Disparities in disease presentation among patients with papillary thyroid cancer: A retrospective cohort study

Purpose: Prior research suggests that racial and ethnic minorities present with advanced papillary thyroid cancer (PTC), traditionally defined using surgical pathology. However, marginalized populations are more likely to experience delays in surgical treatment, raising concerns that surgical staging may misrepresent the extent of disease at initial presentation. This study investigates disparities in disease presentation using cytology from Fine Needle Aspiration (FNA), which is performed at first evaluation and precedes surgery, in an institutional cohort of PTC patients. Methods: A single-site retrospective review of 405 patients with PTC from 2018 to 2019 evaluated the association between sociodemographic variables and the likelihood of presenting with cytologically-confirmed malignancy using FNA. Patients with malignant cytology (Bethesda VI) were compared to those with unconfirmed malignancy (Bethesda III-V). To validate the clinical significance of the Bethesda VI classification, we conducted an additional analysis examining whether these patients presented with more advanced disease. Results: Patients classified as Bethesda VI on FNA were younger and more likely to present with advanced disease features, compared to Bethesda III-V patients. On multivariable analysis, patients in the lowest income group were significantly more likely to present with Bethesda VI compared to those in the highest income group. Conclusion: Differences in initial presentation were observed in our institutional cohort of PTC patients. Lower median household income was independently associated with presenting with Bethesda VI, even after adjusting for race/ethnicity. This analysis highlights the clinical relevance of considering factors beyond race and ethnicity alone to better tailor early detection efforts and strategic resource allocation, thereby addressing disparities more effectively.