Active Surveillance for Patients With Papillary Thyroid Microcarcinoma: A Single Center’s Experience in Korea

Kwon, Hyemi; Oh, Hye-Seon; Kim, Mijin; Park, Suyeon; Jeon, Min Ji; Kim, Won Gu; Shong, Young Kee; Song, Dong Eun; Baek, Jung Hwan; Chung, Ki-Wook; Kim, Tae Yong

doi:10.1210/jc.2016-4026

Cited by 180 publications

(121 citation statements)

References 33 publications

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“…Comprehensive risk stratification of PMC considers a constellation of clinical, pathological, and molecular parameters . Observation without surgical treatment is practiced for patients with low‐risk PMC in several leading medical centers in Japan, Korea and the USA . Less than 15% of low‐risk PMC grow to more than 3 mm or develop lymph node metastasis during follow‐up, and most importantly, no thyroid cancer death was reported among more than 1000 patients for more than 10 years of follow‐up .…”

Section: Papillary Microcarcinomamentioning

confidence: 99%

“…[4][5][6][7][8]68,74,75 Less than 15% of low-risk PMC grow to more than 3 mm or develop lymph node metastasis during follow-up, and most importantly, no thyroid cancer death was reported among more than 1000 patients for more than 10 years of follow-up. [4][5][6][7][8]68,[74][75][76] Expert thyroid pathologists proposed calling it papillary microtumor instead of carcinoma, 77 and a proposal to classify PMC in the borderline tumor category was reported by Kakudo et al 48 However, papillary microtumor has not become a popular diagnosis among pathologists and clinicians because a significant amount of PMC cases (15-35%) have lymph node metastasis at surgery and rare cases (<0.4%) develop distant metastasis. [65][66][67][68][71][72][73][74][75][76][77][78][79][80]…”

Section: Papillary Microcarcinomamentioning

confidence: 99%

See 1 more Smart Citation

The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives

Kakudo

Bychkov

Bai

et al. 2018

Pathology International

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Section: Papillary Microcarcinomamentioning

confidence: 99%

Section: Papillary Microcarcinomamentioning

confidence: 99%

The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives

Kakudo

Bychkov

Bai

et al. 2018

Pathology International

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“…Twelve patients ultimately required surgery for lymph node metastases or increase in tumor size and had no noted recurrence during postoperative follow‐up. Lastly, a retrospective report from a Korean group also published its experience with AS of 192 patients with PTMC . The investigators noted relatively low rates of tumor growth with 24 patients undergoing delayed thyroid surgery after commencing observation.…”

Section: Introductionmentioning

confidence: 99%

Active surveillance for patients with very low‐risk thyroid cancer

Lohia

Hanson

Tuttle

et al. 2020

Laryngoscope Investig Oto

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Over the past 30 years in the United States, increasing identification of small thyroid nodules has led to a dramatic rise in the detection of small thyroid cancers, many of which are unlikely to progress to overt clinical disease. Because autopsy studies reveal that up to 30% of people harbor clinically occult thyroid cancers, the growing use of diagnostic technologies has identified an increasing number of small, clinically low risk papillary thyroid cancers (PTCs). In recent years, clinical practice has evolved to de‐intensify the treatment for PTCs, with fewer total thyroidectomy and nodal dissection procedures being performed, in favor of more limited operations. In addition, vigilant observation of selected low risk cancers has demonstrated outcomes comparable to those patients who undergo immediate surgical intervention. Active surveillance has emerged as a new option within the treatment algorithm of PTCs. There is now robust data from cancer centers in Japan and Korea which have reported excellent oncologic outcomes among patients undergoing active surveillance for PTC, as well as more recent, similar data from the United States. American Thyroid Association guidelines now include the option of active surveillance for appropriately selected patients with low‐risk PTC. With active surveillance now one option within the standard of care for patients with certain thyroid cancers, surgeons have become critical to facilitating shared decision‐making for patients facing this diagnosis.

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“…AS of low-risk PTMC was then included in the guidelines developed by the Japan Association of Endocrine Surgery ( JAES)/Japanese Society of Thyroid Surgery ( JSTS) (12) and the American Thyroid Association (ATA) (13). Favorable results of AS from other countries such as the United States and Korea have also been reported (14)(15)(16).…”

Section: Introductionmentioning

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

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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.

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Active Surveillance for Patients With Papillary Thyroid Microcarcinoma: A Single Center’s Experience in Korea

Abstract: Some PTMCs could grow significantly after a relatively short period of active surveillance. We also found that the change in tumor volume was more sensitive to detect tumor progression than the change in the maximal tumor diameter.

Cited by 180 publications

References 33 publications

The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives

The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives

Active surveillance for patients with very low‐risk 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

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