Therapeutic strategy for low-risk thyroid cancer in Kanaji Thyroid Hospital [Review]

Abstract

Abstract. It is well-known that differentiated thyroid carcinoma (DTC) has a generally indolent character and shows a favorable prognosis in comparison with many other carcinomas. The therapeutic strategy for patients with DTC in Japan has differed from that in Western countries. Total thyroidectomy followed by radioactive iodine (RAI) ablation has been standard in Western countries, whereas limited hemi-thyroidectomy and subtotal thyroidectomy has been extensively accepted in Japan. Papillary thyroid carcinoma (PTC) accounts for over 90% of all thyroid cancers in Japan. The majority of patients with PTC are categorized into a low-risk group on the basis of the recent risk-group classification schemes, and they show excellent outcomes. Several management guidelines for thyroid cancers have been published in Western countries. However, the optimal therapeutic options for PTC remain controversial, and high-level clinical evidence aimed at resolving these issues is lacking. Moreover, as socioeconomic differences in medical care exist, conventional policies for the treatment of PTC have differed between Japan and other countries. This review focuses on the special features of treatment in Japan for patients with low-risk DTC involving subtotal thyroidectomy without adjuvant therapies, rather than total thyroidectomy with RAI, with the aim of preserving quality of life. At our institution in Japan, we have had extensive experience with RAI treatment for high-risk DTC patients, and this represents a very rare situation. Here we introduce the therapeutic strategy for low-risk thyroid cancer in Japan, including the measures adopted at our institution.

Introducing the reporting system for thyroid fine-needle aspiration cytology according to the new guidelines of the Japan Thyroid Association [Review]

“…In Japan, further selection for surgical treatment was considered for all patients with follicular neoplasms [26][27][28][29][30][31][32][33]. It was recommended that surgical treatment should not be indicated for patients based on cytological diagnosis alone, particularly for those with A-1: follicular neoplasm, favor benign [26].…”

“…From the cytological report of indeterminate A (follicular neoplasm), surgeons and endocrinologists in Japan will apply other clinical examinations useful for decision-making in clinical management of a patient [26][27][28][29][30][31][32][33][34][35][36]. This is because FNA cytology alone did not effi-cases of follicular neoplasm, and when these 27 cases were divided into two groups (with or without atypical cells), 28.6% (2/7 cases) were malignant in the group with atypia and 10% (2/20 cases) were malignant in the other group [42].…”

“…One involves combination into a single group as follicular neoplasm, which can undergo diagnostic lobectomy for a final conclusion unselectively because cytological examination alone cannot achieve a conclusive diagnosis. This was the standard approach in most of the guidelines in Western countries [1-14, [28][29][30][31][32][33][34][35][36]. The other approach is grading of follicular neoplasms into several subcategories depending on cytological characteristics using cellular atypia, loss of cellular polarity, loss of cellular cohesiveness and structural abnormality, which may be linked to the probability of malignancy [1-14, 28-36, 59] (Figs.…”

Aspectos tácticos y técnicos en cirugía de la glándula tiroides

“…La tiroidectomía total constituye el tratamiento quirúrgico convencional para tratar el cáncer diferenciado de tiroides, dado que tiene mejores índices de sobrevida global y libre de enfermedad que resecciones subtotales o lobectomías 16,17 .…”

Avaliação Da Qualidade De Vida De Indivíduos Com Carcinoma Bem Diferenciado De Tireoide Pelo Whoqol-100

“…O tratamento para o CDT inclui cirurgia, terapia com radiodo ou uma combinação destas modalidades (8) . Na maioria dos casos de CDT, o procedimento cirúrgico indicado é a cirurgia ablativa da tireoide (ou tireoidectomia) com retirada das metástases ganglionares locais, seguida por terapia com iodo radioativo (RIT) (9) . Essas intervenções frequentemente têm consequências físicas e psicológicas indesejáveis para os indivíduos (8,10) , que nem sempre são passíveis de controle (8) e podem gerar impacto negativo em sua QV (2) .…”