C. DiGennaro1,2, V. Vahdat1,2, A. Toumi1,2, J. Chhatwal2, M. S. Jalali2, C. Lubitz1,2 1Massachusetts General Hospital,Surgery,Boston, MA, USA 2Massachusetts General Hospital,Institute Of Technology Assessment,Boston, MA, USA
Introduction: The incidence of thyroid cancer has increased more than 300% over the past four decades, US prevalence exceeds 700,000 patients and related healthcare costs are projected to double to over $3 billion/year in the next decade. The majority of incident cancers are small, indolent papillary thyroid carcinomas (PTC) that are not associated with significant effects on patient survival. This has led to a shift in recommendations to less aggressive management to avoid potential over-treatment. Our goal was to assess the adoption of appropriate management following the introduction of the revised American Thyroid Association’s (ATA) guidelines.
Methods: We used natural language processing (NLP) on a hospital patient data repository to assess pre- and post-operative reporting practices, indication for surgery, and final surgical pathology from 1990-2016 and compared three key time-points (i.e. ATA guideline release dates). We also assessed changes in the total number and type of surgeries by examining the proportion of thyroidectomy, lobectomy, completion thyroidectomy, and cervical lymphadenectomy in each year between 2001-2016.
Results: Our search of the surgical pathology data yielded 5724 patients. By applying NLP to the data, we were able to successfully identify trends in frequency, type, and result of surgeries between 1990-2016. While the proportion of total thyroidectomy to lobectomy (percentages for recent ATA guideline release years: 2006 – 54.4% vs. 23.9%; 2009 – 56.4% vs. 24.5%; 2015 – 65.3% vs. 20.7%) appears to have shifted slightly upward over the time horizon, the proportion of surgery for ultimately benign disease declined and the proportion of “problematic nodules” (including patients with indeterminate nodules on cytology) has increased. In addition, the length of reports has increased and language within reports has adapted to contemporary techniques in thyroid cancer treatment.
Conclusion: NLP offers several techniques that are increasingly sophisticated and able to process large amounts of real-world text data into intuitive, quantified data. We were able to utilize these techniques to identify and trend changes in thyroid nodule management. We found a decrease in operations on nodules which are benign on final pathology as recent guidelines are more widely incorporated into practice. Conversely, we do not observe the recommended shift away from total thyroidectomy after 2015, but we do see fewer surgeries performed overall. More prolific reporting in patients’ medical records at each stage of diagnosis and treatment after 2009, in tandem with a shift toward methodological terminology, suggests an adopted commitment to detail and informed decision-making.
