1 Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia.
2 School of Public Health, The University of Queensland, Brisbane, Australia.
Thyroid. 2019 Mar;29(3):341-348. doi: 10.1089/thy.2018.0570.
The incidence of thyroid cancer has rapidly increased, and ecological evidence suggests this is due in some part to over-diagnosis. Understanding pathways to diagnosis could help determine whether unnecessary diagnosis can be avoided.
A population-based sample (n = 1007) of thyroid cancer patients diagnosed between July 2013 and August 2016 was recruited from Queensland, Australia (response rate 67%). Information from structured telephone interviews was used to describe diagnostic pathways for thyroid cancer, to investigate factors associated with diagnostic pathways, and to assess the most prevalent modes of diagnoses by which the lowest-risk, potentially over-diagnosed thyroid cancers (intrathyroidal microcarcinomas) are detected.
Only 38% of participants presented with symptoms potentially related to thyroid cancer. Older age at diagnosis was associated with a lower prevalence of symptomatic diagnosis (prevalence ratio [PR] = 0.46 [confidence interval (CI) 0.31-0.68] for 70-79 vs. <30 years), as was frequent medical contact, while living in rural/regional areas was associated with a higher prevalence of symptomatic diagnosis (PR = 1.17 [CI 1.00-1.37] for rural/regional areas vs. major cities). Symptomatic diagnosis also occurred more for those whose tumors had adverse histopathological features (larger size, lymph node involvement, lymphovascular invasion). The likelihood of diagnosis of intrathyroidal microcarcinomas was greatest for those having surgical resection or monitoring for benign thyroid disease (PR = 3.87 [CI 2.81-5.32] and PR = 2.21 [CI 1.53-3.18], respectively).
A minority of newly detected thyroid cancer cases were diagnosed because of symptoms. Access to medical care and factors related to cancer aggressiveness were associated with how diagnoses occurred. The likelihood of diagnosing the lowest-risk thyroid cancers was higher in situations related to management of other thyroid conditions. Adherence to thyroid management guidelines could reduce some thyroid cancer over-diagnosis, but ultimately better diagnostic tools are needed to differentiate between indolent cancers and those of clinical significance.
甲状腺癌的发病率迅速上升，生态证据表明，部分原因是过度诊断。了解诊断途径有助于确定是否可以避免不必要的诊断。
从澳大利亚昆士兰州招募了 2013 年 7 月至 2016 年 8 月期间诊断的 1007 例甲状腺癌患者的基于人群的样本（应答率为 67%）。使用来自结构化电话访谈的信息来描述甲状腺癌的诊断途径，研究与诊断途径相关的因素，并评估最常见的诊断方式，以发现风险最低、可能过度诊断的甲状腺癌（甲状腺内微癌）。
只有 38%的参与者出现了与甲状腺癌相关的症状。诊断时年龄较大与症状性诊断的患病率较低相关（70-79 岁与<30 岁相比，患病率比 [PR] = 0.46 [95%置信区间 0.31-0.68]），经常接触医疗保健也是如此，而居住在农村/地区与症状性诊断的患病率较高相关（农村/地区与主要城市相比，PR = 1.17 [95%CI 1.00-1.37]）。肿瘤具有不良组织病理学特征（更大的大小、淋巴结受累、血管淋巴管侵犯）的患者也更有可能出现症状性诊断。对于那些进行手术切除或监测良性甲状腺疾病的患者，诊断甲状腺内微癌的可能性最大（PR = 3.87 [95%CI 2.81-5.32]和 PR = 2.21 [95%CI 1.53-3.18]）。
新发现的甲状腺癌病例中，少数是因为症状而被诊断出来的。获得医疗保健和与癌症侵袭性相关的因素与诊断方式有关。在与管理其他甲状腺疾病相关的情况下，诊断最低风险甲状腺癌的可能性更高。遵循甲状腺管理指南可以减少一些甲状腺癌的过度诊断，但最终需要更好的诊断工具来区分惰性癌症和具有临床意义的癌症。
