title: Imaging Surveillance in Patients After a Benign Fine-Needle Aspiration Biopsy of the Thyroid: Associated Cost and Incidence of Subsequent Cancer.
abstract: OBJECTIVE
  The objective of our study was to determine patterns and cost of imaging tumor surveillance in patients after a benign fine-needle aspiration (FNA) biopsy of the thyroid in a large teaching hospital as well as the rate of subsequent cancer detection.
  
  
  METHODS
  This cohort study was approved by the appropriate institutional review board and complied with HIPAA. All patients who had a benign thyroid FNA biopsy between January 1, 1999, and December 31, 2003, were identified from an institutional pathology database. We gathered information from electronic medical records on imaging tumor surveillance and subsequent cancer detection. Cost was determined using the facility total relative value unit and the 2014 Hospital Outpatient Prospective Payment System conversion factor.
  
  
  RESULTS
  Between January 1, 1999, and December 31, 2003, 1685 patients had a benign thyroid FNA biopsy, 800 (47.5%) of whom underwent follow-up imaging. These patients underwent 2223 thyroid ultrasound examinations, 606 ultrasound-guided thyroid FNA biopsies, 78 thyroid scintigraphy examinations, 168 neck CTs, and 53 neck MRIs at a cost of $529,874, $176,157, $39,622, $80,580, and $53,114, respectively, for a total cost of $879,347 or $1099 per patient. The mean length of follow-up was 7.3 years, during which time 19 (2.4%) patients were diagnosed with thyroid cancer at a cost of $46,281 per cancer. Seventeen (89.5%) were diagnosed with papillary carcinoma and two (10.5%) with Hurthle cell carcinoma.
  
  
  CONCLUSIONS
  Over a 5-year period, about half of the patients who had a benign thyroid FNA biopsy underwent follow-up imaging at considerable cost with a small rate of subsequent malignancy.
authors.affiliation: 1 Department of Radiology, Thomas Jefferson University, Philadelphia, PA.|2 Present address: Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215.
authors.forename: David J S
authors.initials: DJ
authors.lastname: Becker-Weidman
authors.affiliation: 1 Department of Radiology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Neil
authors.initials: N
authors.lastname: Malhotra
authors.affiliation: 3 Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: David F
authors.initials: DF
authors.lastname: Reilly
authors.affiliation: 4 Department of Radiology, Henry Ford Hospital, Detroit, MI.
authors.forename: Naveen
authors.initials: N
authors.lastname: Selvam
authors.affiliation: 1 Department of Radiology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Parker
authors.affiliation: 1 Department of Radiology, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Levon N
authors.initials: LN
authors.lastname: Nazarian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000191:economics* / Q000453:epidemiology; D010414:Pennsylvania / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D014463:Ultrasonography / Q000191:economics* / Q000706:statistics & numerical data; D057832:Watchful Waiting / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult
keywords: fine-needle aspiration (FNA); health care costs; thyroid; thyroid cancer; thyroid cancer incidence