Physician Perspectives of Overdiagnosis and Overtreatment of Low-Risk Papillary Thyroid Cancer in the US

Dedhia, Priya H.; Saucke, Megan C.; Long, Kristin L.; Doherty, Gerard M.; Pitt, Susan C.

doi:10.1001/jamanetworkopen.2022.8722

Cited by 20 publications

(14 citation statements)

References 6 publications

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“…The notions of "overdiagnosis" and "overtreatment" are actively discussed over the past decade in many areas of contemporary medicine, including management of small thyroid nodules (3)(4)(5)(9)(10)(11). Avoiding overtreatment of patients with MPTCs became a challenging clinical problem in the field of endocrine oncology.…”

Section: Introductionmentioning

confidence: 99%

The high degree of similarity in histopathological and clinical characteristics between radiogenic and sporadic papillary thyroid microcarcinomas in young patients

et al. 2022

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The potential overtreatment of patients with papillary thyroid microcarcinoma (MPTC) has been an important clinical problem in endocrine oncology over the past decade. At the same time, current clinical guidelines tend to consider prior radiation exposure as a contraindication to less extensive surgery, even for low-risk thyroid carcinomas, which primarily include microcarcinomas. This study aims to determine whether there are differences in the behavior of MPTC of two etiological forms (radiogenic and sporadic), including invasive properties, clinical data, and recurrence in patients aged up to 30 years. For this purpose, 136 radiogenic (from patients aged up to 18 years at the time of the Chornobyl accident) and 83 sporadic (from patients born after the Chornobyl accident) MPTCs were selected and compared using univariate and multivariate statistical methods in a whole group and in age and tumor size subgroups. No evidence of more aggressive clinical and histopathological behavior of radiogenic MPTCs as compared to sporadic tumors for basic structural, invasive characteristics, treatment options, and postoperative follow-up results was found. Moreover, radiogenic MPTCs were characterized by the lower frequencies of oncocytic changes (OR = 0.392, p = 0.004), nodal disease (OR = 0.509, p = 0.050), and more frequent complete remission (excellent response) after radioiodine therapy (OR = 9.174, p = 0.008). These results strongly suggest that internal irradiation does not affect tumor phenotype, does not associate with more pronounced invasive properties, and does not worsen prognosis in pediatric or young adult patients with MPTC, implying that radiation history may be not a pivotal factor for determining treatment strategy in such patients.

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Section: Introductionmentioning

confidence: 99%

The high degree of similarity in histopathological and clinical characteristics between radiogenic and sporadic papillary thyroid microcarcinomas in young patients

et al. 2022

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“…Indeed, in 2017, the United States Preventative Services Task Force issued a recommendation against screening for thyroid cancer in asymptomatic adults, giving the practice their lowest evidence rating of a D (indicating that the harms may outweigh the benefits), and more conservative staging and treatment guidelines have been recently established (18,19). Despite this, thyroid cancer overdiagnosis remains a persistent problem, with evidence that the majority of clinicians recommend tests that lead to overdiagnosis (20).…”

mentioning

confidence: 99%

Putting GLP-1 RAs and Thyroid Cancer in Context: Additional Evidence and Remaining Doubts

Thompson¹,

Stürmer²

2022

Diabetes Care

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“…A recent study indicated that more than 50% of physicians thought that total thyroidectomy for low-risk PTC was not overused, whereas more than 60% of physicians believed that radioiodine for low-risk PTC was overused (41). It implies that, regarding low-risk PTC treatment, conditional total thyroidectomy was acceptable and that radioiodine should be used less frequently.…”

Section: Discussionmentioning

confidence: 99%

Relationship between pretracheal and/or prelaryngeal lymph node metastasis and paratracheal and lateral lymph node metastasis of papillary thyroid carcinoma: A meta-analysis

et al. 2022

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ObjectiveWe conducted a meta-analysis to study the relationship between pretracheal and/or prelaryngeal lymph node metastasis and paratracheal and lateral lymph node metastasis in papillary thyroid carcinoma.MethodA systematic literature search was conducted using PubMed, Embase, and the Cochrane Library electronic databases for studies published up to February 2022. The reference lists of retrieved articles were also reviewed. Two authors independently assessed the methodological quality and extracted the data. A random-effects model was used to calculate the overall pooled relative risk. Publication bias in these studies was evaluated using Egger’s test and Begg’s test.ResultsTwenty-five independent studies involving 10,525 patients were included in the meta-analysis. The pooled relative risk for ipsilateral and contralateral paratracheal lymph node metastasis was 3.01 (95% confidence interval [CI]: 1.66, 5.45) and 5.68 (95% CI: 2.50, 12.88), respectively, in patients with pretracheal lymph node metastasis. Among patients with prelaryngeal lymph node metastasis, the pooled relative risk for ipsilateral paratracheal and/or pretracheal contralateral paratracheal, and lateral lymph node metastasis was 2.02 (95% CI: 1.90, 2.14), 2.22 (95% CI: 1.34, 3.67), and 3.85 (95% CI: 2.89, 5.14), respectively.ConclusionPretracheal lymph node metastasis and prelaryngeal lymph node metastasis were significantly associated with an increased likelihood of both ipsilateral lymph node metastasis and contralateral paratracheal lymph node metastasis in papillary thyroid carcinoma. Prelaryngeal lymph node metastasis was positively correlated with the incidence of lateral lymph node metastasis.

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Physician Perspectives of Overdiagnosis and Overtreatment of Low-Risk Papillary Thyroid Cancer in the US

Abstract: This survey study assesses physicians’ recommendations regarding overdiagnosis and overtreatment of thyroid nodules and low-risk papillary thyroid cancer.

Cited by 20 publications

References 6 publications

The high degree of similarity in histopathological and clinical characteristics between radiogenic and sporadic papillary thyroid microcarcinomas in young patients

The high degree of similarity in histopathological and clinical characteristics between radiogenic and sporadic papillary thyroid microcarcinomas in young patients

Putting GLP-1 RAs and Thyroid Cancer in Context: Additional Evidence and Remaining Doubts

Relationship between pretracheal and/or prelaryngeal lymph node metastasis and paratracheal and lateral lymph node metastasis of papillary thyroid carcinoma: A meta-analysis

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