Castellnou Solène, Lifante Jean-Christophe, Polazzi Stéphanie, Pascal Léa, Borson-Chazot Françoise, Duclos Antoine
Endocrinology Department, Groupement Hospitalier Est, Hospices Civils de Lyon, 69500 Bron, France.
Endocrine Surgery Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre Bénite, France.
J Clin Med. 2020 Jul 17;9(7):2271. doi: 10.3390/jcm9072271.
Guidelines recommend using fine-needle aspiration cytology (FNAC) to guide thyroid nodule surgical indication. However, the extent to which these guidelines are followed remains unclear. This study aimed to analyze the quality of the preoperative care pathway and to evaluate whether compliance with the recommended care pathway influenced the relevance of surgical indications.
Nationwide historical cohort study based on data from a sample (1/97th) of French health insurance beneficiaries. Evaluation of the care pathway of adult patients operated on between 2012 and 2015 during the year preceding thyroid nodule surgery. The pathway containing only FNAC was called "FNAC", the pathway including an endocrinology consultation (ENDO) with FNAC was called "FNAC+ENDO", whereas the no FNAC pathway was called "NO FNAC". The main outcome was the malignant nature of the nodule.
Among the 1080 patients included in the study, "FNAC+ENDO" was found in 197 (18.2%), "FNAC" in 207 (19.2%), and "NO FNAC" in 676 (62.6%) patients. Cancer diagnosis was recorded in 72 (36.5%) "FNAC+ENDO" patients and 66 (31.9%) "FNAC" patients, against 119 (17.6%) "NO FNAC" patients. As compared to "NO FNAC", the "FNAC+ENDO" care pathway was associated with thyroid cancer diagnosis (OR 2.67, 1.88-3.81), as was "FNAC" (OR 2.09, 1.46-2.98). Surgeries performed in university hospitals were also associated with thyroid cancer diagnosis (OR 1.61, 1.19-2.17). Increasing the year for surgery was associated with optimal care pathway (2015 vs. 2012, OR 1.52, 1.06-2.18).
The recommended care pathway was associated with more relevant surgical indications. While clinical guidelines were insufficiently followed, compliance improved over the years.
指南推荐使用细针穿刺细胞学检查（FNAC）来指导甲状腺结节的手术指征。然而，这些指南的遵循程度仍不明确。本研究旨在分析术前护理路径的质量，并评估遵循推荐的护理路径是否会影响手术指征的相关性。
基于法国健康保险受益人的样本（1/97）数据进行的全国性历史队列研究。对2012年至2015年期间在甲状腺结节手术前一年接受手术的成年患者的护理路径进行评估。仅包含FNAC的路径称为“FNAC”，包括内分泌科会诊（ENDO）和FNAC的路径称为“FNAC+ENDO”，而无FNAC的路径称为“无FNAC”。主要结局是结节的恶性性质。
在纳入研究的1080例患者中，197例（18.2%）采用“FNAC+ENDO”，207例（19.2%）采用“FNAC”，676例（62.6%）采用“无FNAC”。“FNAC+ENDO”组72例（36.5%）患者和“FNAC”组66例（31.9%）患者诊断为癌症，而“无FNAC”组为119例（17.6%）。与“无FNAC”相比，“FNAC+ENDO”护理路径与甲状腺癌诊断相关（比值比[OR]2.67，1.88 - 3.81），“FNAC”也是如此（OR 2.09，1.46 - 2.98）。在大学医院进行的手术也与甲状腺癌诊断相关（OR 1.61，1.19 - 2.17）。手术年份增加与最佳护理路径相关（2015年与2012年相比，OR 1.52，1.06 - 2.18）。
推荐的护理路径与更相关的手术指征相关。虽然临床指南的遵循情况不足，但多年来依从性有所改善。
