Impact of thyroid surgery volume and pathologic detection on risk of thyroid cancer: A geographical analysis in the Rhône‐Alpes region of France

Abstract

The risk of thyroid cancer, particularly microcancer, is related to the volume of surgery and to the level of pathologist scrutiny. Both factors contribute to the increase in overdiagnosis. This further advocates for appropriate selection of patients for thyroid surgery.

Changes in the Demographic and Clinicopathological Characteristics of Thyroid Cancer: A Population-Based Investigation in Algeria, 1993-2013

“…Iodine deficiency and supplementation may increase the risk of benign thyroid diseases, which may lead to increased rates of thyroid surgery and incidental discovery of subclinical TC [ 50 ]. In addition, differences in risk according to the histologic type have also been associated with iodine intake [ 20 , 21 ].…”

“…When iodine supplementation is introduced in a population with a previous background of iodine deficiency, there is a shift towards an increase in the PTC-to-FTC ratio within 15 to 40 years, with no actual change in the overall TC incidence [ 30 ]. Algeria was iodine-deficient with a high prevalence of endemic goiter [ 50 ]. In 1967, the program of table salt iodization was implemented, first in areas with high prevalence of endemic goiter and nationwide since 1990 [ 51 ].…”

Influence of Care Pathway on Thyroid Nodule Surgery Relevance: A Historical Cohort Study

“…In addition, it can have financial consequences for the patient, as a loan may be more difficult to obtain after a cancer diagnosis. FNAC is recommended in all guidelines [ 7 , 8 , 9 , 10 , 43 ] to help select patients requiring surgery, since studies have reported FNAC to be the most useful tool for preoperative diagnosis of thyroid cancer [ 1 , 35 , 36 , 37 , 38 ]. One of the advantages of the present study is that it allowed the evaluation of guideline compliance and the resulting outcome in real practice, in a nationwide historical cohort study, and on patients managed in or outside hospitals.…”

“…Furthermore, a certain proportion of thyroid cancer in the cohort might have been related to fortuitous discoveries, although this is difficult to assess, since symptoms and pathology analysis were unknown [ 45 , 46 ]. A previous study showed that incidental cancer discovery was more common in multinodular goiter than in thyroid operations for a nodule [ 35 ]. Therefore, we can assume that the proportion of fortuitous cancer findings was higher in the non-optimal care pathway groups, with the proportion of goiters being higher in this group.…”

“…Studies conducted in France in 2010 and in Germany in 2006 found low rates of FNAC prior to thyroid surgery [ 1 , 31 ], while surveys performed in several countries found a heterogeneous management of thyroid nodules [ 32 , 33 , 34 ]. Moreover, if some studies suggest that FNAC is the most selective examination for preoperative cancer diagnosis [ 1 , 35 , 36 , 37 ], the impact of this examination on surgery relevance in real practice still needs to be studied.…”