Trimboli Pierpaolo, Nasrollah Naim, Amendola Stefano, Crescenzi Anna, Guidobaldi Leo, Chiesa Carlo, Maglio Riccardo, Nigri Giuseppe, Pontecorvi Alfredo, Romanelli Francesco, Giacomelli Laura, Valabrega Stefano
1 Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy ; 2 Section of Surgery, Ospedale Israelitico, Rome, Italy ; 3 Pathology Unit, Campus Bio-medico University Hospital, Rome, Italy ; 4 Section of Pathology, Ospedale Israelitico, Rome, Italy ; 5 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 6 Department of Surgical and Medical Sciences, Sapienza University, Ospedale S. Andrea, Rome, Italy ; 7 Institute of Endocrinology, Catholic University of Rome, 00168 Rome, Italy ; 8 Department of Experimental Medicine, Sapienza University, Rome, Italy.
Gland Surg. 2015 Aug;4(4):307-11. doi: 10.3978/j.issn.2227-684X.2015.06.05.
Twenty percent of thyroid fine needle aspiration (FNA) is indeterminate. Because 3 in 4 of these are actually benign, a method of clarifying the pathology could help patients to avoid diagnostic thyroidectomy. Recently, core needle biopsy (CNB) has been proven to be highly reliable for this purpose. However, there are no reports of any potential cost benefit provided by CNB. Here we analyzed the impact on management costs of CNB compared with traditional diagnostic surgery in indeterminate FNA.
Over 24 months, 198 patients with thyroid indeterminate cytology underwent CNB at Ospedale Israelitico of Rome or diagnostic surgery at the Department of Surgery of Sapienza University of Rome. We tabulated costs of the medical instruments, operating theater, surgical team, patient recovery, and pathologic examination for each method.
In CNB group, 42.4% of patients had benign lesions and avoided surgery, 20.8% was cancer, and the remaining 36.8% uncertain. The malignancy rate in CNB group was 26.4%, and mean cost of CNB per nodule was 1,032€. In diagnostic surgery group, 24.7% had cancer and 75.3% had benign lesions, and mean expense for each thyroidectomy was 6,364€. In an ideal cohort of 100 patients with indeterminate FNA, the cost of CNB is 33.8% lower than that of diagnostic surgery.
CNB can detect a large proportion of the benign thyroid nodules that are classified as indeterminate by FNA. These patients can avoid diagnostic thyroidectomy and hospitals can reduce their surgical costs by one-third.
20%的甲状腺细针穿刺活检（FNA）结果为不确定。由于其中四分之三实际上是良性的，一种明确病理的方法有助于患者避免诊断性甲状腺切除术。最近，已证明粗针活检（CNB）在此方面高度可靠。然而，尚无关于CNB所带来的任何潜在成本效益的报道。在此，我们分析了在FNA结果不确定的情况下，CNB与传统诊断性手术相比对管理成本的影响。
在24个月期间，198例甲状腺细胞学检查结果不确定的患者在罗马以色列医院接受了CNB，或在罗马第一大学外科接受了诊断性手术。我们将每种方法的医疗器械、手术室、手术团队、患者恢复和病理检查的成本制成表格。
在CNB组中，42.4%的患者有良性病变并避免了手术，20.8%为癌症，其余36.8%不确定。CNB组的恶性率为26.4%，每个结节的CNB平均成本为1032欧元。在诊断性手术组中，24.7%患有癌症，75.3%有良性病变，每次甲状腺切除术的平均费用为6364欧元。在理想的100例FNA结果不确定的患者队列中，CNB的成本比诊断性手术低33.8%。
CNB可以检测出很大一部分被FNA归类为不确定的良性甲状腺结节。这些患者可以避免诊断性甲状腺切除术，医院可以将手术成本降低三分之一。
