临床实践中的地区差异对甲状腺癌诊断的影响：一项基于全国人口的研究。
The Impact of Regional Variation in Clinical Practice on Thyroid Cancer Diagnosis: A National Population-Based Study.
作者信息
Decallonne Brigitte, Van den Bruel Annick, Macq Gilles, Elaut Nathalie, De Schutter Harlinde
机构信息
Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
Department of Endocrinology, General Hospital St Jan, Bruges, Belgium.
出版信息
Eur Thyroid J. 2020 Jan;9(1):32-39. doi: 10.1159/000504046. Epub 2019 Nov 21.
OBJECTIVE
Regional variation in thyroid cancer incidence in Belgium, most pronounced for low risk cancer, was previously shown to be related to variation in clinical practice, with higher thyroid surgery rates and lower proportions of preoperative fine-needle aspiration (FNA) in regions with high thyroid cancer incidence (period 2004-2006). The objective of this study was to investigate regional thyroid cancer incidence variation in relation with variation in thyroid surgery threshold in a more recent Belgian thyroid cancer cohort.
METHODS
A population-based cohort of thyroid cancer patients that underwent a (near) total thyroidectomy in the period 2009-2011 ( = 2,329 patients) was identified and studied by linking data from the Belgian cancer registry and the Belgian health insurance companies, and case-by-case study of the pathology protocols. The execution of preoperative FNA and the thyroid resection specimen weight were compared between high and low thyroid cancer incidence regions. Thyroid weight in the pT1a-restricted group was studied as a proxy for surgical threshold for benign nodular goiter. Furthermore, time trend analyses were performed for the execution of FNA for the period 2004-2012.
RESULTS
Although a lower proportion of FNA in the high thyroid cancer incidence region persisted in the period 2009-2011 (41.2% [31.9-50.9] vs. 72.9% [64.9-79.7] in the low-incidence region (LIR), < 0.001), a positive time trend was observed for the period 2004-2012. The median thyroid surgical specimen weight was lower in the high incidence region compared to the LIR (27.0 g [IQR 18.0-45.3] vs. 36.0 g [IQR 22.0-73.0], < 0.0001), and this finding was corroborated in the pT1a-restricted group.
CONCLUSION
Interregional differences in use of FNA and surgical thyroid specimen weight are consistent with an inverse relation between thyroid cancer incidence and thyroid surgery threshold, carrying risk for overdiagnosis.
目的
先前研究表明，比利时甲状腺癌发病率存在地区差异，在低风险癌症中最为明显，这与临床实践差异有关，在甲状腺癌发病率高的地区（2004 - 2006年期间），甲状腺手术率较高，术前细针穿刺（FNA）比例较低。本研究的目的是在一个更新的比利时甲状腺癌队列中，调查与甲状腺手术阈值变化相关的地区甲状腺癌发病率差异。
方法
通过链接比利时癌症登记处和比利时健康保险公司的数据，并逐例研究病理方案，确定并研究了2009 - 2011年期间接受（近）全甲状腺切除术的基于人群的甲状腺癌患者队列（n = 2329例患者）。比较了甲状腺癌发病率高和低的地区术前FNA的实施情况以及甲状腺切除标本的重量。研究了pT1a限制组中的甲状腺重量，作为良性结节性甲状腺肿手术阈值的替代指标。此外，对2004 - 2012年期间FNA的实施情况进行了时间趋势分析。
结果
尽管在2009 - 2011年期间，甲状腺癌发病率高的地区FNA比例仍然较低（41.2% [31.9 - 50.9]，而低发病率地区（LIR）为72.9% [64.9 - 79.7]，P < 0.001），但在2004 - 2012年期间观察到了积极的时间趋势。与LIR相比，高发病率地区甲状腺手术标本的中位数重量较低（27.0 g [IQR 18.0 - 45.3] vs. 36.0 g [IQR 22.0 - 73.0]，P < 0.0001），这一发现在pT1a限制组中得到了证实。
结论
FNA使用和甲状腺手术标本重量的地区差异与甲状腺癌发病率和甲状腺手术阈值之间的负相关一致，存在过度诊断风险。
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