Impact of healthcare resources on management of indeterminate thyroid tumors

Abstract

Thyroid nodules are being encountered more and more in clinical practice, occurring in at least 33% of the population. Making a good differential diagnosis between malignant and benign nodules is of utmost importance in clinical management. Fine needle aspiration biopsy (FNAB) is a very useful tool for the assessment of thyroid nodules. With the development of the Bethesda Thyroid Cytopathology Reporting System (TBSRTC), some of the leading problems related to the reporting of thyroid FNA samples and communication between clinicians and cytopathologists have been resolved. The TBSRTC categorizes thyroid FNAB reports under six headings, including three indeterminate categories. The TBSRTC has brought molecular testing into use as an ancillary diagnostic tool for the FNAB cytology, allowing unnecessary operations to be avoided. Performing surgery in low- and middle-income countries has the potential to lead to unwarranted damage and interruptions to the healthcare system. Clinical risk evaluation tools and algorithms must be incorporated into the clinical practice to ensure the personalized management of indeterminate thyroid tumors (ITTs). The international guidelines for the management of thyroid nodules and cancers usually cannot be used when healthcare resource are limited. Healthcare resources play an important role in ITT management. Western countries, which have access to more advanced healthcare resources, make faster diagnostic surgery decisions than Asian countries when encountering indeterminate nodules. From an economic perspective, in when faced with limited healthcare resources, surgery should not be considered as a diagnostic procedure for ITTs. In this review we investigate the impact of healthcare resources on the management of ITTs and the cost-effectiveness of the diagnosis and management options of indeterminate nodules in the light of literature data and the challenges faced in their diagnosis and management. © Annals of Thyroid. All rights reserved.