Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States

doi:10.1016/j.surg.2013.07.006

Surgery

Volume 154, Issue 6, December 2013, Pages 1420-1427

https://doi.org/10.1016/j.surg.2013.07.006 Get rights and content

Background

To provide population-based estimates of trends in thyroid nodule fine-needle aspirations (FNA) and operative volumes, we used multiple claims databases to quantify rates of these procedures and their association with the increasing incidence of thyroid cancer in the United States.

Method

Private and public insurance claims databases were used to estimate procedure volumes from 2006 to 2011. Rates of FNA and thyroid operations related to thyroid nodules were defined by CPT4 codes associated with International Classification of Diseases, Ninth Revision Clinical Modification codes for nontoxic uni- or multinodular goiter and thyroid neoplasms.

Results

Use of thyroid FNA more than doubled during the 5-year study period (16% annual growth). The number of thyroid operations performed for thyroid nodules increased by 31%. Total thyroidectomies increased by 12% per year, whereas lobectomies increased only 1% per year. In 2011, total thyroidectomies accounted for more than half (56%) of the operations for thyroid neoplasms in the United States. Thyroid operations became increasingly (62%) outpatient procedures.

Conclusion

Thyroid FNA and operative procedures have increased rapidly in the United States, with an associated increase in the incidence of thyroid cancer. The more substantial increase in number of total versus partial thyroid resections suggests that patients undergoing thyroid operation are perceived to have a greater risk of cancer as determined by preoperative assessments, but this trend could also increase detection of incidental microcarcinomas.

Section snippets

Methods

Utilization data were obtained for 2006–2011 from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) and the Thomson Reuters MarketScan Outpatient View database. HCUP is the largest collection of longitudinal inpatient hospital care data in the United States, with all-payer, encounter-level information maintained by the Agency for Healthcare Research and Quality. Outpatient View uses proprietary and public claims as well as federal surveys to construct

Results

Estimates of non-population adjusted, annual thyroid cancer incidence and thyroid cancer-related deaths from the ACS are shown for 2001 to 2013 (Fig 1).¹² During the 12-year period, the incidence of thyroid cancer tripled (209% total increase, 17% APC), whereas thyroid cancer-related deaths increased more slowly (42% total increase, 4% APC). For the 2006–2011 study period, the incidence of thyroid cancer increased from 30,180 to 48,020 (59% total increase, 12% APC), and thyroid cancer-related

Discussion

This report of recent trends in thyroid nodule-related procedures is novel in that it is based on national sampling of both publicly and privately insured populations. The rate of thyroid FNAs is increasing rapidly, consistent with the hypothesis that increased use of more sensitive neck imaging is a key driver of this procedure. In contrast, the rate of thyroid nodule-related operations is not increasing as quickly as the rate of thyroid FNA, consistent with the cost-effective role of FNA

Uncited table

Table I.

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: R.B.L. and J.W.H. are employed by Veracyte. K.A.R. has received institutional research support from Veracyte.

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American Association of Endocrine SurgeonIncreases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States

Background

Method

Results

Conclusion

Section snippets

Methods

Results

Discussion

Uncited table

Am J Surg

Best Pract Res Clin Endocrinol Metab

Surgery

Endocr Pract

J Am Coll Surg

Surgery

Increasing incidence of thyroid cancer in the United States, 1973-2002

JAMA

Thyroid cancer survival in the United States: observational data from 1973 to 2005

Arch Otolaryngol Head Neck Surg

Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005

Cancer

Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980-2005

Cancer Epidemiol Biomarkers Prev

Impact of enhanced detection on the increase in thyroid cancer incidence in the United States: review of incidence trends by socioeconomic status within the surveillance, epidemiology, and end results registry, 1980-2008

Thyroid

American Association of Endocrine Surgeon
Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States