Dataset Information

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.

ABSTRACT:

Background

Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.

Methods

In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.

Findings

Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039).

Interpretation

Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.

Funding

None.

SUBMITTER: Medas F

PROVIDER: S-EPMC10147315 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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Publications

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.

Medas Fabio F Dobrinja Chiara C Al-Suhaimi Ebtesam Abdullah EA Altmeier Julia J Anajar Said S Arikan Akif Enes AE Azaryan Irina I Bains Lovenish L Basili Giancarlo G Bolukbasi Hakan H Bononi Marco M Borumandi Farzad F Bozan Mehmet Buğra MB Brenta Gabriela G Brunaud Laurent L Brunner Maximilian M Buemi Antoine A Canu Gian Luigi GL Cappellacci Federico F Cartwright Sara Burchfield SB Castells Fusté Ignasi I Cavalheiro Beatriz B Cavallaro Giuseppe G Chala Andres A Chan Shun Yan Bryant SYB Chaplin John J Cheema Mustafa Sajjad MS Chiapponi Costanza C Chiofalo Maria Grazia MG Chrysos Emmanuel E D'Amore Annamaria A de Cillia Michael M De Crea Carmela C de Manzini Nicolò N de Matos Leandro Luongo LL De Pasquale Loredana L Del Rio Paolo P Demarchi Marco Stefano MS Dhiwakar Muthuswamy M Donatini Gianluca G Dora Jose Miguel JM D'Orazi Valerio V Doulatram Gamgaram Viyey Kishore VK Eismontas Vitalijus V Kabiri El Hassane EH El Malki Hadj Omar HO Elzahaby Islam I Enciu Octavian O Eskander Antoine A Feroci Francesco F Figueroa-Bohorquez David D Filis Dimitrios D François Gorostidi G Frías-Fernández Pedro P Gamboa-Dominguez Armando A Genc Volkan V Giordano Davide D Gómez-Pedraza Antonio A Graceffa Giuseppa G Griffin James J Guerreiro Sofia Cuco SC Gupta Karan K Gupta Keshav Kumar KK Gurrado Angela A Hajiioannou Jiannis J Hakala Tommi T Harahap Wirsma Arif WA Hargitai Lindsay L Hartl Dana D Hellmann Andrzej A Hlozek Jiri J Hoang Van Trung VT Iacobone Maurizio M Innaro Nadia N Ioannidis Orestis O Jang J H Isabelle JHI Xavier-Junior Jose Candido JC Jovanovic Milan M Kaderli Reto Martin RM Kakamad Fahmi F Kaliszewski Krzysztof K Karamanliev Martin M Katoh Hiroshi H Košec Andro A Kovacevic Bozidar B Kowalski Luiz Paulo LP Králik Robert R Yadav Sanjay Kumar SK Kumorová Adriána A Lampridis Savvas S Lasithiotakis Konstantinos K Leclere Jean-Christophe JC Leong Eugene Kwong Fei EKF Leow Melvin Khee-Shing MK Lim James Y JY Lino-Silva Leonardo S LS Liu Shirley Yuk Wah SYW Llorach Núria Perucho NP Lombardi Celestino Pio CP López-Gómez Javier J Lori Eleonora E Quintanilla-Dieck Lourdes L Lucchini Roberta R Madani Amin A Manatakis Dimitrios D Markovic Ivan I Materazzi Gabriele G Mazeh Haggi H Mercante Giuseppe G Meyer-Rochow Goswin Yason GY Mihaljevic Olgica O Miller Julie A JA Minuto Michele M Monacelli Massimo M Mulita Francesk F Mullineris Barbara B Muñoz-de-Nova José Luis JL Muradás Girardi Fábio F Nader Saki S Napadon Tangjaturonrasme T Nastos Constantinos C Offi Chiara C Ronen Ohad O Oragano Luigi L Orois Aida A Pan Yongqin Y Panagiotidis Emmanouil E Panchangam Ramakanth Bhargav RB Papavramidis Theodosios T Parida Pradipta Kumar PK Paspala Anna A Pérez Òscar Vidal ÒV Petrovic Sabrina S Raffaelli Marco M Ramacciotti Constanza Fernanda CF Ratia Gimenez Tomas T Rivo Vázquez Ángel Á Roh Jong-Lyel JL Rossi Leonardo L Sanabria Alvaro A Santeerapharp Alena A Semenov Arseny A Seneviratne Sanjeewa S Serdar Altinay A Sheahan Patrick P Sheppard Sean C SC Slotcavage Rachel L RL Smaxwil Constantin C Kim Soo Young SY Sorrenti Salvatore S Spartalis Eleftherios E Sriphrapradang Chutintorn C Testini Mario M Turk Yigit Y Tzikos George G Vabalayte Kristina K Vargas-Osorio Kelly K Vázquez Rentería Rafael Sebastián RS Velázquez-Fernández David D Vithana Sanura Malinda Pallegoda SMP Yücel Levent L Yulian Erwin Danil ED Zahradnikova Petra P Zarogoulidis Paul P Ziablitskaia Evgeniia E Zolotoukho Anna A Calò Pietro Giorgio PG

The lancet. Diabetes & endocrinology 20230428 6

<h4>Background</h4>Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.<h4>Methods</h4> ...[more]

PMID: 37127041

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Project description:PurposeTo assess the impact of an [18F]FDG-PET/CT-driven diagnostic workup to rule out malignancy, avoid futile diagnostic surgeries, and improve patient outcomes in thyroid nodules with indeterminate cytology.MethodsIn this double-blinded, randomised controlled multicentre trial, 132 adult euthyroid patients with scheduled diagnostic surgery for a Bethesda III or IV thyroid nodule underwent [18F]FDG-PET/CT and were randomised to an [18F]FDG-PET/CT-driven or diagnostic surgery group. In the [18F]FDG-PET/CT-driven group, management was based on the [18F]FDG-PET/CT result: when the index nodule was visually [18F]FDG-positive, diagnostic surgery was advised; when [18F]FDG-negative, active surveillance was recommended. The nodule was presumed benign when it remained unchanged on ultrasound surveillance. In the diagnostic surgery group, all patients were advised to proceed to the scheduled surgery, according to current guidelines. The primary outcome was the fraction of unbeneficial patient management in one year, i.e., diagnostic surgery for benign nodules and active surveillance for malignant/borderline nodules. Intention-to-treat analysis was performed. Subgroup analyses were performed for non-Hürthle cell and Hürthle cell nodules.ResultsPatient management was unbeneficial in 42% (38/91 [95% confidence interval [CI], 32-53%]) of patients in the [18F]FDG-PET/CT-driven group, as compared to 83% (34/41 [95% CI, 68-93%]) in the diagnostic surgery group (p < 0.001). [18F]FDG-PET/CT-driven management avoided 40% (25/63 [95% CI, 28-53%]) diagnostic surgeries for benign nodules: 48% (23/48 [95% CI, 33-63%]) in non-Hürthle cell and 13% (2/15 [95% CI, 2-40%]) in Hürthle cell nodules (p = 0.02). No malignant or borderline tumours were observed in patients under surveillance. Sensitivity, specificity, negative and positive predictive value, and benign call rate (95% CI) of [18F]FDG-PET/CT were 94.1% (80.3-99.3%), 39.8% (30.0-50.2%), 95.1% (83.5-99.4%), 35.2% (25.4-45.9%), and 31.1% (23.3-39.7%), respectively.ConclusionAn [18F]FDG-PET/CT-driven diagnostic workup of indeterminate thyroid nodules leads to practice changing management, accurately and oncologically safely reducing futile surgeries by 40%. For optimal therapeutic yield, application should be limited to non-Hürthle cell nodules.Trial registration numberThis trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544 .

Project description:Background: Gene panels are routinely used to assess predisposition to hereditary cancers by simultaneously testing multiple susceptibility genes and/or variants. More recently, genetic panels have been implemented as part of solid tumor malignancy testing assessing somatic alterations. One example is targeted variant panels for thyroid nodules that are not conclusively malignant or benign upon fine-needle aspiration (FNA). We systematically reviewed published studies from 2009 to 2018 that contained genetic data from preoperative FNA specimens on cytologically indeterminate thyroid nodules (ITNs) that subsequently underwent surgical resection. Pooled prevalence estimates per gene and variant, along with their respective positive predictive values (PPVs) for malignancy, were calculated. Summary: Our systematic search identified 540 studies that were supplemented by 18 studies from bibliographies or personal files. Sixty-one studies met all inclusion criteria and included >4600 ITNs. Overall, 26% of nodules contained at least 1 variant or fusion. However, half of them did not include details on the specific gene, variant, and/or complete fusion pair reported for inclusion toward PPV calculations. The PPVs of genomic alterations reported at least 10 times were limited to BRAFV600E (98%, 95% confidence interval [CI 96-99%]), PAX8/PPARG (55% [CI 34-78%]), HRASQ61R (45% [CI 22-72%]), BRAFK601E (42% [CI 19-68%]), and NRASQ61R (38% [CI 23-55%]). Excluding BRAFV600E, the pooled PPV for all other specified variants and fusions was 47%. Multiple variants within the same nodule were identified in ∼1% of ITN and carried a cumulative PPV of 77%. Conclusions: The chance that a genomic alteration predicts malignancy depends on the individual variant or fusion detected. Only five alterations were reported at least 10 times; BRAFV600E had a PPV of 98%, while the remaining four had individual PPVs ranging from 38% to 55%. The small sample size of most variants and fusion pairs found among ITNs, however, limits confidence in their individual PPV point estimates. Better specific reporting of genomic alterations with cytological category, histological subtype, and cancer staging would facilitate better understanding of cancer prediction, and the independent contribution of the genomic profile to prognosis.

Dataset Information

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.

Background

Methods

Findings

Interpretation

Funding

Publications

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.

Similar Datasets

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