{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:24:24Z","timestamp":1787761464642,"version":"build-2784847793"},"reference-count":61,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2025,9,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    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\u2010needle aspirations (FNAs). This study assessed the effectiveness of a multi\u2010hospital network that implemented a unified thyroid care pathway in reducing the number of FNAs without compromising malignancy detection. In this nationwide population\u2010based 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\u20132017, coinciding with the care pathway implementation (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). In contrast, in the rest of the Netherlands, a decline was observed in 2020, potentially attributable to the COVID\u201019 pandemic. In both cases, the reduction mainly involved Bethesda categories 1 and 2, without compromising malignancy detection. High\u2010volume surgical centers seemed to initiate a decline more rapidly compared to non\u2010high\u2010volume surgical centers. This study indicates that a unified care pathway within a multi\u2010hospital network can reduce the number of FNAs without compromising malignancy detection, which could alleviate the burden on both patients and the healthcare system.\n                  <\/jats:p>","DOI":"10.1002\/ijc.35462","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T23:02:50Z","timestamp":1746226970000},"page":"1120-1129","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nationwide trends and the impact of an oncology hospital network on reducing the burden of thyroid cytology procedures"],"prefix":"10.1002","volume":"157","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4605-8497","authenticated-orcid":false,"given":"Roos G. F. M.","family":"van der Ven","sequence":"first","affiliation":[{"name":"Department of Research &amp; Development Netherlands Comprehensive Cancer Organisation (IKNL)  Utrecht The Netherlands"},{"name":"Department of Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences (FHML) Maastricht University  Maastricht The Netherlands"},{"name":"Department of Health Services Research, Faculty of Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML) Maastricht University  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0125-1429","authenticated-orcid":false,"given":"Felice N.","family":"van Erning","sequence":"additional","affiliation":[{"name":"Department of Research &amp; Development Netherlands Comprehensive Cancer Organisation (IKNL)  Utrecht The Netherlands"},{"name":"Department of Surgery Catharina Hospital  Eindhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daan D.","family":"Westra","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Faculty of Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML) Maastricht University  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignace H. J. T.","family":"de Hingh","sequence":"additional","affiliation":[{"name":"Department of Research &amp; Development Netherlands Comprehensive Cancer Organisation (IKNL)  Utrecht The Netherlands"},{"name":"Department of Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences (FHML) Maastricht University  Maastricht The Netherlands"},{"name":"Department of Surgery Catharina Hospital  Eindhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aggie T. G.","family":"Paulus","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Faculty of Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML) Maastricht University  Maastricht The Netherlands"},{"name":"School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences (FHML) Maastricht University  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne M. E.","family":"Engelen","sequence":"additional","affiliation":[{"name":"Department of Surgery Maastricht University Medical Center  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"de Vries","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology Zuyderland Medical Center  Sittard\u2010Geleen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grard A. P.","family":"Nieuwenhuijzen","sequence":"additional","affiliation":[{"name":"Department of Surgery Catharina Hospital  Eindhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the OncoZON network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.2307\/2655234"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/1056492609337493"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2020.0305"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-21-1440"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-01933"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2020-0159"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.2719"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2022.1743"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1604412"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina60050722"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2009.0110"},{"key":"e_1_2_12_14_1","first-page":"12","article-title":"European thyroid association clinical practice guidelines for thyroid nodule management","volume":"2023","author":"Durante C","year":"2023","journal-title":"Eur Thyroid J"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.sult.2011.12.002"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.18.2164"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.1198"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002680010163"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1309\/H86KM785Q9KBWPW5"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00020-X"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1113977"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1159\/000478927"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2017.01.046"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2021.114664"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/ppmgov\/gvz012"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.5465\/amj.2006.20785500"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.5465\/amr.2005.15281445"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/smj.252"},{"issue":"1","key":"e_1_2_12_30_1","first-page":"s423","article-title":"Aligning forces for quality multi\u2010stakeholder healthcare alliances: do they have a sustainable future?","volume":"22","author":"Alexander JA","year":"2016","journal-title":"Am J Manag Care"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/1355819619858374"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.publhealth.21.1.369"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/10775587221118156"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2023.2238545"},{"key":"e_1_2_12_35_1","volume-title":"SONCOS Normeringsrapport \u2010 Version 10 2022","author":"Stichting Oncologische Samenwerking (SONCOS)","year":"2022"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jasc.2017.09.002"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0500"},{"key":"e_1_2_12_38_1","unstructured":"IKNL.N.C.C.O. Netherlands Cancer Registry (NCR).www.iknl.nl\/en\/ncr\/ncr\u2010data\u2010figuresAccessed August 26 2024."},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2023.2170275"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1155\/2007\/971816"},{"key":"e_1_2_12_41_1","unstructured":"GrootendorstM.PolyFuzz: Fuzzy string matching grouping and evaluation v0.2.2.2020. doi:10.5281\/zenodo.4461050"},{"key":"e_1_2_12_42_1","unstructured":"BachmannM.rapidfuzz\/RapidFuzz: Release 3.8.1.2024. doi:10.5281\/zenodo.10938887"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1080\/10803548.2022.2111847"},{"key":"e_1_2_12_44_1","first-page":"20","article-title":"Segmented: an R package to fit regression models with broken\u2010line relationships","volume":"8","author":"Muggeo VMR","year":"2008","journal-title":"R News"},{"key":"e_1_2_12_45_1","first-page":"604","article-title":"Why, when and how to adjust your P values?","volume":"20","author":"Jafari M","year":"2019","journal-title":"Cell J"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(21)00027-9"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(20)30115-7"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-022-03292-x"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-020-02335-5"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2024.03.393"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40842-016-0035-7"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02559-z"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-020-01407-1"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-21-0716"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-20-0269"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14379"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0100"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.1177\/01945998221086203"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2012.0461"},{"key":"e_1_2_12_60_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.0898"},{"key":"e_1_2_12_61_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2009.0274"},{"key":"e_1_2_12_62_1","doi-asserted-by":"publisher","DOI":"10.1017\/cts.2022.467"}],"container-title":["International Journal of Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijc.35462","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijc.35462","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijc.35462","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:54:17Z","timestamp":1787759657000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ijc.35462"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,2]]},"references-count":61,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,9,15]]}},"alternative-id":["10.1002\/ijc.35462"],"URL":"https:\/\/doi.org\/10.1002\/ijc.35462","archive":["Portico"],"relation":{},"ISSN":["0020-7136","1097-0215"],"issn-type":[{"value":"0020-7136","type":"print"},{"value":"1097-0215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,2]]},"assertion":[{"value":"2024-10-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}