Estimation of the lifetime probability of disease progression of papillary microcarcinoma of the thyroid during active surveillance

Miyauchi, Akira; Kudo, Takumi; Ito, Yasuhiro; Oda, Hitomi; Sasai, Hisanori; Higashiyama, Takuya; Fukushima, Mitsuhiro; Masuoka, Hiroo; Kihara, Minoru; Miya, Akihiro

doi:10.1016/j.surg.2017.03.028

Cited by 141 publications

(106 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recent data from observation trials of PTMs proved an indolent feature of PTMs after middle age. Most of them stay at the same size, and some even shrink [18]. Data accumulated thus far support the concept that most papillary carcinomas are initiated in childhood, undergo a rapid growth period during adolescence and early adulthood, and become indolent or nonprogressive in middle age.…”

Section: Natural History Of Juvenile Thyroid Cancermentioning

confidence: 77%

Overdiagnosis of Juvenile Thyroid Cancer

Takano

2019

Eur Thyroid J

View full text Add to dashboard Cite

Overdiagnosis is the detection of a disease that does not do any harm to the patient throughout the lifetime. Thyroid cancer in children is a rare disease; however, since 2011, many children in Fukushima, Japan, have been diagnosed with it, and the number has shown a steady increase to over 200 cases at present. Some experts have stated that this phenomenon is due to overdiagnosis caused by thyroid ultrasound (US)-based thyroid screening detecting self-limiting thyroid cancer, which will not lead to clinical symptoms in the future. Harm caused by overdiagnosis of thyroid cancer is more serious in the young, since it is difficult to perform active surveillance and children diagnosed with cancer are likely to suffer from stigma. Thus, overdiagnosis of thyroid cancer in the young is not only a health problem but also a problem of human rights. Conflicts of interest among people related to screening programs and some experts with incomplete knowledge on overdiagnosis help to spread misleading opinions together with fear of radiation exposure among residents, which has led to their erroneous understanding of the nature of US-based thyroid screening. Scien-tific and honest discussions among experts to enhance education of residents and consideration of medical ethics are crucial to prevent the expansion of overdiagnosis.

show abstract

Section: Natural History Of Juvenile Thyroid Cancermentioning

confidence: 77%

Overdiagnosis of Juvenile Thyroid Cancer

Takano

2019

Eur Thyroid J

View full text Add to dashboard Cite

show abstract

“…Also, one study showed that only a subset of PTMC enlarges during pregnancy and, if enlarged, surgery after delivery remains safe (21). Although low-risk PTMC in young patients is more likely to progress (9-11), Miyauchi et al estimated that more than 50% of patients who are in their 20s at presentation and *75% of the patients in their 30s will not require surgery in their lifetime (22). Furthermore, older patients have a lower probability of needing surgery (22).…”

Section: Discussionmentioning

confidence: 99%

“…Although low-risk PTMC in young patients is more likely to progress (9-11), Miyauchi et al estimated that more than 50% of patients who are in their 20s at presentation and *75% of the patients in their 30s will not require surgery in their lifetime (22). Furthermore, older patients have a lower probability of needing surgery (22). Miyauchi et al conducted a kinetic analysis on tumor volume of PTMCs during AS and reported that only 3% of the tumors showed rapid growth, 22% showed slow growth, 57% showed stable disease, and 17% showed a decrease in their tumor volume over time (23).…”

Section: Discussionmentioning

confidence: 99%

Active Surveillance Versus Immediate Surgery: Questionnaire Survey on the Current Treatment Strategy for Adult Patients with Low-Risk Papillary Thyroid Microcarcinoma in Japan

Sugitani

Ito

Miyauchi

et al. 2019

Thyroid

Self Cite

View full text Add to dashboard Cite

Background: Two Japanese prospective trials of active surveillance (AS) for adult patients with low-risk papillary thyroid carcinoma (PTC) £1 cm (cT1aN0M0 PTMC) have verified the safety of AS in oncological control and its superiority over immediate surgery with respect to unfavorable outcomes. Thus, AS has been accepted as an alternative to immediate surgery for asymptomatic papillary thyroid microcarcinomas (PTMCs). However, the real-world clinical approach for PTMC is unknown. Thus, this study aimed to investigate the current state of management of asymptomatic PTMCs in Japan. Methods: We conducted a questionnaire survey on the actual treatment patterns for adult patients with low-risk PTMCs. The subjects were member institutions of the Japan Association of Endocrine Surgery ( JAES) or Japanese Society of Thyroid Surgery ( JSTS), including the departments of surgery and head and neck surgery (HNS). Results: Responses were obtained from 134 institutes, where 72.4% of Japanese thyroid cancer cases operated by surgeons were treated. For suspicious tumors on ultrasound, 18 responders (13.4%) conducted cytological examination routinely, while 69 (51.5%) and 40 (27.8%) conducted it only for tumors >5 and >10 mm, respectively. After the diagnosis, 42 responders (31.3%) recommend AS, 35 (26.1%) recommend immediate surgery as the management, and 52 (38.8%) allowed patients to decide the treatment course. The present responders tended to recommend surgery for PTMCs that were located adjacent to the dorsal surface of the thyroid, were multiple, or measured almost 10 mm in size. At these institutions, 1176 patients with PTMC underwent surgery in 2017, accounting for 18.1% of surgeries for PTC. During the succeeding three months, 310 of 576 (53.8%) PTMC patients underwent AS. The treatment strategies did not differ between the departments (Surgery or HNS). The institutions that have six or more surgeons, that were located in metropolitan areas, or that were certified by JAES or JSTS performed AS more actively. Conclusion: More than 50% of low-risk PTMCs are on AS in Japan. However, the indication and recommendation for AS vary significantly between institutions. To improve the implementation of this management modality, physicians and patients should be further educated, and the sociomedical environment should be improved.

show abstract

“…In Japan, the recommended clinical management for SFM/malignant nodules include surgical resection, lobectomy, or total thyroidectomy [21], while reaspiration is not recommended. Meanwhile, follow-up (active surveillance) is optional in low-risk papillary microcarcinoma [22,23]. Low risk means nodules without the following findings: nodal and/or distant metastasis, signs or symptoms of invasion to the recurrent laryngeal nerve or trachea, high-grade malignancy on cytology, and size enlargement or novel appearance of nodal metastasis during observation [23].…”

Section: Discussionmentioning

confidence: 99%

Impact of the modification of the diagnostic criteria in the 2017 Bethesda System for Reporting Thyroid Cytopathology: a report of a single institution in Japan

et al. 2018

Self Cite

View full text Add to dashboard Cite

The Bethesda System for Reporting Thyroid Cytopathology has recently been revised in 2017 (TBSRTC 2017). This study aimed to evaluate the impact of modifying the diagnostic criteria in TBSRTC 2017 at a single institute. We retrospectively reviewed cytological specimens of 10,399 thyroid nodules submitted for thyroid fine-needle aspiration cytology. Among them, 56 atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) nodules, 16 suspicious for malignancy (SFM) nodules, and 8 malignant nodules were re-categorized into follicular neoplasm or suspicious for a follicular neoplasm (FN/SFN). The incidence of FN/SFN was increased by 0.8%, while that of AUS/ FLUS, SFM, and malignant nodule was decreased by 0.5%, 0.2%, and 0.1%, respectively. In nine (60%) of the 15 nodules that were re-classified from AUS/FLUS to FN/SFN nodules and re-aspiration was performed, it was possible to judge whether they were benign or malignant. Of the 24 patients with FN/SFN nodules originally diagnosed with SFM or malignant, 16 were followed up without surgical resection. In conclusion, TBSRTC 2017 only caused minor changes in the incidence of each diagnostic category. TBSRTC 2017 was revised to avoid false positives owing to noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) that account for >10% of papillary thyroid carcinomas; however, it is not necessary in low frequency NIFTP institutes or countries. In Japan, we propose active surveillance as an accepted option for clinically managing AUS/FLUS, FN/SFN, SFM, or malignant nodules having favorable benign clinical findings or being part of the low-risk group.

show abstract

Estimation of the lifetime probability of disease progression of papillary microcarcinoma of the thyroid during active surveillance

Abstract: The estimated lifetime disease progression probabilities of papillary microcarcinoma during active surveillance vary greatly according to the age at presentation.

Cited by 141 publications

References 13 publications

Overdiagnosis of Juvenile Thyroid Cancer

Overdiagnosis of Juvenile Thyroid Cancer

Active Surveillance Versus Immediate Surgery: Questionnaire Survey on the Current Treatment Strategy for Adult Patients with Low-Risk Papillary Thyroid Microcarcinoma in Japan

Impact of the modification of the diagnostic criteria in the 2017 Bethesda System for Reporting Thyroid Cytopathology: a report of a single institution in Japan

Contact Info

Product

Resources

About