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Determining Patient Preferences for Indeterminate Thyroid Nodules: Observation, Surgery or Molecular Tests

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Abstract

Background

Gene-expression classifiers (GEC) and genetic mutation panels (GMP) have been shown to improve preoperative diagnostic evaluations of indeterminate thyroid nodules. Despite the improvement, uncertainty regarding the proper management exists. Patient preferences may better inform the management of these indeterminate thyroid nodules.

Methods

Hypothetical scenarios were administered to two groups of patients: those with previous FNA-confirmed indeterminate thyroid nodules (Group A, n = 50) and those presenting to a general otolaryngology clinic for other reasons (Group B, n = 50). We evaluated patient preferences for surgery, observation and the use of molecular tests while varying the risk of malignancy, cost and diagnostic properties of the tests.

Results

The mean threshold for choosing surgery over observation was a 38.6% risk of malignancy on FNA. When offered either GEC, GMP or both (with their inherent imperfect diagnostic properties) in addition to the indeterminate FNA, 85.0% of respondents picked at least one of the molecular tests over either observation or surgery if the test(s) were free of charge. However, only 51.7% of respondents chose at least one of the tests when asked to pay the current cost of the test(s) (p < 0.001). On multivariable analysis, sex, the presence of an indeterminate FNA diagnosis and income level significantly predicted the desire to proceed with a molecular test above standard management.

Conclusion

Patient preferences for thyroid nodule management are dependent on the risk of malignancy, prognosis of cancer and costs. Patients prefer molecular tests over standard management with indeterminate thyroid nodules, but the costs of the test(s) reduce the desire.

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Abbreviations

FNA:

Fine needle biopsy

GEC:

Genetic-expression classifiers

GMP:

Genetic mutation panels

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Author contributions

DJL, JJX, DHB, RWG, PJG, JCI, LER, DPG and JRA were involved in study concept and design and critically revised the manuscript for important intellectual content; DJL and JJX were involved in acquisition of data and provided administrative, technical or material support; DJL and JRA analyzed and interpreted the data; DJL involved in statistical analysis; JRA supervised the study; all authors have given their agreement for this study.

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Authors and Affiliations

  1. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Daniel Joonil Lee

  2. Department of Otolaryngology – Head and Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada

    Jason J. Xu, Dale H. Brown, Ralph W. Gilbert, Patrick J. Gullane, Jonathan C. Irish, David P. Goldstein & John R. de Almeida

  3. Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada

    Lorne E. Rotstein

  4. Princess Margaret Hospital–University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2C4, Canada

    Dale H. Brown, Ralph W. Gilbert, Patrick J. Gullane, Jonathan C. Irish, Lorne E. Rotstein, David P. Goldstein & John R. de Almeida

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  1. Daniel Joonil Lee
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Correspondence to John R. de Almeida.

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The authors report no conflicts of interest for this work.

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Ethics approval was obtained from the University Health Network Research Ethics Board.

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Availability of data and materials Dr. John R. de Almeida and Mr. Daniel J. Lee had full access to all of the data in the study and take full responsibility for the integrity of the data and the accuracy of data analysis.

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Lee, D.J., Xu, J.J., Brown, D.H. et al. Determining Patient Preferences for Indeterminate Thyroid Nodules: Observation, Surgery or Molecular Tests. World J Surg 41, 1513–1520 (2017). https://doi.org/10.1007/s00268-017-3887-9

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  • DOI: https://doi.org/10.1007/s00268-017-3887-9

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