Kovatch Kevin J, Reyes-Gastelum David, Sipos Jennifer A, Caoili Elaine M, Hamilton Ann S, Ward Kevin C, Haymart Megan R
Department of Otolaryngology-Head & Neck Surgery, Vanderbilt Bill Wilkerson Center, Vanderbilt University, Nashville, Tennessee.
Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor.
JAMA Otolaryngol Head Neck Surg. 2020 Dec 23;147(2):166-72. doi: 10.1001/jamaoto.2020.4471.
Neck ultrasonography, a mainstay of long-term surveillance for recurrence of differentiated thyroid cancer (DTC), is routinely used by endocrinologists, general surgeons, and otolaryngologists; however, physician confidence in their ability to use ultrasonography to identify lymph nodes suggestive of cancer recurrence remains unknown.
To evaluate physicians' posttreatment surveillance practices for DTC recurrence, specifically their use of and confidence in ultrasonography.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 448 physicians in private and academic hospitals who completed a survey on DTC posttreatment practices from October 2018 to August 2019 (response rate, 69%) and self-reported involvement in long-term surveillance for thyroid cancer recurrence. Physicians were identified by patients affiliated with the Surveillance, Epidemiology, and End Results Program registries in Georgia State and Los Angeles County. Of the respondents, 320 physicians who reported involvement with DTC surveillance were included in the analysis.
Physician-reported long-term surveillance practices for DTC, including frequency of use and level of confidence in ultrasonography for detecting lymph nodes suggestive of cancer recurrence.
In the cohort of 320 physicians who reported involvement with DTC surveillance, 186 (60%) had been in practice for 10 years to less than 30 years; 209 (68%) were White; and 212 (66%) were men. The physicians included 170 (56%) endocrinologists, 67 (21%) general surgeons, and 75 (23%) otolaryngologists. Just 84 (27%) physicians reported personally performing bedside ultrasonography. Only 57 (20%) had high confidence (rated quite or extremely confident) in their ability to use bedside ultrasonography to identify lymph nodes suggestive of recurrence; 94 (33%) did not report high confidence in either their ability or a radiologist's ability to use ultrasonography to detect recurrence. Higher confidence in ultrasonography was associated with the general surgery subspecialty (odds ratio [OR], 5.7; 95% CI, 2.2-14.4; reference endocrinology) and with treating a higher number of patients per year (>50 patients: OR, 14.4; 95% CI, 4.4-47.4; 31-50 patients: OR, 8.4; 95% CI, 2.6-26.7; 11-30 patients: OR, 4.3; 95% CI, 1.5-12.1; reference 0-10 patients).
Given the importance of neck ultrasonography in long-term surveillance for thyroid cancer, these findings of physicians' low confidence in their own ability and that of radiologists to use ultrasonography to detect recurrence point to a major obstacle to standardizing long-term DTC surveillance practices.
颈部超声检查是分化型甲状腺癌（DTC）复发长期监测的主要手段，内分泌科医生、普通外科医生和耳鼻喉科医生经常使用；然而，医生对自己使用超声检查来识别提示癌症复发的淋巴结的能力的信心仍不明确。
评估医生对DTC复发的治疗后监测实践，特别是他们对超声检查的使用情况和信心。
设计、背景和参与者：对私立和学术医院的448名医生进行横断面研究，这些医生在2018年10月至2019年8月完成了一项关于DTC治疗后实践的调查（回复率为69%），并自我报告参与了甲状腺癌复发的长期监测。医生是通过佐治亚州和洛杉矶县监测、流行病学和最终结果计划登记处附属的患者确定的。在受访者中，320名报告参与DTC监测的医生被纳入分析。
医生报告的DTC长期监测实践，包括超声检查用于检测提示癌症复发的淋巴结的使用频率和信心水平。
在报告参与DTC监测的320名医生队列中，186名（60%）从业10年至不到30年；209名（68%）为白人；212名（66%）为男性。这些医生包括170名（56%）内分泌科医生、67名（21%）普通外科医生和75名（23%）耳鼻喉科医生。只有84名（27%）医生报告亲自进行床边超声检查。只有57名（20%）医生对自己使用床边超声检查识别提示复发的淋巴结的能力有高度信心（评为非常或极其有信心）；94名（33%）医生对自己或放射科医生使用超声检查检测复发的能力均未报告有高度信心。对超声检查的更高信心与普通外科亚专业相关（优势比[OR]，5.7；95%CI，2.2-14.4；参考内分泌科），以及与每年治疗更多患者相关（>50名患者：OR，14.4；95%CI，4.4-47.4；31-50名患者：OR，8.4；95%CI，2.6-26.7；11-30名患者：OR，4.3；95%CI，1.5-12.1；参考0-10名患者）。
鉴于颈部超声检查在甲状腺癌长期监测中的重要性，这些关于医生对自己和放射科医生使用超声检查检测复发能力信心不足的发现指出了标准化DTC长期监测实践的一个主要障碍。
