Published on The Journal of the American Medical Asssociation (JAMA) Internal Medicine the systematic review on the most significant studies for a rational and sustainable use of healthcare resources

JAMA Intern Med. 2016 Nov. 1; 176 (11): 1687-1692. doi: 10.1001 / jamainternmed.2016.5381.

 

Last November 2016, JAMA Internal Medicine published a systematic review identifying the 10 most important research studying the abuse and the excessive and not justified recourse to medical assistance. In this prestigious top ten has been included The natural history of benign thyroid nodules. JAMA. 2015; 313 (9): 926-935

It is a study that has involved several clinical and research Italian centers with the active participation of the CORESEARCH team led by Dr. Antonio Nicolucci.

The study focused on the optimal follow-up to be set in the evaluation of asymptomatic thyroid nodules. In particular, those injuries with a benign cytology and those sonographically non suspicious nodules.

Current guidelines recommend serial ultrasound examinations and a cytologic re-evaluation of the nodule in case of volumetric growth.

This study, prospective, observational, evaluated nearly 1,000 consecutive patients recruited from 2006 to 2008 in eight hospital specialized in the study and treatment of thyroid diseases. Patients included in the research were required to have from 1 to 4 asymptomatic and benign lesions as determined by specific cytology and ultrasound. In accordance with the study aims, patients were followed for 5 years until January 2013.

The research has been able to demonstrate that, in such patients, most of the nodules did not show a statistically significant increase in the size and rare were the cases of tumor development.

A similar result clearly induces to consider an appropriate and advantageous review of the guidelines by moderating rate, invasive monitoring, and use of resources in the assessment of the thyroid nodules course before diagnosed as asymptomatic and benign.

 

Bibliography

DJ Morgan, Dhruva SS, Wright SM, Korenstein D. 2016 Update on Medical Overuse: A Systematic Review. JAMA Intern Med. 2016 Nov. 1; 176 (11): 1687-1692. doi: 10.1001 / jamainternmed.2016.5381.

During C, constant G, Lucisano G, Bruno R, D Meringolo, Paciaroni A, Puxeddu And, Torlontano M, Tumino S, M Attard, Lamartina L, Nicolucci A, fillets S. The natural history of benign thyroid nodules. JAMA. 3 March 2015; 313 (9): 926-35. doi: 10.1001 / jama.2015.0956.