Abstract
To evaluate the causes of the first referral to an endocrine visit of patients with thyroid cancer in a mildly iodine-deficient area and to correlate them with prognostic features. We studied 298 consecutive patients (64 M and 234 F) with thyroid cancer. Of these, 281 had differentiated thyroid cancer. The causes of referral were categorized as follows: (Group A) clinical evidence of a neck lump; (Group B) incidental imaging in subjects without known thyroid diseases; (Group C) incidental imaging during a workup of thyroid disorders. Also, in differentiated thyroid cancer cases, clinical, histomorphologic, and prognostic parameters were compared among the three different groups of referral causes. In both total thyroid cancer and differentiated thyroid cancer cohorts, Group A, B, and C accounted for about 25, 35, and 40 % of causes, respectively. Considering the differentiated thyroid cancer, in Group B, ultrasound accounted for 94 % of cases, with 73 % resulting from screening or serendipitous study. Within a median follow-up of 5.6 [IQR: 2.7–9.5] years, disease-free survival was significantly lower in patients of Group A (Log-Rank test p = 0.030 vs. the other groups of causes). However, at the Cox multivariate analysis only male sex (p = 0.002) and stage (p = 0.005), but not referral cause, resulted independent predictors of events. In patients without known thyroid disease, unjustified thyroid ultrasound represents the main cause of referral of thyroid cancer patients to the first endocrine visit. The fact that this is not related to the disease-free survival strengthens the concept of the uselessness of thyroid cancer screening.
Similar content being viewed by others
References
J.R. Burgess, P. Tucker, Incidence trends for papillary thyroid carcinoma and their correlation with thyroid surgery and thyroid fine needle aspirate cytology. Thyroid 16, 47–53 (2006)
M. Colonna, A.V. Guizard, C. Schvartz, M. Velten, N. Raverdy, F. Molinie, P. Delafosse, B. Franc, P. Grosclaude, A time trend analysis of papillary and follicular cancers as a function of tumour size: a study of data from six cancer registries in France (1983–2000). Eur. J. Cancer 43, 891–900 (2007)
L. Davies, H.G. Welch, Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295, 2164–2167 (2006)
L. Leenhardt, P. Grosclaude, L. Cherie-Challine, Thyroid cancer committee. Increased incidence of thyroid carcinoma in France: a true epidemic or thyroid nodule management effects? Report from the French thyroid cancer committee. Thyroid 4, 1056–1060 (2004)
S. Liu, R. Semenciw, A.M. Ugnat, Y. Mao, Increasing thyroid cancer incidence in Canada, 1970–1996: time trends and age-period-cohort effects. Br. J. Cancer 85, 1335–1339 (2001)
R.M. Reynolds, J. Weir, D.L. Stockton, D.H. Brewster, T.C. Sandeep, M.W. Strachan, Changing trends in incidence and mortality of thyroid cancer in Scotland. Clin. Endocrinol. (Oxf). 62, 156–162 (2005)
G. Smailyte, E. Miseikyte-Kaubriene, J. Kurtinaitis, Increasing thyroid cancer incidence in Lithuania in 1978–2003. BMC Cancer 6, 284 (2006)
N. Howlader, A. Noone, M. Krapcho et al., (eds.) SEER Cancer Statistics Review. (National Cancer Institute, Bethesda, MD), 2012. Available at http://seer.cancer.gov/csr/1975_2009_pops09/. Accessed January 23, 2013
G. Ceresini, L. Corcione, M. Michiara, P. Sgargi, G. Teresi, A. Gilli, E. Usberti, E. Silini, G.P. Ceda, Thyroid cancer incidence by histological type and related variants in a mildly iodine-deficient area of Northern Italy, 1998 to 2009. Cancer 118, 5473–5480 (2012)
L. Enewold, K. Zhu, E. Ron, A.J. Marrogi, A. Stojadinovic, G.E. Peoples, S.S. Devesa, Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980–2005. Cancer Epidemiol. Biomarkers Prev. 18, 784–791 (2009)
L. Leenhardt, M.O. Bernier, M.H. Boin-Pineau, B. Conte Devolx, R. Maréchaud, P. Niccoli-Sire, M. Nocaudie, J. Orgiazzi, M. Schlumberger, J.L. Wémeau, L. Chérie-Challine, F. De Vathaire, Advances in diagnostic practices affect thyroid cancer incidence in France. Eur. J. Endocrinol. 150, 133–139 (2004)
P. Boyle, J. Ferlay, Cancer incidence and mortality in Europe, 2004. Ann. Oncol. 16, 481–488 (2005)
S. Sherman, J. Fagin, Why thyroid cancer? Thyroid 15, 303–304 (2005)
L.A.G. Ries, D. Melbert, M. Krapcho et al., (eds.) SEER Cancer Statistics Review, 1975-2005. (National Cancer Institute, Bethesda, MD), 2008
H.L. Howe, P.A. Wingo, M.J. Thun, L.A. Ries, H.M. Rosenberg, E.G. Feigal, B.K. Edwards, Annual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends. J. Natl. Cancer Inst. 93, 824–842 (2001)
A.Y. Chen, A. Jemal, E.M. Ward, Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005. Cancer 115, 3801–3807 (2009)
L.G.T. Morris, D. Myssiorek, Improved detection does not fully explain the rising incidence of well-differentiated thyroid cancer: a population-based analysis. Am. J. Surg. 200, 454–461 (2010)
J.P. Brito, A.A. Nofal, V.M. Montori, I.D. Hay, J.C. Morris, The impact of subclnical disease and mechanism of detection on the rise in thyroid cancer incidence: a population-based study in Olmsted county, Minnesota during 1935 through 2012. Thyroid 9, 999–1007 (2015)
G.H. Tan, H. Gharib, Thyroid Incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann. Intern. Med. 126, 226–231 (1997)
C. Hudon, M. Fortin, A. Vanasse, Cumulative illness rating scale was a reliable and valid index in a family practice context. J. Clin. Epidemiol. 58, 603–608 (2005)
C. Hudon, M. Fortin, H. Soubhi, Abbreviated guidelines for scoring the cumulative illness rating scale (CIRS) in family practice. J. Clin. Epidemiol. 60, 212–213 (2007)
F.L. Greene (ed.) AJCC Cancer Staging Manual. 6th edn.. Springer-Verlag, New York), 2002
S.R. Steele, M.J. Martin, P.S. Mullenix, K.S. Azarow, C.A. Andersen, The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography. Arch. Surg. 140, 981–985 (2005)
M.N. Minuto, M. Miccoli, D. Viola, C. Ugolini, R. Giannini, L. Torregrossa, L. Antonangeli, F. Aghini-Lombardi, R. Elisei, F. Basolo, P. Miccoli, Incidental versus clinically evident thyroid cancer: a 5-year follow-up study. Head Neck 35, 408–412 (2013)
F. Yoo, I. Chaikhoutdinov, R. Mitzner, J. Liao, D. Goldenberg, Characteristics of incidentally discovered thyroid cancer. JAMA Otolaryngol. Head Neck Surg 139, 1181–1186 (2013)
L. Davies, M. Oulette, M. Hunter, H.G. Welch, The increasing incidence of small thyroid cancers: where are the cases coming from?. Laryngoscope 120, 2446–2451 (2010)
N.F. Bruneton. Ultrasonography of the Neck. (Springer-Verlag, Berlin), 1987
K. Shimamoto, H. Satake, A. Sawaki, T. Ishigaki, H. Funahashi, T. Imai, Preoperative staging of thyroid papillary carcinoma with ultrasonography. Eur. J. Radiol. 29, 4–10 (1998)
Y.E. Nikiforov, R.R. Seethala, G. Tallini, Z.W. Baloch, F. Basolo, L.D. Thompson, J.A. Barletta, B.M. Wenig, A. Al Ghuzlan, K. Kakudo, T.J. Giordano, V.A. Alves, E. Khanafshar, S.L. Asa, A.K. El-Naggar, W.E. Gooding, S.P. Hodak, R.V. Lloyd, G. Maytal, O. Mete, M.N. Nikiforova, V. Nosé, M. Papotti, D.N. Poller, P.M. Sadow, A.S. Tischler, R.M. Tuttle, K.B. Wall, V.A. LiVolsi, G.W. Randolph, R.A. Ghossein, Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol 2, 1023–1029 (2016)
B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 26, 1–133 (2016)
I.J. Nixon, I. Ganly, S. Patel, F.L. Palmer, M.M. Whitcher, R.M. Tuttle, A.R. Shaha, J.P. Shah, The impact of microscopic extrathyroid extension on outcome in patients with clinical T1 and T2 well-differentiated thyroid cancer. Surgery. 150, 1242–1249 (2011)
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Marina, M., Ceda, G.P., Aldigeri, R. et al. Causes of referral to the first endocrine visit of patients with thyroid carcinoma in a mildly iodine-deficient area. Endocrine 57, 247–255 (2017). https://doi.org/10.1007/s12020-016-1140-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-016-1140-1