Abstract
The diagnostic care pathway of thyroid nodules spans multiple institutions. Collaborative networks are important to deal with such pathways that result from centralization and differentiation of care. Despite the high prevalence of thyroid nodules and the increase in cancer diagnoses, most nodules are benign and attributable to overdiagnosis, leading to an increase in fine-needle aspirations (FNAs). This study assessed the effectiveness of a multi-hospital network that implemented a unified thyroid care pathway in reducing the number of FNAs without compromising malignancy detection. In this nationwide population-based cohort study, Bethesda scores were extracted from all thyroid FNA reports from 2010 to 2021 in the Netherlands using text mining. Trends in the number of FNAs and Bethesda scores were visualized for the network and the rest of the country. Joinpoint analyses with the Davies test determined the statistical significance of observed trend changes. Nationwide, FNAs increased by an average of 5.7% annually from 2010 to 2018. In the network, FNAs started to decrease in 2016-2017, coinciding with the care pathway implementation (p < 0.001). In contrast, in the rest of the Netherlands, a decline was observed in 2020, potentially attributable to the COVID-19 pandemic. In both cases, the reduction mainly involved Bethesda categories 1 and 2, without compromising malignancy detection. High-volume surgical centers seemed to initiate a decline more rapidly compared to non-high-volume surgical centers. This study indicates that a unified care pathway within a multi-hospital network can reduce the number of FNAs without compromising malignancy detection, which could alleviate the burden on both patients and the healthcare system.