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Title: | Quantifying the differences in surgical management of patients with definitive and indeterminate thyroid nodule cytology. | Authors: | Stewart R.;Lee J.C.;Serpell J.;Grodski S.;Bhatt C.R.;Leang Y.J. | Monash Health Department(s): | Emergency Medicine General Surgery |
Institution: | (Stewart, Leang, Bhatt, Grodski, Serpell, Lee) Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Australia (Bhatt) Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia (Bhatt) Department of Emergency Medicine, Monash Health, Melbourne, Australia (Grodski, Serpell, Lee) Department of Surgery, Monash University, Melbourne, Australia (Grodski, Lee) Department of Surgery, Monash Health, Melbourne, Australia | Issue Date: | 7-Feb-2020 | Copyright year: | 2020 | Publisher: | W.B. Saunders Ltd | Place of publication: | United Kingdom | Publication information: | European Journal of Surgical Oncology. 46 (2) (pp 252-257), 2020. Date of Publication: February 2020. | Journal: | European Journal of Surgical Oncology | Abstract: | Introduction: Thyroid nodules are increasingly common. Despite being an essential pre-operative diagnostic tool, up to 30% of fine needle aspirate cytology (FNAC) yields a non-definitive diagnosis. This study aimed to quantify differences in surgical management of patients with definitive and indeterminate thyroid nodule cytology, and determine if clinical factors can improve cytological diagnosis. Material(s) and Method(s): Patients who underwent thyroidectomy for nodules from 2001 to 2015 were recruited. Those with benign and malignant preoperative cytology were included in the "definitive diagnosis" (DC) group; patients with all other preoperative cytology results were included in the "indeterminate diagnosis" (IC) group. We compared demographics and procedures between these groups. Clinical factors and demographics were also compared between patients with benign and malignant histology in the IC group. Result(s): A total of 3821 cases were included. A significantly larger proportion of the IC patients had a hemithyroidectomy (IC 69% vs. DC 39%, p < 0.001) initially, and also had a significantly higher rate of two-stage surgery compared to the DC group (IC 17% vs. DC 11%, p < 0.001). Patients in the DC group were twice as likely to undergo concurrent central lymph node dissection for papillary and medullary cancers than the IC group (p < 0.001). Overall, up to 60% of IC patients had been over- or under-treated at initial surgery. The clinical factors examined were not significantly associated with higher risk of malignancy in IC patients. Conclusion(s): This study highlights the potential for improved preoperative diagnosis to streamline decision making for surgical management of patients with thyroid nodules.Copyright © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1016/j.ejso.2019.10.004 | PubMed URL: | 31648951 [http://www.ncbi.nlm.nih.gov/pubmed/?term=31648951] | ISSN: | 0748-7983 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/35467 | Type: | Article | Subjects: | hyperthyroidism hypoparathyroidism incidental finding lymph node dissection postoperative postoperative hemorrhage preoperative evaluation radiation exposure recurrent laryngeal nerve injury retrosternal goiter sex subtotal thyroidectomy surgical oncology thyroid cancer thyroid follicular carcinoma thyroid medullary carcinoma thyroid metastasis thyroid nodule thyroid papillary carcinoma thyroidectomy thyrotoxicosis tumor biopsy tumor differentiation wound thyroid antibody histopathology airway obstruction cancer cyto cancer patient dysphagia dyspnea fine needle aspiration biopsy hematoma high risk patient hoarseness |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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