Na Hyun Kim, Jong Soo Han, Woo Kyung Bae, Joo Young Kim, Kiheon Lee, Hyejin Lee, Kee Hyuck Lee, Se Young Jung, HanKyung Lee, Hee-Yeong Jeong, Young A Kim, Suyoun Sim, Ji-Won Kang
Korean J Fam Med 2022;43(4):225-230. Published online July 19, 2022
Background Since the era of “thyroid cancer epidemic,” many Korean academic societies discouraged the use of ultrasonography in healthy individuals and revised the Korean Thyroid Imaging Reporting and Data System to address the overscreening and overdiagnosis issues. This study aimed to evaluate the change in the diagnostic effectiveness of thyroid cancer screening over the last decade.
Methods This single-center, retrospective observational study analyzed the data of 125,962 thyroid nodules obtained during cancer screening at the health promotion center of Seoul National University Bundang Hospital from 2010 to 2019. Only 327 thyroid cancer cases pathologically confirmed by fine-needle aspiration (FNA) were included in the study. The strength of the association between the number of FNA and (1) the number of thyroid cancer diagnoses, (2) the positive predictive values (PPVs), and (3) the difference in PPV from the previous year were evaluated using Pearson’s correlation analysis.
Results The number of thyroid FNA biopsies as well as the thyroid cancer diagnoses decreased from 2010 to 2019 (166 to 48 [-71.1%] vs. 43 to 22 [-48.8%]). The PPV of FNA biopsies increased from 25.9% to 45.8% (+76.8%) and was negatively correlated with the number of FNA biopsies performed (R=-0.87, P<0.001). The difference in PPV from the previous year increased similarly but without statistical significance (R=-0.59, P=0.09).
Conclusion The diagnostic efficiency of thyroid cancer screening has increased over the last decade, as evidenced by the increasing PPV of FNA biopsies.
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Increasing thyroid cancer incidence is due to the increased detection of small papillary cancers and may not interpreted as an increase in the true occurrence of disease. Further workup of thyroid incidentalomas—impalpable nodules detected fortuitously during a radiological investigation—may contribution of the increasing thyroid cancer. Screening asymptomatic adults or children for thyroid cancer using either neck palpation or ultrasonography is not recommended in the US Preventive Services Task Force and the Korean lifetime health maintenance program. Generally, only thyroid incidentalomas > 1 cm should be evaluated, since they have a greater potential to be clinically significant cancers and thyroid nodules < 1 cm that require evaluation because of suspicious US findings, associated lymphadenopathy, a history of head and neck irradiation, or a history of thyroid cancer in one or more first-degree relatives
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