Study on HRQOL and Cost-effectiveness Analysis in Management of Patients With <2cm Thyroid Nodules

NCT ID: NCT02398721

Last Updated: 2018-05-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

314 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-03-31

Study Completion Date

2018-02-28

Brief Summary

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Ideally randomized controlled trials should be carried out to compare the cost-effectiveness between FNAC and watchful waiting but such studies are very difficult to conduct in practice because they require following up very large number of subjects for a long period of time.

The aims are to determine the health-related quality of life (HRQOL) and HRQOL preference (utility) of patients undergoing watchful observation (no FNAC) and routine FNAC, and to determine the cost-effectiveness of two strategies in managing small incidental thyroid nodules for the Chinese population in Hong Kong.

Detailed Description

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Conditions

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Thyroid Nodules

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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FNAC

patients will then be randomized routine FNAC strategy

Group Type OTHER

Fine Needle Aspiration Cytology

Intervention Type OTHER

No FNAC

patients will be randomized to watchful observation strategy (no FNAC)

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Fine Needle Aspiration Cytology

Intervention Type OTHER

Other Intervention Names

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FNAC

Eligibility Criteria

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Inclusion Criteria

* Aged 18 or above
* Have life expectancy of at least 6 months
* Have an incidental nodule which measures between 1.0 to 2.0cm in the largest dimension on ultrasound guidance (USG) and has benign ultrasonographic features such as spongiform or honeycomb appearance, purely-cystic, egg shell type calcification, iso-echoic or hyper-echoic in relation to the rest of the thyroid tissue and peripheral vascularity on Doppler USG. For subjects with more than one nodule on USG, provided that the other nodules are not \>2.0cm or have suspicious features (see below), they will still be eligible.
* Normal thyroid function (both serum thyroid-stimulating hormone (TSH) and free T4 levels within normal range)
* Given consent to take part in the study

Exclusion Criteria

* Have suspicious ultrasonographic features such as microcalcifications, marked hypoechogenicity, irregular margins and / or taller than wide and intranodular vascularity on transverse view on Doppler USG that warrant a FNAC
* Nodule size \> 2.0cm
* Insisting or refusing FNAC or surgical intervention despite medical reassurance
* Inability to understand or communicate in Cantonese or Chinese
* Significant cognitive impairment judged by the doctor to be unable to answer the questionnaire
* Too ill to carry out interview
* Refusal to give consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The University of Hong Kong

OTHER

Sponsor Role lead

Responsible Party

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Dr. Lang Hung Hin, Brian

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Queen Mary Hospital

Hong Kong, , Hong Kong

Site Status

Countries

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Hong Kong

References

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Reiners C, Wegscheider K, Schicha H, Theissen P, Vaupel R, Wrbitzky R, Schumm-Draeger PM. Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96,278 unselected employees. Thyroid. 2004 Nov;14(11):926-32. doi: 10.1089/thy.2004.14.926.

Reference Type BACKGROUND
PMID: 15671771 (View on PubMed)

Van den Bruel A, Francart J, Dubois C, Adam M, Vlayen J, De Schutter H, Stordeur S, Decallonne B. Regional variation in thyroid cancer incidence in Belgium is associated with variation in thyroid imaging and thyroid disease management. J Clin Endocrinol Metab. 2013 Oct;98(10):4063-71. doi: 10.1210/jc.2013-1705. Epub 2013 Aug 21.

Reference Type BACKGROUND
PMID: 23966243 (View on PubMed)

Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1993 Feb 25;328(8):553-9. doi: 10.1056/NEJM199302253280807. No abstract available.

Reference Type BACKGROUND
PMID: 8426623 (View on PubMed)

Mehanna HM, Jain A, Morton RP, Watkinson J, Shaha A. Investigating the thyroid nodule. BMJ. 2009 Mar 13;338:b733. doi: 10.1136/bmj.b733. No abstract available.

Reference Type BACKGROUND
PMID: 19286747 (View on PubMed)

McLeod DS, Sawka AM, Cooper DS. Controversies in primary treatment of low-risk papillary thyroid cancer. Lancet. 2013 Mar 23;381(9871):1046-57. doi: 10.1016/S0140-6736(12)62205-3. Epub 2013 Mar 22.

Reference Type BACKGROUND
PMID: 23668555 (View on PubMed)

Sosa JA, Hanna JW, Robinson KA, Lanman RB. Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States. Surgery. 2013 Dec;154(6):1420-6; discussion 1426-7. doi: 10.1016/j.surg.2013.07.006. Epub 2013 Oct 2.

Reference Type BACKGROUND
PMID: 24094448 (View on PubMed)

Bonavita JA, Mayo J, Babb J, Bennett G, Oweity T, Macari M, Yee J. Pattern recognition of benign nodules at ultrasound of the thyroid: which nodules can be left alone? AJR Am J Roentgenol. 2009 Jul;193(1):207-13. doi: 10.2214/AJR.08.1820.

Reference Type BACKGROUND
PMID: 19542415 (View on PubMed)

Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, Tomoda C, Takamura Y, Kobayashi K, Miya A. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2010 Jan;34(1):28-35. doi: 10.1007/s00268-009-0303-0.

Reference Type BACKGROUND
PMID: 20020290 (View on PubMed)

Pacini F. Management of papillary thyroid microcarcinoma: primum non nocere! J Clin Endocrinol Metab. 2013 Apr;98(4):1391-3. doi: 10.1210/jc.2013-1634. No abstract available.

Reference Type BACKGROUND
PMID: 23564944 (View on PubMed)

Moon WJ, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, Kwak JY, Lee JH, Lee JH, Lee YH, Na DG, Park JS, Park SW; Korean Society of Thyroid Radiology (KSThR); Korean Society of Radiology. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol. 2011 Jan-Feb;12(1):1-14. doi: 10.3348/kjr.2011.12.1.1. Epub 2011 Jan 3.

Reference Type BACKGROUND
PMID: 21228935 (View on PubMed)

American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated

Reference Type BACKGROUND

Wong CKH, Liu X, Lang BHH. Cost-effectiveness of fine-needle aspiration cytology (FNAC) and watchful observation for incidental thyroid nodules. J Endocrinol Invest. 2020 Nov;43(11):1645-1654. doi: 10.1007/s40618-020-01254-0. Epub 2020 Apr 19.

Reference Type DERIVED
PMID: 32307641 (View on PubMed)

Wong CKH, Lang BHH. A randomized trial comparing health-related quality-of-life and utility measures between routine fine-needle aspiration cytology (FNAC) and surveillance alone in patients with thyroid incidentaloma measuring 1-2 cm. Endocrine. 2020 Feb;67(2):397-405. doi: 10.1007/s12020-019-02129-y. Epub 2019 Nov 18.

Reference Type DERIVED
PMID: 31741168 (View on PubMed)

Wong CKH, Lang BHH, Yu HMS, Lam CLK. EQ-5D-5L and SF-6D Utility Measures in Symptomatic benign Thyroid Nodules: Acceptability and Psychometric Evaluation. Patient. 2017 Aug;10(4):447-454. doi: 10.1007/s40271-017-0220-5.

Reference Type DERIVED
PMID: 28224296 (View on PubMed)

Other Identifiers

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UW 14-500

Identifier Type: -

Identifier Source: org_study_id

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