Thyroid Cancer 101: Active Surveillance What is It and Can I Be Treated by Just Follow up examinations without surgery?
Comments by Dr.Guttler.
The Japanese experience is quite positive for AS but the population in Japan is different than the USA. 63% use of AS is remarkable but can that happen in the US? With a more questioning population and the fear of cancer sitting in the neck for years have made some centers including mine to offer a minimal invasive method to destroy the cancer as a third avenue for therapy. Mayo clinic’s Ian Hay has lead the way in ethanol ablation PEI of micro-cancers.
Dr.Hay presenting his data on PEI for micro-papillary cancers. He calls PEI a third arm for treating these low risk micro-cancers besides surgery or AS.
Dr.JH Baek in Seoul Korea has used Radiofrequency RFA to ablate micro-papillary cancers.
If you have been offered AS as the therapy for you and have doubts and want a third alternative to surgery or watching the cancer for years, call me at 310-393-8860, or email to firstname.lastname@example.org. for details of Micro-papillary cancer ethanol ablation in my center or referral to Dr.Baek in Korea for RFA.
Dr.Baek has presented data on the use of Thyroid RFA for micropapillary thyroid cancers, with folowup cutting needle evidence the tumor was ablated.
Thyroid RFA is already an accepted therapy for Benign nodules, and recurrent cancer lymph nodes.
It has been used to treat large recurrences with other combined therapy. Now it can be used for micro-papillary cancers in-situ leaving the thyroid gland intact without thyroidectomies.
The frequency of active surveillance to monitor low-risk papillary thyroid microcarcinoma has increased as evidence points to its safety and superiority over immediate surgery, but researchers observed high variation of its use between endocrinologists and surgeons, according to an analysis of long-term data from a Japanese hospital.
“The acceptance of active surveillance will vary according to institutions and countries and even each doctor,” Yasuhiro Ito, MD, PhD, of the department of surgery at Kuma Hospital in Kobe, Japan, told Endocrine Today. “These findings are socially important and could predict how our strategy is accepted from now on worldwide.”
Ito and colleagues analyzed data from 4,023 patients cytologically diagnosed with low-risk papillary thyroid microcarcinoma at Kuma Hospital between October 1993, when active surveillance was first initiated at the institution, and June 2016. Patients who opted for active surveillance were monitored by ultrasound once yearly. Researchers analyzed the trend in the frequency of active surveillance use over time, dividing the 24-year study period into five parts based on the change in frequency of active surveillance use: 1993-1997, 1998-2002, 2003-2006, 2007-2013 and 2014-2016.
Within the cohort, 65% chose active surveillance and the remaining 35% of patients underwent surgery within 1 year after diagnosis.
The frequency of active surveillance increased from 8% in 1993 to 63% in 1996, before nearly plateauing from 1997 to 2002. Active surveillance gradually decreased from 2003 to 2006 before increasing again, and then markedly increased after 2014, reaching about 90%, according to the researchers.
The researchers observed “marked differences” in the frequency of active surveillance use among physicians at Kuma Hospital, with 86% of endocrinologists and 58% of surgeons employing the management strategy.
“The number of patients whose therapeutic strategies were determined by endocrinologists increased from 2007, but the endocrinologists still tended to refer cases with risky features to surgeons,” the researchers wrote. This might partially explain the difference in the frequency of [active surveillance] use between these two groups.”
Ito said as evidence of the safety and superiority of active surveillance continues to accumulate, this management option will be likely adopted more quickly in other countries.
“It may be meaningful to study the same issue by other institutions in the future,” Ito said. – by Regina Schaffer
For more information:
Yasuhiro Ito, MD, PhD, can be reached at Kuma Hospital, 8-2-35, Shimoyamate-dori, Chuo-ku, Kobe, 65-0011, Japan; email: email@example.com.
Disclosures : The authors report no relevant financial disclosures.