دورية أكاديمية
Assessing the Frequency of Deferrable Thyroid Nodule Biopsies to De-escalate Low-Value Care.
| العنوان: | Assessing the Frequency of Deferrable Thyroid Nodule Biopsies to De-escalate Low-Value Care. |
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| المؤلفون: | Alexis M; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Ginzberg SP; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Healthcare Improvement and Patient Safety, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: sara.ginzberg@pennmedicine.upenn.edu., Soegaard Ballester JM; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Mandel SJ; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Langer JE; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Kelz RR; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania., Wachtel H; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. |
| المصدر: | Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists [Endocr Pract] 2024 Apr; Vol. 30 (4), pp. 305-310. Date of Electronic Publication: 2023 Dec 29. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 9607439 Publication Model: Print-Electronic Cited Medium: Print ISSN: 1530-891X (Print) Linking ISSN: 1530891X NLM ISO Abbreviation: Endocr Pract Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2021- : [New York] : Elsevier Inc. Original Publication: Jacksonville, Fla. : The College and the Association, |
| مواضيع طبية MeSH: | Thyroid Nodule*/surgery , Thyroid Nodule*/pathology , Thyroid Neoplasms*/pathology, Humans ; Female ; Male ; Low-Value Care ; Retrospective Studies ; Biopsy, Fine-Needle |
| مستخلص: | Objective: Thyroid nodules are common, yet fewer than 1 in 10 harbors malignancy. When present, thyroid cancer is typically indolent with excellent survival. Therefore, patients who are not candidates for thyroid cancer treatment due to comorbid disease may not require further thyroid nodule evaluation. The goal of this study was to determine the rate of deferrable thyroid nodule biopsies in patients with limited life expectancy. Methods: We identified patients who underwent thyroid fine needle aspiration (FNA) between 2015 and 2018 at our institution. The primary outcome was the number of deferrable FNAs, defined as FNAs performed in patients who died within 2 years after biopsy. Secondary outcomes included cytologic Bethesda score, procedure costs, and final diagnosis on surgical pathology. Multivariable logistic and Cox proportional hazards regressions were used to evaluate factors associated with FNA in patients with limited life expectancy. Results: A total of 2565 FNAs were performed. Most patients were female (79%), and 37 (1.5%) patients died within 2 years. Nonthyroid specialists were significantly more likely to order deferrable FNAs (odds ratio 4.13, P < .001). Of the patients who died within 2 years, most (78%) had a concomitant diagnosis of nonthyroid cancer, and 4 went on to have thyroid surgery (Bethesda scores: 3, 4, 4, and 6). Spending associated with deferrable FNAs and subsequent surgery totaled over $98 000. Conclusions: Overall, the rate of deferrable thyroid nodule biopsies was low. However, there is an opportunity to reduce low-value biopsies in patients with a concurrent nonthyroid cancer by partnering with oncology providers. Competing Interests: Disclosure The authors have no multiplicity of interest to disclose. (Copyright © 2023 AACE. Published by Elsevier Inc. All rights reserved.) |
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| معلومات مُعتمدة: | K08 CA270385 United States CA NCI NIH HHS |
| فهرسة مساهمة: | Keywords: de-escalation of care; fine needle aspiration; low-value care; thyroid cancer; thyroid neoplasms; thyroid nodule |
| تواريخ الأحداث: | Date Created: 20231231 Date Completed: 20240405 Latest Revision: 20240405 |
| رمز التحديث: | 20240405 |
| مُعرف محوري في PubMed: | PMC10990838 |
| DOI: | 10.1016/j.eprac.2023.12.015 |
| PMID: | 38160939 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1530-891X |
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| DOI: | 10.1016/j.eprac.2023.12.015 |