Cost-effective initial assessment strategies for thyroid nodules in iodine-adequate areas
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ORIGINAL ARTICLE
Cost-effective initial assessment strategies for thyroid nodules in iodine-adequate areas Haidong Cai1 • Yu Qiao2 • Xiao Huang3 • Ming Sun1 • Qiong Luo1 Xueyu Yuan1 • Yuehua Yang1 • Weiqing Mao1 • Zhongwei Lv1
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Received: 13 December 2015 / Accepted: 8 September 2016 / Published online: 13 September 2016 Ó The Japanese Society of Nuclear Medicine 2016
Abstract Objective In the initial assessment of thyroid nodules, thyrotropin (TSH) has very low sensitivity for assessing functional thyroid nodules (FTNs). The false negativity in FTNs and the false positivity in non-FTNs misinterpreted by TSH will raise unnecessary assessment costs. Therefore, the aim of this study is to explore the values of the TSH and color flow Doppler sonography (CFDS) combined strategies in reducing the unnecessary assessment costs. Methods 2383 patients with thyroid nodules were retrospectively analyzed, including 107 FTNs and 2276 nonFTNs. Four strategies including TSH, CFDS, Combination 1 (TSH?/CFDS?, TSH?/CFDS-, and TSH-/CFDS? defined as positive; TSH-/CFDS- defined as negative) and Combination 2 (TSH?/CFDS? defined as positive; TSH?/CFDS-, TSH-/CFDS?, and TSH-/CFDSdefined as negative) were separately used for initial assessment. The four strategies were compared using the testing cost ratio of fine-needle aspiration (FNA) to thyroid scintigraphy (TS) (marked as CFNA/TS) as main outcome measure.
H. Cai and Y. Qiao contributed equally. & Zhongwei Lv [email protected] 1
Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Yanchang Middle Road 301, Shanghai 20072, China
2
Department of Blood Transfusion, Changhai Hospital, Changhai Road 168, Shanghai 200433, China
3
Department of Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Yanchang Middle Road 301, Shanghai 20072, China
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Results Compared with TSH, Combination 1 prevented 15.89 % of FTNs from unnecessary FNA, but increased the number of non-FTNs subjected to unnecessary 99mTcTS by 9.31 %. Combination 2 prevented 5.32 % of nonFTNs from unnecessary TS, but increased the number of FTNs subjected to unnecessary FNA by 18.69 %. When CFNA/TS was \6.05, the lowest total cost was found in Combination 2. The TSH and Combination 1 were optimal at 6.05 B CFNA/TS B 12.47 and CFNA/TS [ 12.47, respectively. Conclusions The combined strategies can be used to supplement TSH in the initial assessment of thyroid nodules in iodine-adequate areas, depending on the testing costs of FNA and TS. Keywords Thyroid nodule Initial assessment Thyrotropin Color flow Doppler sonography
Introduction Serum thyrotropin (TSH) has been recommended for initial assessment of thyroid nodules by American Association of Clinical Endocrinologists (AACE) in 2006 [1], American Thyroid Association (ATA) in 2009 [2], and joint guidelines between three large societies, AACE, Associazione Medici Endocrinologi (AME), and European Thyroid Association in 2010 [3]. The purpose of the initial assessment is to exclude fun
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