Triggers of thyroid cancer diagnosis: a systematic review and meta-analysis
Open accessAbstract
Purpose Understanding the method of thyroid cancer detection has potential implications on interpreting incidence rates, the diagnosis and management of thyroid cancer. We conducted a systematic review of studies reporting methods of thyroid cancer detection to estimate the frequency of incidentally found cancers and classify triggers of incidental thyroid cancer diagnosis.Methods We searched multiple bibliographic databases from inception to June 2020. A pair of reviewers, working independently and in duplicate selected studies for inclusion, extracted data, and evaluated each trial's risk of bias. Studies enrolling patients older than 18 years with thyroid cancer confirmed histologically were included.Results In total, 17 cohorts and 1 cross-sectional study, conducted between 1991 and 2018, enrolling 4668 patients with thyroid cancer were included: 88% had papillary thyroid cancer and 23% had papillary thyroid microcarcinoma. The proportion of patients with non-incidental and incidental thyroid cancer was similar: 49% [95% confidence interval (CI): 40-58%]. Subgroup analysis showed that most patients with incidental thyroid cancers had tumor size <10 mm (76%; 95% CI: 56-92%), age >45 (61%; 95% CI: 56-67%), and were detected through imaging (35%; 95% CI: 26-45%), of which ultrasound was the most common modality (27%; 95% CI: 14-43%). The heterogeneity for all the effect sizes was large and significant.Conclusions About half of thyroid cancers were found incidentally through the use of imaging studies, in particular neck ultrasound. These incidentally found cancers were mostly small papillary thyroid cancer. These results highlight opportunities for interventions aimed at reducing drivers of overdiagnosis.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Thyroid cancer diagnosis is an outcome prone to over-detection owing to medical surveillance.
“In other words, thyroid cancer diagnosis is an outcome that is prone to over-detection owing to medical surveillance, an important covariate to be assessed in clinical studies.40,41”
From Glucagon-Like Peptide-1 Receptor Agonists and Thyroid Cancer: A Narrative Review (2024) · cites this paper as [41]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552 · see citing works
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164 · see citing works
Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y. E., Pacini, F., Randolph, G. W., Sawka, A. M., Schlumberger, M., et al. (2016) · Thyroid® · doi:10.1089/thy.2015.0020 · Cited by 16,535 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00136 · Cited by 10,349 · see citing works
THE USE OF CONFIDENCE OR FIDUCIAL LIMITS ILLUSTRATED IN THE CASE OF THE BINOMIAL
Clopper, C. J., & Pearson, E. S. (1934) · Biometrika · doi:10.1093/biomet/26.4.404 · Cited by 5,106 · see citing works
Transformations Related to the Angular and the Square Root
Freeman, M. F., & Tukey, J. W. (1950) · The Annals of Mathematical Statistics · doi:10.1214/aoms/1177729756 · Cited by 2,634 · see citing works
Herzog, R., Álvarez-Pasquin, M. J., Díaz, C., Del Barrio, J. L., Estrada, J. M., & Gil, Á. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-154 · Cited by 1,652 · see citing works
Current Thyroid Cancer Trends in the United States
Davies, L., & Welch, H. G. (2014) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2014.1 · Cited by 1,619 · see citing works
Luchini, C., Stubbs, B., Solmi, M., & Veronese, N. (2017) · World Journal of Meta-Analysis · doi:10.13105/wjma.v5.i4.80 · Cited by 977 · see citing works
Ottawa Hospital Research Institute
Bouhassira, E. E. (2015) · Sage eBooks · doi:10.4135/9781483347660.n335 · Cited by 851 · see citing works
An Observational Trial for Papillary Thyroid Microcarcinoma in Japanese Patients
Ito, Y., Miyauchi, A., Inoue, H., Fukushima, M., Kihara, M., Higashiyama, T., Tomoda, C., Takamura, Y., Kobayashi, K., & Miya, A. (2009) · World Journal of Surgery · doi:10.1007/s00268-009-0303-0 · Cited by 809 · see citing works
International patterns and trends in thyroid cancer incidence, 1973–2002
Aschebrook‐Kilfoy, B., Zheng, T., Holford, T. R., Han, X., Ward, M. H., Sjödin, A., Zhang, Y., Bai, Y., Zhu, C., Guo, G. L., et al. (2008) · Cancer Causes & Control · doi:10.1007/s10552-008-9260-4 · Cited by 710 · see citing works
Usefulness of Ultrasonography in the Management of Nodular Thyroid Disease
Marqusee, E., Benson, C. B., Frates, M. C., Doubilet, P. M., Larsen, P. R., Cibas, E. S., & Mandel, S. J. (2000) · Annals of Internal Medicine · doi:10.7326/0003-4819-133-9-200011070-00011 · Cited by 411 · see citing works
Davies, L., Morris, L. G. T., Haymart, M. R., Chen, A. Y., Goldenberg, D., Morris, J., Ogilvie, J. B., Terris, D. J., Netterville, J. L., Wong, R. J., et al. (2015) · Endocrine Practice · doi:10.4158/ep14466.dscr · Cited by 327 · see citing works
Thyroid cancer: zealous imaging has increased detection and treatment of low risk tumours
Brito, J. P., Morris, J. C., & Montori, V. M. (2013) · BMJ · doi:10.1136/bmj.f4706 · Cited by 323 · see citing works
Self-citationRoti, E., Rossi, R. E., Trasforini, G., et al. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-2372 · Cited by 260 · see citing works
Hughes, D. T., Haymart, M. R., Miller, B. S., Gauger, P. G., & Doherty, G. M. (2011) · Thyroid · doi:10.1089/thy.2010.0137 · Cited by 248 · see citing works
Sosa, J. A., Hanna, J. W., Robinson, K. A., & Lanman, R. B. (2013) · Surgery · doi:10.1016/j.surg.2013.07.006 · Cited by 248 · see citing works
Prevalence of Differentiated Thyroid Cancer in Autopsy Studies Over Six Decades: A Meta-Analysis
Furuya‐Kanamori, L., Bell, K., Clark, J. M., Glasziou, P., & Doi, S. A. R. (2016) · Journal of Clinical Oncology · doi:10.1200/jco.2016.67.7419 · Cited by 235 · see citing works
Advances in diagnostic practices affect thyroid cancer incidence in France
Leenhardt, L., Bernier, M., Bouin-Pineau, M. H., Conte‐Devolx, B., Maréchaud, R., Niccoli, P., Calzada-Nocaudie, M., Orgiazzi, J., Schlumberger, M. J., Wémeau, J.-L., et al. (2004) · European Journal of Endocrinology · doi:10.1530/eje.0.1500133 · Cited by 234 · see citing works
The increasing incidence of small thyroid cancers: Where are the cases coming from?
Davies, L., Ouellette, M. C., Hunter, M. A., et al. (2010) · The Laryngoscope · doi:10.1002/lary.21076 · Cited by 189 · see citing works
Merom, D., Cumming, R. G., Mathieu, E., Anstey, K. J., Rissel, C. E., Simpson, J. M., Morton, R. L., Cerin, E., Sherrington, C., & Lord, S. R. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-477 · Cited by 183 · see citing works
Thyroid Ultrasound and the Increase in Diagnosis of Low-Risk Thyroid Cancer
Haymart, M. R., Banerjee, M., Reyes‐Gastelum, D., Caoili, E. M., & Norton, E. C. (2018) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-01933 · Cited by 159 · see citing works
Brito, J. P., Nofal, A. A., Montori, V. M., HAY, I. D., & Morris, J. C. (2015) · Thyroid · doi:10.1089/thy.2014.0594 · Cited by 122 · see citing works
Self-citationBlackberry, I. D., Furler, J. S., Best, J. D., Chondros, P., Vale, M., Walker, C., Dunning, T., Segal, L., Dunbar, J., Audehm, R., et al. (2013) · BMJ · doi:10.1136/bmj.f5272 · Cited by 113 · see citing works
Julious, S. A. (2005) · Statistics in Medicine · doi:10.1002/sim.2164 · Cited by 111 · see citing works
Review: indications for ultrasound use in low‐ and middle‐income countries
Groen, R. S., Leow, J. J. J., Sadasivam, V., & Kushner, A. L. (2011) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2011.02868.x · Cited by 82 · see citing works
Active Surveillance for Low-Risk Cancers — A Viable Solution to Overtreatment?
Haymart, M. R., Miller, D. C., & Hawley, S. T. (2017) · New England Journal of Medicine · doi:10.1056/nejmp1703787 · Cited by 78 · see citing works
Simulation-Based Comparison of Methods for Meta-Analysis of Proportions and Rates
Trikalinos, T. A., Trow, P., & Schmid, C. H. (2013) · Europe PMC (PubMed Central) · Cited by 57 · see citing works
Thyroid Cancers Detected by Imaging Are Not Necessarily Small or Early Stage
Malone, M. K., Zagzag, J., Ogilvie, J. B., et al. (2013) · Thyroid · doi:10.1089/thy.2012.0651 · Cited by 57 · see citing works
Bahl, M., Sosa, J. A., Nelson, R. C., et al. (2013) · World Journal of Surgery · doi:10.1007/s00268-013-2407-9 · Cited by 48 · see citing works
Kahn, C., Simonella, L., Sywak, M. S., BOYAGES, S. C., Ung, O., & O’Connell, D. L. (2011) · Cancer Causes & Control · doi:10.1007/s10552-011-9852-2 · Cited by 30 · see citing works
Ospina, N. S., Maraka, S., Ycaza, A. E. E. D., et al. (2016) · Endocrine · doi:10.1007/s12020-016-1054-y · Cited by 23 · see citing works
‘Incidental’ and ‘non-incidental’ thyroid papillary microcarcinomas are two different entities
Provenzale, M. A., Fiore, E., Ugolini, C., et al. (2016) · European Journal of Endocrinology · doi:10.1530/eje-15-1223 · Cited by 21 · see citing works
González-Sánchez-Migallón, E., Flores-Pastor, B. M., Pérez-Guarinos, C. V., et al. (2016) · Endocrinología y Nutrición · doi:10.1016/j.endonu.2016.05.009 · Cited by 19 · see citing works
Thyroid cancer is more likely to be detected incidentally on imaging in private hospital patients
Zagzag, J., Kenigsberg, A. P., Patel, K. N., et al. (2017) · Journal of Surgical Research · doi:10.1016/j.jss.2017.03.059 · Cited by 18 · see citing works
Preoperative diagnostics in differentiated thyroid carcinoma
Seifert, P., & Freesmeyer, M. G. (2017) · Nuklearmedizin - NuclearMedicine · doi:10.3413/nukmed-0924-17-08 · Cited by 16 · see citing works
An International Perspective on Ultrasound Training and Use for Thyroid and Parathyroid Disease
Miller, B. S., Gauger, P. G., Broome, J. T., et al. (2010) · World Journal of Surgery · doi:10.1007/s00268-010-0481-9 · Cited by 14 · see citing works
Papillary thyroid carcinoma: prognostic significance of cancer presentation
Choi, H., Kasaian, K., Melck, A. L., et al. (2015) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2014.12.047 · Cited by 12 · see citing works
Surgical treatment of differentiated microcarcinomas of the thyroid.
Ruggieri, M., Genderini, M., Gargiulo, P., et al. (2002) · PubMed · Cited by 11 · see citing works
Iwata, A. J., Bhan, A., Lahiri, S. W., et al. (2018) · Head & Neck · doi:10.1002/hed.25132 · Cited by 11 · see citing works
Rothberger, G. D., Cohen, M., Sahay, P., et al. (2019) · Head & Neck · doi:10.1002/hed.25984 · Cited by 11 · see citing works
Lower Rates of Residual/Recurrent Disease in Patients With Incidentally Discovered Thyroid Carcinoma
Shakil, J., Ansari, M. Z., Brady, J. R., et al. (2016) · Endocrine Practice · doi:10.4158/ep161497.or · Cited by 9 · see citing works
Incidental versus clinically evident thyroid cancer: A 5‐year follow‐up study
Minuto, M. N., Miccoli, M., Viola, D., et al. (2012) · Head & Neck · doi:10.1002/hed.22974 · Cited by 7 · see citing works
Marina, M., Serra, M. F., Aldigeri, R., et al. (2020) · Endocrine · doi:10.1007/s12020-020-02200-z · Cited by 5 · see citing works
Picasso, M. F. R., Vicens, J., Giuliani, C., Jaen, A. D. V., Cabezón, C., Figari, M. F., Saldaño, A. M. G., & Figar, S. (2018) · Journal of Cancer Epidemiology · doi:10.1155/2018/8986074 · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [17]17. S.R. Distiller, Systematic review and literature review software by evidence partners. Accessed 10 Nov 2019. https://www.evidencepa rtners.com/products/distillersr-systematic-review-software/
Cited by
Sorted by citations
Glucagon-Like Peptide-1 Receptor Agonists and Thyroid Cancer: A Narrative Review
Espinosa De Ycaza, A. E., Brito, J. P., McCoy, R. G., Shao, H., & Singh Ospina, N. (2024) · Thyroid · doi:10.1089/thy.2023.0530 · Cited by 37 · see citing works
Self-citation
- Authors
- Lincango-Naranjo, E., Solis-Pazmino, P., El Kawkgi, O., Salazar-Vega, J., Garcia, C., Ledesma, T., Rojas, T., Alvarado-Mafla, B., Young, G., Dy, B., Ponce, O. J., & Brito, J. P.
- Affiliations
- Mayo Clinic (US)
- Hospital de Especialidades Eugenio Espejo (EC)
- Central University of Ecuador (EC)
- Universidad San Francisco de Quito (EC)
- Corresponding author
- Brito, Juan P.
- ORCID
- Venue
- Endocrine
- Published
- 2021-01-29
- Volume
- 72
- Issue
- 3
- Pages
- 644-659
- ISSN
- 0969-711X (ISSN-L)
- 1355-008X
- 1559-0100
- OpenAlex
- W3122044354
- Semantic Scholar
- cb5029b411265266877c6e1aa940f7603893de67
- Cited by
- 49
- References
- 47
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 9 · 2023: 9 · 2022: 7 · 2021: 4
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Endocrine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- thyroid cancer, incidental thyroid cancer, papillary thyroid carcinoma, papillary thyroid microcarcinoma, thyroid cancer detection, neck ultrasound, thyroid imaging, overdiagnosis, tumor size, age at diagnosis
- MeSH terms
- Thyroid Cancer, Papillary, Carcinoma, Papillary, Cross-Sectional Studies, Humans, Thyroid Neoplasms, Ultrasonography, Incidental Findings
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
