Imaging Surveillance in Patients After a Benign Fine-Needle Aspiration Biopsy of the Thyroid: Associated Cost and Incidence of Subsequent Cancer.

OBJECTIVE: The objective of our study was to determine patterns and cost of imaging tumor surveillance in patients after a benign fine-needle aspiration (FNA) biopsy of the thyroid in a large teaching hospital as well as the rate of subsequent cancer detection. MATERIALS AND METHODS: This cohort study was approved by the appropriate institutional review board and complied with HIPAA. All patients who had a benign thyroid FNA biopsy between January 1, 1999, and December 31, 2003, were identified from an institutional pathology database. We gathered information from electronic medical records on imaging tumor surveillance and subsequent cancer detection. Cost was determined using the facility total relative value unit and the 2014 Hospital Outpatient Prospective Payment System conversion factor. RESULTS: Between January 1, 1999, and December 31, 2003, 1685 patients had a benign thyroid FNA biopsy, 800 (47.5%) of whom underwent follow-up imaging. These patients underwent 2223 thyroid ultrasound examinations, 606 ultrasound-guided thyroid FNA biopsies, 78 thyroid scintigraphy examinations, 168 neck CTs, and 53 neck MRIs at a cost of $529,874, $176,157, $39,622, $80,580, and $53,114, respectively, for a total cost of $879,347 or $1099 per patient. The mean length of follow-up was 7.3 years, during which time 19 (2.4%) patients were diagnosed with thyroid cancer at a cost of $46,281 per cancer. Seventeen (89.5%) were diagnosed with papillary carcinoma and two (10.5%) with Hurthle cell carcinoma. CONCLUSION: Over a 5-year period, about half of the patients who had a benign thyroid FNA biopsy underwent follow-up imaging at considerable cost with a small rate of subsequent malignancy.

The Things They Carry: Diphyllobothriasis at Sea, a Case Report.

Diphyllobothrium, also known as the "Broad Tapeworm" or "Fish Tapeworm," is a genus of Cestoda acquired through the consumption of undercooked fish. Although infection by a Diphyllobothrium spp. in the United States is rare, it remains an important global zoonosis, with an estimated burden of approximately 20 million people worldwide. A seldom on the Primary Care Physician's differential diagnosis in the United States, Diphyllobothrium spp. should be considered more readily when treating operational service members as they are exposed to endemic regions more frequently than the civilian population. This case presents one such service member diagnosed with Diphyllobothrium while aboard a U.S. naval vessel at sea, illustrating the importance of military medical providers considering Tapeworm infection even when risk factors seem remote. Diagnostic considerations, practical limitations of the Ova and Parasite (O&P) exam, particulars of specimen collection and handling, and recommendations for empiric treatment in the operational setting will be reviewed.