ATA practice guidelines for the treatment of differentiated thyroid cancer: were they followed in the United States?

作者：Famakinwa Olatokunbo M; Roman Sanziana A^*; Wang Tracy S; Sosa Julie Ann

来源：American Journal of Surgery, 2010, 199(2): 189-198.

DOI：10.1016/j.amjsurg.2009.04.022

• Differentiated thyroid cancer
• American Thyroid Association guidelines
• Thyroidectomy
• Radioactive iodine
• Lymphadenectomy

BACKGROUND: The aim of this study was to benchmark national practice patterns against American Thyroid Association guidelines for thyroidectomy, lymphadenectomy, and radioactive iodine (RAI) for differentiated thyroid cancer (DTC).
METHODS: A cross-sectional analysis of patients with DTC in Surveillance, Epidemiology, and End Results was performed. Outcomes were practice accordance with guidelines for extent of surgery and RAI treatment. Predictors of accordance were identified.
RESULTS: A total of 52,964 patients with DTC were included. Seventy-six percent were women, and 83% white. There was 71% accordance with surgery recommendations; among these, 15% underwent central lymphadenectomy, 31% had RAI but no lymphadenectomy, and 25% had RAI and lymphadenectomy. The highest accordance with guidelines was for patients aged <45 years with stage II disease (80%); the lowest accordance was for patients aged 45 years with stage II disease (52%). Patients aged >65 years and of black race had the lowest accordance (P < .001).
CONCLUSIONS: Variation in practice suggests variation in the quality of care for DTC. Greater dissemination of evidence-based recommendations is needed for elderly and minority patients.

• 出版日期2010-2