(n = 7700) Age < 20 20 29 30 39 40 49 50 59 60 69 70 79 > = 80 Gender Male Female Initial Diagnosis Thyrotoxicosis Hypothyroidism Diffuse goiter Nodular goiter Multinodular goiter Unspecified goiter Neoplasm of thyroid Thyroid cyst Acute thyroiditis Subacute thyroiditis Chronic lymphocytic thyroiditis Other thyroiditis Other thyroid disorders Not specified* Hospital Medical Center Beclabuvir mechanism of action Regional Hospital Area Hospital Clinic Physician Endocrinology Surgery Internal medicine Otolaryngology Family medicine Others * Thyroid related Thonzonium (bromide) chemical information diagnoses were not recorded. doi:10.1371/journal.pone.0127354.t001 4756 (61.8) 1044 (13.6) 909 (11.8) 650 (8.4) 288 (3.7) 53 (0.7) 4607 (96.9) 988 (94.6) 883 (97.1) 620 (95.4) 276 (95.8) 50 (94.3) 149 (3.1) 56 (5.4) 26 (2.9) 30 (4.6) 12 (4.2) 3 (5.7) 3658 (47.5) 2757 (35.8) 1128 (14.6) 157 (2.0) 3523 (96.3) 2658 (96.4) 1089 (96.5) 154 (98.1) 135 (3.7) 99 (3.6) 39 (3.5) 3 (1.9) 0.006 451 (5.9) 95 (1.2) 304 (3.9) 1878 (24.4) 537 (7.0) 2459 (31.9) 379 (4.9) 132 (1.7) 4 (0.1) 80 (1.0) 127 (1.6) 31 (0.4) 588 (7.6) 635 (8.2) 445 (98.7) 94 (98.9) 300 (98.7) 1797 (95.7) 513 (95.5) 2365 (96.2) 360 (95.0) 129 (97.7) 3 (75.0) 80 (100.0) 125 (98.4) 30 (96.8) 567 (96.4) 616 (97.0) 6 (1.3) 1 (1.1) 4 (1.3) 81 (4.3) 24 (4.5) 94 (3.8) 19 (5.0) 3 (2.3) 1 (25.0) 0 (0.0) 2 (1.6) 1 (3.2) 21 (3.6) 19 (3.0) 0.69 1291 (16.8) 6409 (83.2) 1240 (96.0) 6184 (96.5) 51 (4.0) 225 (3.5) 0.004 168 (2.2) 671 (8.7) 1302 (16.9) 1945 (25.3) 2061 (26.8) 978 (12.7) 481 (6.2) 94 (1.2) 162 (96.4) 641 (95.5) 1240 (95.2) 1863 (95.8) 1998 (96.9) 954 (97.5) 472 (98.1) 94 (100.0) 6 (3.6) 30 (4.5) 62 (4.8) 82 (4.2) 63 (3.1) 24 (2.5) 9 (1.9) 0 (0.0) 0.43 Benign (n = 7424) Malignancy (n = 276) p-value rstb.2015.0074 0.Among the 276 thyroid cancer patients who underwent thyroid pnas.1408988111 aspiration evaluation, 70.7 of the thyroid malignancies were identified within half a year. The cumulative diagnosis rate increased to 81.2 and 92.0 by the end of year one and year two, respectively. TherePLOS ONE | DOI:10.1371/journal.pone.0127354 May 28,5 /Thyroid FNA and Thyroid Cancer DiagnosisTable 2. Time from first thyroid fine-needle aspiration to thyroid cancer diagnosis. Time to diagnosis < 1 month 1 3 month 3 6 month 0.5 1 year 1 2 year 2 3 year 3 4 year 4 5 year 5 6 year doi:10.1371/journal.pone.0127354.t002 No. of patients (n) 65 100 30 29 30 12 6 1 3 Cancer ( ) 23.6 36.2 10.9 10.5 10.9 4.3 2.2 0.4 1.1 Cumulative ( ) 23.6 59.8 70.7 81.2 92.0 96.4 98.6 98.9 100.0 Undiagnosed ( ) 76.4 40.2 29.3 18.8 8.0 3.6 1.4 1.1 0.were 8.0 and 3.6 of thyroid cancer cases undiagnosed at the end of year two and year three, respectively (Table 2). Among the 276 malignant cases, 61.6 underwent only one aspiration biopsy, while 21.0 received a second aspiration before their final diagnoses of cancer and 9.8 of patients need more than three aspirations before cancer was diagnosed (Table 3). The median time to cancer diagnosis, calculated by Kaplan-Meier survival analysis, was shortest among patients with extremely high follow-up intensity (0.13 years), followed by patients with high (1.21 years), medium (1.88 years), and low (3.25 years) follow-up intensity. These were statistically different (p<0.0001) (Table 4). In the Cox proportional hazard model, older age (HR 1.01, 95 CI 1.00?.02), male sex (HR 1.18, 95 CI 1.00?.38), higher aspiration frequency (HR 1.07, 95 CI 1.06?.08), higher ultrasound frequency (HR 1.02, 95 CI 1.01?.03), and physician specialty of surgery (HR 2.55, 95 CI 1.39?.02), endocrinolog.(n = 7700) Age < 20 20 29 30 39 40 49 50 59 60 69 70 79 > = 80 Gender Male Female Initial Diagnosis Thyrotoxicosis Hypothyroidism Diffuse goiter Nodular goiter Multinodular goiter Unspecified goiter Neoplasm of thyroid Thyroid cyst Acute thyroiditis Subacute thyroiditis Chronic lymphocytic thyroiditis Other thyroiditis Other thyroid disorders Not specified* Hospital Medical Center Regional Hospital Area Hospital Clinic Physician Endocrinology Surgery Internal medicine Otolaryngology Family medicine Others * Thyroid related diagnoses were not recorded. doi:10.1371/journal.pone.0127354.t001 4756 (61.8) 1044 (13.6) 909 (11.8) 650 (8.4) 288 (3.7) 53 (0.7) 4607 (96.9) 988 (94.6) 883 (97.1) 620 (95.4) 276 (95.8) 50 (94.3) 149 (3.1) 56 (5.4) 26 (2.9) 30 (4.6) 12 (4.2) 3 (5.7) 3658 (47.5) 2757 (35.8) 1128 (14.6) 157 (2.0) 3523 (96.3) 2658 (96.4) 1089 (96.5) 154 (98.1) 135 (3.7) 99 (3.6) 39 (3.5) 3 (1.9) 0.006 451 (5.9) 95 (1.2) 304 (3.9) 1878 (24.4) 537 (7.0) 2459 (31.9) 379 (4.9) 132 (1.7) 4 (0.1) 80 (1.0) 127 (1.6) 31 (0.4) 588 (7.6) 635 (8.2) 445 (98.7) 94 (98.9) 300 (98.7) 1797 (95.7) 513 (95.5) 2365 (96.2) 360 (95.0) 129 (97.7) 3 (75.0) 80 (100.0) 125 (98.4) 30 (96.8) 567 (96.4) 616 (97.0) 6 (1.3) 1 (1.1) 4 (1.3) 81 (4.3) 24 (4.5) 94 (3.8) 19 (5.0) 3 (2.3) 1 (25.0) 0 (0.0) 2 (1.6) 1 (3.2) 21 (3.6) 19 (3.0) 0.69 1291 (16.8) 6409 (83.2) 1240 (96.0) 6184 (96.5) 51 (4.0) 225 (3.5) 0.004 168 (2.2) 671 (8.7) 1302 (16.9) 1945 (25.3) 2061 (26.8) 978 (12.7) 481 (6.2) 94 (1.2) 162 (96.4) 641 (95.5) 1240 (95.2) 1863 (95.8) 1998 (96.9) 954 (97.5) 472 (98.1) 94 (100.0) 6 (3.6) 30 (4.5) 62 (4.8) 82 (4.2) 63 (3.1) 24 (2.5) 9 (1.9) 0 (0.0) 0.43 Benign (n = 7424) Malignancy (n = 276) p-value rstb.2015.0074 0.Among the 276 thyroid cancer patients who underwent thyroid pnas.1408988111 aspiration evaluation, 70.7 of the thyroid malignancies were identified within half a year. The cumulative diagnosis rate increased to 81.2 and 92.0 by the end of year one and year two, respectively. TherePLOS ONE | DOI:10.1371/journal.pone.0127354 May 28,5 /Thyroid FNA and Thyroid Cancer DiagnosisTable 2. Time from first thyroid fine-needle aspiration to thyroid cancer diagnosis. Time to diagnosis < 1 month 1 3 month 3 6 month 0.5 1 year 1 2 year 2 3 year 3 4 year 4 5 year 5 6 year doi:10.1371/journal.pone.0127354.t002 No. of patients (n) 65 100 30 29 30 12 6 1 3 Cancer ( ) 23.6 36.2 10.9 10.5 10.9 4.3 2.2 0.4 1.1 Cumulative ( ) 23.6 59.8 70.7 81.2 92.0 96.4 98.6 98.9 100.0 Undiagnosed ( ) 76.4 40.2 29.3 18.8 8.0 3.6 1.4 1.1 0.were 8.0 and 3.6 of thyroid cancer cases undiagnosed at the end of year two and year three, respectively (Table 2). Among the 276 malignant cases, 61.6 underwent only one aspiration biopsy, while 21.0 received a second aspiration before their final diagnoses of cancer and 9.8 of patients need more than three aspirations before cancer was diagnosed (Table 3). The median time to cancer diagnosis, calculated by Kaplan-Meier survival analysis, was shortest among patients with extremely high follow-up intensity (0.13 years), followed by patients with high (1.21 years), medium (1.88 years), and low (3.25 years) follow-up intensity. These were statistically different (p<0.0001) (Table 4). In the Cox proportional hazard model, older age (HR 1.01, 95 CI 1.00?.02), male sex (HR 1.18, 95 CI 1.00?.38), higher aspiration frequency (HR 1.07, 95 CI 1.06?.08), higher ultrasound frequency (HR 1.02, 95 CI 1.01?.03), and physician specialty of surgery (HR 2.55, 95 CI 1.39?.02), endocrinolog.
