J Korean Med Assoc.  2015 Apr;58(4):302-312. 10.5124/jkma.2015.58.4.302.

The Korean guideline for thyroid cancer screening

• Yi KH
• Kim SY
• Kim DH
• Kim SW
• Na DG
• Lee YJ
• Chung KW
• Choi KS
• Koh YW
• Kim WB
• Nam KH
• Baek SK
• Baek JH
• Lee SY
• Jung YS
• Cho JJ
• Ju YS
• Dang JY
• Kim Y
• Lee WC

• KMID: 2194962
• DOI: http://doi.org/10.5124/jkma.2015.58.4.302

Abstract

Thyroid cancer is the most common malignancy in Korea; in 2012, about 44,000 new cases (19.6% of all malignancies) were registered and the estimated age-standardized incidence rate of thyroid cancer was 73.6 per 100,000 (17.3 and 88.6 per 100,000 in men and women, respectively). Despite the steep increase in its incidence, the age-standardized mortality rate of thyroid cancer has remained stable and 10-year relative survival rate is 99.2%. Increased detection using high-resolution ultrasonography may have contributed to the increased incidence of thyroid cancer if not all. However, the effectiveness of thyroid cancer screening using ultrasonography has not been fully evaluated as to whether screening and early diagnosis could decrease the morbidity or mortality of thyroid cancer. A multidisciplinary expert committee for developing a guideline for thyroid cancer screening was organized and established a recommendation for thyroid cancer screening using ultrasonography in Korea based on scientific evidence for the first time. In conclusion, the current evidence is insufficient to assess the balance of benefits and harms of the thyroid cancer screening by ultrasonography and the recommendation is that thyroid ultrasonography is not routinely recommended for healthy subjects.

Keyword

Cancer screening; Thyroid cancer; Ultrasonography; Guideline; Evidence

MeSH Terms

Early Detection of Cancer
Early Diagnosis
Female
Humans
Incidence
Korea
Male
Mass Screening*
Mortality
Survival Rate
Thyroid Gland
Thyroid Neoplasms*
Ultrasonography

Figure

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  Figure 1 Framework of developing a guideline for thyroid cancer screening. Key question 1, benefit of thyroid cancer screening with ultrasonography to reduce severity or mortality of thyroid cancer; Key question 2, harms of thyroid cancer screening with ultrasonography; Key question 3, benefit of thyroid cancer screening in high risk patients to reduce severity or mortality of thyroid cancer in high risk group; Key question 4, definition of high risk group for thyroid cancer, target age and interval of thyroid cancer screening for high risk group.

• 

  Figure 2 The results of metaanalysis for key question 1. (A) Tumor <1 cm, (B) tumor size (mean difference, cm), (C) capsular invasion, (D) cervical lymph node invasion, (E) lateral neck lymph node metastasis (N1b), and (F) distant metastasis. IV, inverse variance; CI, confidence interval.

Reference

1. National Cancer Information Center. Korea cancer registry statistics 2012 [Internet]. Goyang: National Cancer Information Center;cited 2015 Apr 9. Available from: http://www.cancer.go.kr/mbs/cancer/jsp/album/gallery.jsp?addCancerTitle=&spage=1&boardId=31817&boardSeq=8471320&mcategoryId=&id=cancer_050207000000.

2. International Agency for Research on Cancer. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012 [Internet]. Lyon: International Agency for Research on Cancer;cited 2015 Apr 9. Available from: http://globocan.iarc.fr.

3. Jung KW, Won YJ, Kong HJ, Oh CM, Lee DH, Lee JS. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2011. Cancer Res Treat. 2014; 46:109–123.

4. Morris LG, Myssiorek D. Improved detection does not fully explain the rising incidence of well-differentiated thyroid cancer: a population-based analysis. Am J Surg. 2010; 200:454–461.

5. Han MA, Choi KS, Lee HY, Kim Y, Jun JK, Park EC. Current status of thyroid cancer screening in Korea: results from a nationwide interview survey. Asian Pac J Cancer Prev. 2011; 12:1657–1663.

6. National Evidence-based Healthcare Collaborating Agency. A research on evidence-based healthcare for thyroid cancer screening. Seoul: National Evidence-based Healthcare Collabo-rating Agency;2012.

7. Choi YJ, Park YL, Koh JH. Prevalence of thyroid cancer at a medical screening center: pathological features of screen-detected thyroid carcinomas. Yonsei Med J. 2008; 49:748–756.

8. Chung WY, Chang HS, Kim EK, Park CS. Ultrasonographic mass screening for thyroid carcinoma: a study in women scheduled to undergo a breast examination. Surg Today. 2001; 31:763–767.

9. Yamada H, Katoh A, Ishinaga H. Ultrasonographic screening for thyroid cancer in the screening. Nihon Jibiinkoka Gakkai Kaiho. 2000; 103:13–18.

10. Han YM, Lim SM, Choi HY, Kim Y. Value of ultrasonographic mass screening for thyroid carcinoma in patients undergoing a breast ultrasonography. J Korean Soc Ultrasound Med. 2005; 24:75–80.

11. Lee YS, Nam KH, Chung WY, Chang HS, Park CS. Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci. 2010; 25:541–545.

12. Jung YM, Kim JS, Park JS. Recurrence and complications from the surgical procedure for treating a papillary thyroid carcinoma. J Korean Surg Soc. 2001; 61:135–141.

13. Kim KB, Suh YJ, Ahn GH, Chun SW, Cho WI, Kim SN, Lee JH. A clinical review of 81 cases of total thyroidectomy. J Korean Surg Soc. 1997; 52:13–20.

14. Polyzos SA, Anastasilakis AD. Clinical complications following thyroid fine-needle biopsy: a systematic review. Clin Endocrinol (Oxf). 2009; 71:157–165.

15. Christou N, Mathonnet M. Complications after total thyroidectomy. J Visc Surg. 2013; 150:249–256.

16. American Thyroid Association Guidelines Task Force. Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, Wells SA Jr. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid. 2009; 19:565–612.

17. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: thyroid carcinoma version 2 [Internet]. Fort Washington: National Comprehensive Cancer Network;2013. cited 2015 Mar 18. Available from: http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp.

18. National Comprehensive Cancer Network. NCCN clinical prac-tice guidelines in oncology: neuroendocrine tumors ver-sion I [Internet]. Fort Washington: National Comprehensive Cancer Network;2013. cited 2015 Mar 18. Available from: http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp.

19. Scottish Intercollegiate Guidelines Network. Long term follow up of survivors of childhood cancer [Internet]. Edinburgh: Scottish Intercollegiate Guidelines Network;2013. cited 2015 Apr 9. Available from: http://www.sign.ac.uk.

20. British Thyroid Association. Royal College of Physicians of London. Guidelines for the management of thyroid cancer. 2nd ed. London: Royal College of Physicians;2007.

21. The Korean Academy of Family Medicine. Periodic health exa-mination and prevention guidelines for Koreans. 3rd ed. Seoul: Gukjin P&D;2009.

22. Petitti DB, Teutsch SM, Barton MB, Sawaya GF, Ockene JK, DeWitt T. U.S. Preventive Services Task Force. Update on the methods of the U.S. Preventive Services Task Force insufficient evidence. Ann Intern Med. 2009; 150:199–205.

23. Gomella LG, Liu XS, Trabulsi EJ, Kelly WK, Myers R, Showalter T, Dicker A, Wender R. Screening for prostate cancer: the current evidence and guidelines controversy. Can J Urol. 2011; 18:5875–5883.