Hospital of Limoges, Limoges, France.
Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France.
BMJ Open. 2017 Apr 7;7(4):e013589. doi: 10.1136/bmjopen-2016-013589.
The rate of thyroid cancer is increasing in France, as well as concerns about overdiagnosis and treatment.
To examine the care pathway of patients who undergo thyroid surgery in France and detect potential pitfalls.
A large observational study based on medical reimbursements, 2009-2011.
Data from the Sniiram (National Health Insurance Information System).
Patients with thyroid surgery in 2010, classified into 4 groups: thyroid cancer, benign nodule, goitre or multiple nodules, other (hyperthyroidism, head-neck cancer).
Medical investigations during, prior and after thyroidectomy.
A total of 35 367 patients underwent surgery (mean age 51 years, 80% women): 17% had a reported diagnosis of thyroid cancer, 20% benign nodule, 38% goitre or multiple nodules and 25% another diagnosis. The ratio of thyroidectomies with cancer over thyroidectomies with benign nodule was 0.8 and varied across regions. In the year preceding surgery, 82% of patients had an investigation by thyroid ultrasonography, 21% thyroid scintigraphy, 34% fine-needle aspiration cytology, 40% serum calcitonin assay and 54% serum calcium assay. In the following year, all patients with total thyroidectomy and 44% of patients with partial thyroidectomy and a diagnosis of benign nodule were taking thyroid hormone therapy. 100 patients had been reoperated for a compressive haematoma and 63 died during the first month, half of whom had been operated for cancer. Mean rates of recurrent laryngeal nerve injury and hypocalcaemia (requiring blood tests plus treatments within 4-12 months) were estimated at 1.5% and 3.4%, respectively, and were higher in the cancer group (2.3% and 5.7%).
This almost nationwide study demonstrates the suboptimal management of patients prior to thyroidectomy in France. It suggests overdiagnosis and potential harms to patients, and calls for a review of the relevance of thyroidectomy, particularly with regard to microcancers.
法国的甲状腺癌发病率正在上升，同时人们也对过度诊断和治疗感到担忧。
检查法国甲状腺手术患者的治疗途径，并发现潜在的问题。
基于医疗报销数据的大型观察性研究，时间为 2009-2011 年。
Sniiram（国家健康保险信息系统）的数据。
2010 年接受甲状腺手术的患者，分为 4 组：甲状腺癌、良性结节、甲状腺肿或多个结节、其他（甲状腺功能亢进、头颈部癌症）。
甲状腺切除术期间、之前和之后的医疗检查。
共有 35367 名患者接受了手术（平均年龄 51 岁，80%为女性）：17%有甲状腺癌的报告诊断，20%为良性结节，38%为甲状腺肿或多个结节，25%为其他诊断。甲状腺癌切除术与良性结节切除术的比例为 0.8，且在不同地区有所差异。在手术前一年，82%的患者进行了甲状腺超声检查，21%进行了甲状腺闪烁扫描，34%进行了细针抽吸细胞学检查，40%进行了降钙素检测，54%进行了血钙检测。在接下来的一年中，所有行全甲状腺切除术的患者和 44%行部分甲状腺切除术且诊断为良性结节的患者都接受了甲状腺激素治疗。100 名患者因压迫性血肿而再次手术，63 名患者在术后第一个月死亡，其中一半为癌症患者。估计喉返神经损伤和低钙血症（需要在 4-12 个月内进行血液检查和治疗）的发生率分别为 1.5%和 3.4%，且在癌症组中更高（2.3%和 5.7%）。
这项几乎覆盖全国的研究表明，法国在甲状腺切除术之前对患者的管理不够理想。这表明存在过度诊断和对患者的潜在危害，并呼吁重新评估甲状腺切除术的必要性，特别是对于微小癌症。
