title: Use of imaging tests after primary treatment of thyroid cancer in the United States: population based retrospective cohort study evaluating death and recurrence.
abstract: OBJECTIVE
  To determine whether the use of imaging tests after primary treatment of differentiated thyroid cancer is associated with more treatment for recurrence and fewer deaths from the disease.
  
  
  METHODS
  Population based retrospective cohort study.
  
  
  METHODS
  Surveillance Epidemiology and End Results-Medicare database in the United States.
  
  
  METHODS
  28 220 patients diagnosed with differentiated thyroid cancer between 1998 and 2011. The study cohort was followed up to 2013, with a median follow-up of 69 months.
  
  
  METHODS
  Treatment for recurrence of differentiated thyroid cancer (additional neck surgery, additional radioactive iodine treatment, or radiotherapy), and deaths due to differentiated thyroid cancer. We conducted propensity score analyses to assess the relation between imaging (neck ultrasound, radioiodine scanning, or positron emission tomography (PET) scanning) and treatment for recurrence (logistic model) and death (Cox proportional hazards model).
  
  
  RESULTS
  From 1998 until 2011, we saw an increase in incident cancer (rate ratio 1.05, 95% confidence interval 1.05 to 1.06), imaging (1.13, 1.12 to 1.13), and treatment for recurrence (1.01, 1.01 to 1.02); the change in death rate was not significant. In multivariable analysis, use of neck ultrasounds increased the likelihood of additional surgery (odds ratio 2.30, 95% confidence interval 2.05 to 2.58) and additional radioactive iodine treatment (1.45, 1.26 to 1.69). Radioiodine scans were associated with additional surgery (odds ratio 3.39, 95% confidence interval 3.06 to 3.76), additional radioactive iodine treatment (17.83, 14.49 to 22.16), and radiotherapy (1.89, 1.71 to 2.10). Use of PET scans was associated with additional surgery (odds ratio 2.31, 95% confidence interval 2.09 to 2.55), additional radioactive iodine treatment (2.13, 1.89 to 2.40), and radiotherapy (4.98, 4.52 to 5.49). Use of neck ultrasounds or PET scans did not significantly affect disease specific survival (hazard ratio 1.14, 95% confidence interval 0.98 to 1.27, and 0.91, 0.77 to 1.07, respectively). However, radioiodine scans were associated with an improved disease specific survival (hazard ratio 0.70, 95% confidence interval 0.60 to 0.82).
  
  
  CONCLUSIONS
  The marked rise in use of imaging tests after primary treatment of differentiated thyroid cancer has been associated with an increased treatment for recurrence. However, with the exception of radioiodine scans in presumed iodine avid disease, this association has shown no clear improvement in disease specific survival. These findings emphasize the importance of curbing unnecessary imaging and tailoring imaging after primary treatment to patient risk.
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA Institute for Healthcare Policy and Innovation (IHPI), University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.affiliation: Endocrine Associates of Dallas, Dallas, TX, USA.
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Wiebel
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Cui
authors.initials: C
authors.lastname: Guo
authors.affiliation: Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Gay
authors.affiliation: Institute for Healthcare Policy and Innovation (IHPI), University of Michigan, Ann Arbor, MI 48109, USA Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA meganhay@med.umich.edu.
authors.forename: Megan R
authors.initials: MR
authors.lastname: Haymart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck / Q000000981:diagnostic imaging*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000379:methods*; D012189:Retrospective Studies; D018426:SEER Program; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome; D014463:Ultrasonography; D014481:United States; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes