• 作者：Ignasi Castells^a ; ^{icastells@fhag.es} ; Nú ; ria Pardo^b ; Sebastiá ; n Videla^c ; Gabriel Gim&#233 ; nez^a ; Esteve Llargues^d ; Olga Simó ; ^a ; Marí ; a Asunció ; n Recasens^a ; Xavier Guirao^e ; Xavier Mira^e ; À ; ngel Serrano^b ; Anna Sanmartí ; ^f
• 关键词：Nó ; dulo tiroideo ; Cá ; ncer de tiroides ; Consulta monográ ; fica ; Eficiencia asistencial
• 刊名：Endocrinolog¨ªa y Nutrici¨®n
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：60
• 期：2
• 页码：53-59
• 全文大小：146 K

Introduction

Worldwide incidence of thyroid cancer has increased in recent decades.

Objective

To provide evidence of the diagnostic and care efficiency of a monographic thyroid nodule clinic integrating clinical examination, ultrasound examination, and cytology with on site evaluation.

Patients and methods

Patients attending the monographic thyroid nodule clinic from January 2004 to June 2010. Two periods may be distinguished based on availability of ultrasound equipment at the time of the visit: a first period (P1: 01/2004-09/2007) where no ultrasound equipment was available at the clinic and FNA by palpation was performed, and a second period (P2: 10/2007-06/2010) where this equipment was available and ultrasound-guided FNA was performed.

Results

A total of 1036 patients [P1: 537 (52 % ), P2: 499 (48 % )] were seen and enrolled.

Diagnostic efficiency (P1 vs P2): 143 vs 181 patients were seen annually, p < 0.001; FNA number/nodule: 1.68 vs 1.17, p < 0.001; percent FNAs with inadequate material: 26 % vs 5.3 % , p < 0.001; mean (SD) nodule size: 23.6 (12.4) vs 21.7 (11.7) mm, p 0.040; proportion of nodules examined less than 10 mm in size: 9.9 % vs 13.7 % , p 0.030.

Care efficiency: mean time (range) from the first visit to surgery indication: 332 (0-2177) vs 108 (0-596) days, p < 0.001; proportion of patients referred for surgery due to suspect cytology/other reasons: 1.06 vs 2.21, p < 0.001; and operated benign neoplasm/pathology: 0.47 vs 0.93, p = 0.002.

Conclusion

A monographic thyroid nodule clinic integrating clinical examination, ultrasound, and cytology evaluated on site increases diagnostic and care efficiency in patients with thyroid nodules.