Evaluation of thyroid nodules in the Brazilian Public Health Care System, Supplementary Health System, and Private Health System in the northeastern region of the State of São Paulo.

Ana Paula Figueiredo Engler Goulart,Eduardo Ruas Martins Batista,Patrícia Künzle Ribeiro Magalhães,Marcos Gomes Figueira,Léa Maria Zanini Maciel

doi:10.20945/2359-3997000000294

Abstract

To obtain data about the evaluation of thyroid nodules (TNs) in the northeastern of the State of São Paulo, compared by health care type, and measure the performance of cytology as a screening test for thyroid cancer (TC). We collected data of 597 patients treated in the Brazilian public health care system (SUS), supplementary health (SH) and in private health system (PHS) in 2014. A total of 803 TNs were aspirated, and 125 patients underwent surgery. The distribution of all cytologic results according to the Bethesda system was: I, 135 (16.8%); II, 475 (59.2%); III, 107 (13.3%); IV, 32 (4.0%); V, 20 (2.5%); VI, 34 (4.2%). The time between cytologic analysis and surgery was longer in the SUS than in the SH for TNs in general (p < 0.001) and for TNs with Bethesda V and VI cytology (p = 0.01). The sizes of the TNs and resected malignant TNs was larger in the SUS than in the SH (p = 0.001 and p = 0.02, respectively). The number of PHS surgeries was too small and was not compared. The prevalence of TC was 9.2% and 23.6% of them were treated in the SUS. Cytology showed a 93.6% sensitivity, 95.8% specificity, and 94.7% accuracy when Bethesda III and IV were excluded. Cytology was a good screening test for TC categories Bethesda II, V, and VI. The differences between the SUS and SH indicate a need for improved access to consultations and specialized tests in the SUS.

Highlights

Thyroid nodules (TNs) represent a common clinical scenario and are detected in approximately 5% of women and 1% of men on cervical palpation [1] and up to 19–68% of the individuals on cervical ultrasound (US) [1,2].The evaluation of patients with TNs begins with clinical assessment followed by laboratory tests including serum TSH measurement, cervical US, cytologic analysis, and, eventually, molecular tests [1,3,4].Cervical US is an essential test for the evaluation of TNs since it is accessible, noninvasive, and cost-effective [5]
Data of patients with TNs submitted to fine-needle aspiration biopsy (FNAB) from January 1, 2014, through December 31, 2014, were collected at the three pathology services located in the municipality of Franca
In the present study including 597 patients, the proportion of patients submitted to FNAB in the SUS and the supplementary health (SH) (38.3% versus 52.3%, respectively) differed from the proportion of patients with SUS and SH coverage in the DRS VIII region (64.3% and 35.7%, respectively)

Summary

INTRODUCTION

Thyroid nodules (TNs) represent a common clinical scenario and are detected in approximately 5% of women and 1% of men on cervical palpation [1] and up to 19–68% of the individuals on cervical ultrasound (US) [1,2]. The objective of the present study was to provide data about the diagnosis and treatment of nodular thyroid disease in the northeastern region of the State of São Paulo (SP) in relation to the types of health care, comparing the SUS, the SH and the PHS, assess the performance of cytologic analysis as a screening test for TC and determine the prevalence of TC in the study sample. Data of patients with TNs submitted to FNAB from January 1, 2014, through December 31, 2014, were collected at the three pathology services located in the municipality of Franca These services handle all cytological and histological analyses of DRS VIII, which are performed by the same pathologists.

RESULTS

55 TC cases

DISCUSSION