The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer

Abstract

The Japan Associations of Endocrine Surgeons has developed the revised version of the Clinical Practice Guidelines for Thyroid Tumors. This article describes the guidelines translated into English for the 35 clinical questions relevant to the therapeutic management of thyroid cancers. The objective of the guidelines is to improve health-related outcomes in patients with thyroid tumors by enabling users to make their practice evidence-based and by minimizing any variations in clinical practice due to gaps in evidential knowledge among physicians. The guidelines give representative flowcharts on the management of papillary, follicular, medullary, and anaplastic thyroid carcinoma, along with recommendations for clinical questions by presenting evidence on the relevant outcomes including benefits, risks, and health conditions from patients' perspective. Therapeutic actions were recommended or not recommended either strongly (◎◎◎ or XXX) based on good evidence ( )/good expert consensus (+++), or weakly (◎, ◎◎ or X, XX) based on poor evidence ( )/poor expert consensus (+ or ++). Only 10 of the 51 recommendations given in the guidelines were supported by good evidence, whereas 35 were supported by good expert consensus. While implementing the current guidelines would be of help to achieve the objective, we need further clinical research to make our shared decision making to be more evidence-based.

Prognostic significance of vascular invasion and cell-proliferation activity in widely invasive follicular carcinoma of the thyroid

“…In the Japanese guidelines issued by the Japan Association of Endocrine Surgeons, it is stated that since wi-FTC has an aggressive character, if the first surgery is a hemithyroidectomy, a completion total thyroidectomy is recommended along with RAI therapy [15]. Our present findings indicate that a total thyroidectomy is mandatory for wi-FTC cases with vascular invasion and/or a Ki-67 LI ≥5% even though these cases are classified as M0.…”

ASO Author Reflections: Outcomes for Minimally Invasive Follicular Thyroid Carcinoma in AJCC 8th Edition

“…Completion total thyroidectomy along with radioactive iodine (RAI) therapy is not uniformly recommended for minimally invasive FTCs (MI-FTCs) without distant metastasis in Japanese revised clinical practice guidelines. 1 In our hospital, completion total thyroidectomy along with RAI was recommended for patients aged C 45 years with MI-FTC, based on previous reports. 2,3…”

Additional Tissue Sampling Trials Did Not Change Our Thyroid Practice

“…It is currently questionable whether increasing the frequency of minimally invasive FTC diagnoses based on the examination of a larger number of blocks can improve patients' outcome [34,35]. In particular, in Japan, completion thyroidectomy and RI therapy are seldom performed for patients with minimally invasive FTC, as the clinical guidelines provided by the Japanese Association of Endocrine Surgeons do not recommend it in cases without distant metastasis; nevertheless, the prognosis of such patients is favorable [36,37]. There would be no difference in treatment methods even if minimally invasive FTC cases were misclassified as either follicular adenoma or FT-UMP, as all of these are curable with lobectomy alone.…”