Thyroid Microcancer 101: What we learned from the Japanese Studies.
Thyroid 28(1) 2018: p.23
Miyauchi A. et al
Dr.Guttler comments on this article.
1.10 years on 1235 patients
2. Only 8 % grew > 3mm.
3. Only 4% had node metastaic disease in the neck.
4. Older patients 60 are the least likely to have >3 mm growth.
5. 974 chose initial surgery, compared to 1179 who chose active surveillance AS.
6. Initial surgery patient had more unfavorable outcomes.
7. Total cost was 4 times higher in the initial surgery group over 10 year follow up period compared to the AS group.
8.Poor vascularity and macro or rim calcification was seen in non-progressing disease cases.
9. None of the patients with 3 mm growth who had late rescue surgery had significant recurrence or died of PTC.
10. In Japan AS may be first line option for micro-papillary cancer.
11.Patients over 60 have the best results with AS.
12. US patients may not be ready to have the thyroid cancer sitting in there neck for 40 years.
13. Also they may not want surgery either knowing it is unlikely to cause them to die.
14. Ethanol ablation (PEI ) has been shown by Ian Hay’s group at Mayo Clinic to ablate the micro cancers inside the thyroid without surgery.
15. JH Baek in Korea also ablates microcancers without surgery with radiofrequncy RFA.t