Evaluation of a Clinical Pathway for Thyroid Nodular Disease: Timings and Delays in the Diagnosis and Treatment of Thyroid Cancer.

Autor: Sifontes-Dubón M; Doctoral Programme in Medicine Clinical Research, International PhD School of the University of Santiago de Compostela (EDIUS), 15782 Santiago de Compostela, Spain.; Endocrinology Department, Mateu Orfila General Hospital, 07703 Mahón, Spain., García-López JM; Endocrinology Department, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain., González-Ortega N; Pathology Department, Mateu Orfila General Hospital, 07703 Mahón, Spain., Pazos-Couselo M; Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2021 Dec 01; Vol. 10 (23). Date of Electronic Publication: 2021 Dec 01.
DOI: 10.3390/jcm10235681
Abstrakt: Background: Due to the high prevalence of nodular thyroid disease in the general population and the need to rule out malignant tumours, a clinical pathway for nodular thyroid disease was created at our tertiary-level hospital. Our study aimed to quantify timings and delays in diagnosis and treatment in this clinical pathway, specifically for patients who were diagnosed with thyroid cancer.
Methods: A retrospective review was conducted of patients who were newly diagnosed with thyroid cancer and who had been previously evaluated in the clinical pathway for nodular thyroid disease at our institution during 2015-2017. Patient demographics, previous diagnostic studies, cytological results, tumour details and key dates were analysed to identify wait times in diagnosis and treatment.
Results: Forty patients with thyroid cancer were included. The diagnostic delay had a median time of 60 days, and the treatment delay was dependent on cytopathological results. The main cause for delay in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. In the treatment phase, patients with a cytological result of Bethesda III, V or VI underwent surgery at the suggested time, while those in the Bethesda II or IV category did not.
Conclusions: The major delay found in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. We are not suggesting that this step must be eliminated, though the implementation of routine ultrasonography in a thyroid clinic can help identify patients who need more urgent evaluation for fine needle aspiration cytology. In our hospital, decision for surgery is based mainly on the cytopathological report. Imaging studies and/or molecular testing could be considered to reduce treatment delays.
Databáze: MEDLINE
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