each trial's risk of bias. Studies enrolling patients older than 18 years with thyroid cancer confirmed histologically were included. RESULTS: In total, 17 cohorts and 1 cross-sectional study, conducted between 1991 and 2018, enrolling 4668 patients with thyroid cancer were included: 88% had papillary thyroid cancer and 23% had papillary thyroid microcarcinoma. The proportion of patients with non-incidental and incidental thyroid cancer was similar: 49% [95% confidence interval (CI): 40-58%]. Subgroup analysis showed that most patients with incidental thyroid cancers had tumor size <10 mm (76%; 95% CI: 56-92%), age >45 (61%; 95% CI: 56-67%), and were detected through imaging (35%; 95% CI: 26-45%), of which ultrasound was the most common modality (27%; 95% CI: 14-43%). The heterogeneity for all the effect sizes was large and significant. CONCLUSIONS: About half of thyroid cancers were found incidentally through the use of imaging studies, in particular neck ultrasound. These incidentally found cancers were mostly small papillary thyroid cancer. These results highlight opportunities for interventions aimed at reducing drivers of overdiagnosis.
PURPOSE: Understanding the method of thyroid cancer detection has potential implications on interpreting incidence rates, the diagnosis and management of thyroid cancer. We conducted a systematic review of studies reporting methods of thyroid cancer detection to estimate the frequency of incidentally found cancers and classify triggers of incidental thyroid cancer diagnosis. METHODS: We searched multiple bibliographic databases from inception to June 2020. A pair of reviewers, working independently and in duplicate selected studies for inclusion, extracted data, and evaluated each trial's risk of bias. Studies enrolling patients older than 18 years with thyroid cancer confirmed histologically were included. RESULTS: In total, 17 cohorts and 1 cross-sectional study, conducted between 1991 and 2018, enrolling 4668 patients with thyroid cancer were included: 88% had papillary thyroid cancer and 23% had papillary thyroid microcarcinoma. The proportion of patients with non-incidental and incidental thyroid cancer was similar: 49% [95% confidence interval (CI): 40-58%]. Subgroup analysis showed that most patients with incidental thyroid cancers had tumor size <10 mm (76%; 95% CI: 56-92%), age >45 (61%; 95% CI: 56-67%), and were detected through imaging (35%; 95% CI: 26-45%), of which ultrasound was the most common modality (27%; 95% CI: 14-43%). The heterogeneity for all the effect sizes was large and significant. CONCLUSIONS: About half of thyroid cancers were found incidentally through the use of imaging studies, in particular neck ultrasound. These incidentally found cancers were mostly small papillary thyroid cancer. These results highlight opportunities for interventions aimed at reducing drivers of overdiagnosis.
Entities:
Keywords:
Incidental diagnosis; Mechanism of detection; Meta-analysis; Systematic review; Thyroid cancer
Authors: Heywood Choi; Katayoon Kasaian; Adrienne Melck; Kaye Ong; Steven J M Jones; Adam White; Sam M Wiseman Journal: Am J Surg Date: 2015-04-24 Impact factor: 2.565
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