Natural History of Asymptomatic Papillary Thyroid Microcarcinoma: Time‐Dependent Changes in Calcification and Vascularity During Active Surveillance

Fukuoka, Osamu; Sugitani, Iwao; Ebina, Aya; Toda, Kazuhisa; Kawabata, Kazuyoshi; Yamada, Keiko

doi:10.1007/s00268-015-3349-1

Cited by 108 publications

(126 citation statements)

References 35 publications

(40 reference statements)

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“…Concerning macrocalcification, one group has already reported a similar observation that strong calcification detected by ultrasonography during active surveillance was related to non-progressive disease [28]. However, it is not easy to correctly diagnose follicular variants of PTC from aspirated materials.…”

Section: Discussionmentioning

confidence: 82%

Pathological characteristics of low-risk papillary thyroid microcarcinoma with progression during active surveillance

et al. 2016

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Section: Discussionmentioning

confidence: 82%

Pathological characteristics of low-risk papillary thyroid microcarcinoma with progression during active surveillance

et al. 2016

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“…It was recently reported that PMCs with a rich blood supply or a lack of strong calcification on ultrasound have stronger growth activity [8]. However, in that study's series, no patients showed life-threatening tumor progression during the active surveillance or after the rescue surgery.…”

Section: (4) Is Thyroid-stimulating Hormone (Tsh) Suppression Useful mentioning

confidence: 80%

“…He also suspected that a rescue surgery performed after the detection of signs of PMC progression (such as size enlargement and the novel appearance of node metastases) is not too late and would not influence patients' prognoses. In 1995, Cancer Institute Hospital (Tokyo, Japan) also initiated an active surveillance program for low-risk PMCs, and these two institutions have published promising data using large patient series [3][4][5][6][7][8][9]. thereafter to determine whether novel lymph node metastases or size enlargement are present.…”

Section: History Of the Active Surveillance Of Pmcsmentioning

confidence: 99%

Insights and clinical questions about the active surveillance of low-risk papillary thyroid microcarcinomas [Review]

2016

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Abstract. Over 20 years ago, two Japanese institutions initiated an active surveillance policy for papillary microcarcinomas (PMCs) without high-risk features (such as clinical lymph node and distant metastases) and suspected trachea or recurrent laryngeal nerve invasion. Since the most recent American Thyroid Association (ATA) guidelines adopt active surveillance as a therapy option for low-risk PMCs, the number of institutions worldwide carrying out this policy can be expected to increase. However, before adopting an active surveillance strategy, some important clinical questions must be considered. In this review, conceivable clinical questions with our answers based on the present accumulation of low-risk PMC surveillance data are presented.

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“…Abundant tumor vasculature, for example, is a feature associated with higher growth, while scarce vascularization and calcifications are associated with non-progressive tumors. 12 Molecular markers (BRAF, PIK3CA, AKT1, TERT, TP53) may be useful in the future for prognostic stratification, especially the coexistence of these markers [13][14][15][16] as well as the expression of the Ki67 protein, which is associated with PTMC size, tumor invasion, lymph node metastasis, and may be used in the future as a monitoring and a clinical decision parameter. 17 In the group of patients with low-risk PTMC that demand surgery during the follow-up (<10% of cases), it does not impact on the outcome.…”

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confidence: 99%

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2016

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The referred ATA Guideline 1 eliminates the biopsy from the management of the sub centimeter nodules, suggesting repetition of sonography every 6-12 months. The committee justified this action, to indicate FNAB only for suspicious nodules above 1cm, by the indolence of the papillary thyroid microcarcinoma (PTMC) and because these tumors rarely present ETE, cervical lymph node or distant metastasis, especially in individuals over 60 years of age [patients younger than 40 years are at increased risk for tumor growth (5.9%) and cervical lymph node metastasis (2.2%), when compared to those over 60 years, 5.3% and 0.4%, respectively; p <0.05]. 2 We, however, advocate the realization of the FNAB in all sub centimeter nodules of suspected malignancy, if technically possible, to guide and optimize the follow-up thereof. Considering the high probability of malignancy of these nodules (70% -90%) 3 not performing FNAB would most likely only delay or hide a probable diagnosis. Furthermore, we consider as the main argument for our conduct, the citological fends off the small but existing possibility of FNAB findings of high-grade malignancy. Similar thought is shared by the Korean guideline, 4 which argues that this strategy can avoid unnecessary long-term active surveillance in 20 to 40% of cases and that the FNAB findings of high-grade malignancy may even change the management strategy from active surveillance to surgery, although such cases are rare.However, we are aware that over diagnosis has been the source of the alerted thyroid cancer epidemic and agree with the risks associated with the overtreatment of these patients, when conducted in a wreckless manner.5 Here upon, two Japanese 2,6 prospective studies support the active surveillance as a management strategy of low risk PTMC as an alternative to surgical treatment.Ito et al., 2 followed 1235 patients with PTMC for an average of 60 months (18-227 months). They observed tumor growth of >3mm in sonography in 5% (5 years) and 8% (10 years); lymph node metastasis in 1.7% (5 years) and in 3.8% (10 years); need for surgery during follow-up in 15% (191/1235); progression to clinical disease (increase of >12 mm or lymph node metastasis) in 3.5%. Interestingly, the progression rate was inversely proportional to the age of patients, being 8.9% younger than 40 years, 3.5% aged between 40 and 60 years and 1.6% in patients over 60 years-old. Sugitani et al.,6 followed 230 patients with PTMC for an average of 11 years. The rates of tumor growth, lymph node metastasis and surgical intervention were of 7%, 1% and 7%, respectively, at the end of the period.More recently, Brito et al., 7 proposed an interesting decision making approach to assess the applicability of active surveillance, taking into account tumor and patient variables, as well as staff/ medical resources. In this study, they reinforce the excellent results seen in active surveillance at the Kuma Hospital as a result of a careful and thorough selection of patients by an experienced team in thyroid cancer with easy acc...

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Natural History of Asymptomatic Papillary Thyroid Microcarcinoma: Time‐Dependent Changes in Calcification and Vascularity During Active Surveillance

Abstract: PMCs in older patients showed significantly stronger calcification patterns and poorer vascularity. Both consolidation of calcification and loss of vascularity occurred in a time-dependent manner during observation and were significant indicators for non-progressive disease.

Cited by 108 publications

References 35 publications

Pathological characteristics of low-risk papillary thyroid microcarcinoma with progression during active surveillance

Pathological characteristics of low-risk papillary thyroid microcarcinoma with progression during active surveillance

Insights and clinical questions about the active surveillance of low-risk papillary thyroid microcarcinomas [Review]

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