Physician Confidence in Neck Ultrasonography for Surveillance of Differentiated Thyroid Cancer Recurrence

Abstract

IMPORTANCE 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.OBJECTIVE To evaluate physicians' posttreatment surveillance practices for DTC recurrence, specifically their use of and confidence in ultrasonography. DESIGN, SETTING, AND PARTICIPANTSCross-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.MAIN OUTCOMES AND MEASURES 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. RESULTSIn 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,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] 8.4; 95% CI,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] 4.3; 95% CI,.1; reference 0-10 patients).CONCLUSIONS AND RELEVANCE 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.

Analysis of the value and safety of thyroid-stimulating hormone in the clinical efficacy of patients with thyroid cancer

“…Therefore, it is of great importance to explore the methods for early diagnosis and treatment of TC. At present, the clinical treatment options for patients with TC mainly include initial thyroidectomy, radioiodine therapy, and long-term suppression of thyroid-stimulating hormone (TSH)[ 3 - 5 ]. TSH is a glycoprotein hormone synthesized and secreted by thyroid cells in the anterior pituitary gland and plays a regulatory role by acting on the thyrotropin receptor (TSHR) on the cell surface.…”

Outcomes of Early Transition of Low-Risk Thyroid Cancer Patients from Specialist to Primary Care

“…Over 80% of thyroid cancer patients present with well-differentiated thyroid cancer which includes papillary and follicular tumours [ 2 ]. After initial surgery and adjuvant treatment, these patients are often followed indefinitely by an endocrinologist who monitors for cancer recurrence through periodic blood tests and neck ultrasounds [ 3 ]. However, with the rising incidence of thyroid cancer, the increased need for post-treatment follow-up among survivors, and the limited number of thyroid cancer specialists; there is the opportunity for primary care physicians (PCP) to play a larger role in providing follow-up care.…”

Increasing Confidence in Detecting Metastatic Thyroid Cancer With Neck Ultrasonography

“…The authors found that only 1 in 5 physicians reported having high confidence in their own ability to use ultrasonography to detect lymph nodes suggestive of recurrence; 3 in 5 reported having high confidence in a radiologist's ability to detect recurrence; and 1 in 3 did not have high confidence in either their own or a radiologist's ability to detect recurrence. 3 As with many other aspects of clinical practice, confidence increases with expertise, resources, and experience. Since only 27% of the physicians in the study by Kovatch and colleagues 3 reported performing ultrasonography themselves, we are not surprised by their low confidence.…”

“…3 As with many other aspects of clinical practice, confidence increases with expertise, resources, and experience. Since only 27% of the physicians in the study by Kovatch and colleagues 3 reported performing ultrasonography themselves, we are not surprised by their low confidence. Those who have elected to have a radiologist obtain and interpret the ultrasonography images may feel daunted by the complexity of detecting suggestive findings or by the high number of neck nodes, which could reduce sensitivity.…”

“…Ultrasonography is the modality of choice for neck nodal surveillance after thyroidectomy for patients with differentiated thyroid cancer (DTC), according to the American Thyroid Association and the European Thyroid Association . In a cross-sectional survey study published in this issue of JAMA Otolaryngology–Head & Neck Surgery , Kovatch and colleagues draw attention to low confidence in ultrasonography among a cohort of 320 endocrinologists, general surgeons, and otolaryngologists. The authors found that only 1 in 5 physicians reported having high confidence in their own ability to use ultrasonography to detect lymph nodes suggestive of recurrence; 3 in 5 reported having high confidence in a radiologist's ability to detect recurrence; and 1 in 3 did not have high confidence in either their own or a radiologist’s ability to detect recurrence …”