Endocrinol Metab.  2017 Dec;32(4):399-406. 10.3803/EnM.2017.32.4.399.

Active Surveillance of Papillary Thyroid Microcarcinoma: A Mini-Review from Korea

• Kim TY
• Shong YK

• KMID: 2406182
• DOI: http://doi.org/10.3803/EnM.2017.32.4.399

Abstract

In Korea, the incidence of thyroid cancer increased explosively in the early 2000s, and reached a plateau in the early 2010s. Most cases of newly diagnosed thyroid cancer are small indolent microcarcinoma and could be good candidates for active surveillance (AS) instead of immediate surgery. Many considerations must be taken into account for establishing selection criteria for candidates for AS of papillary thyroid microcarcinoma (PTMC), including the characteristics of the tumor, the patient, and the medical team. If possible, AS of PTMC should be a part of a prospective clinical trial to ensure long-term safety and to identify clinical and/or molecular markers of the progression of PTMC. In this review, we discuss lessons regarding surgical interventions for PTMC, and then describe the concept, application, caveats, unanswered questions, and future perspectives of AS of PTMC. For appropriately selected patients with PTMC, AS can be a good alternative to immediate surgery.

Keyword

Thyroid neoplasms; Active surveillance

MeSH Terms

Humans
Incidence
Korea*
Patient Selection
Prospective Studies
Thyroid Gland*
Thyroid Neoplasms

Reference

1. Jung KW, Won YJ, Oh CM, Kong HJ, Lee DH, Lee KH, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2014. Cancer Res Treat. 2017; 49:292–305.

2. Ahn HS, Kim HJ, Welch HG. Korea's thyroid-cancer “epidemic”: screening and overdiagnosis. N Engl J Med. 2014; 371:1765–1767.

3. Nam-Goong IS, Kim HY, Gong G, Lee HK, Hong SJ, Kim WB, et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin Endocrinol (Oxf). 2004; 60:21–28.

4. Kang HW, No JH, Chung JH, Min YK, Lee MS, Lee MK, et al. Prevalence, clinical and ultrasonographic characteristics of thyroid incidentalomas. Thyroid. 2004; 14:29–33.

5. Jeon MJ, Kim WG, Kwon H, Kim M, Park S, Oh HS, et al. Clinical outcomes after delayed thyroid surgery in patients with papillary thyroid microcarcinoma. Eur J Endocrinol. 2017; 177:25–31.

6. Kwon H, Jeon MJ, Kim WG, Park S, Kim M, Song DE, et al. A comparison of lobectomy and total thyroidectomy in patients with papillary thyroid microcarcinoma: a retrospective individual risk factor-matched cohort study. Eur J Endocrinol. 2017; 176:371–378.

7. Kwon H, Jeon MJ, Kim WG, Park S, Kim M, Kim TY, et al. Lack of efficacy of radioiodine remnant ablation for papillary thyroid microcarcinoma: verification using inverse probability of treatment weighting. Ann Surg Oncol. 2017; 24:2596–2602.

8. Park S, Kim WG, Han M, Jeon MJ, Kwon H, Kim M, et al. Thyrotropin suppressive therapy for low-risk small thyroid cancer: a propensity score-matched cohort study. Thyroid. 2017; 27:1164–1170.

9. Oh HS, Park S, Kim M, Kwon H, Song E, Sung TY, et al. Young age and male sex are predictors of large-volume central neck lymph node metastasis in clinical n0 papillary thyroid microcarcinomas. Thyroid. 2017; 27:1285–1290.

10. Jeon MJ, Chung MS, Kwon H, Kim M, Park S, Baek JH, et al. Features of papillary thyroid microcarcinoma associated with lateral cervical lymph node metastasis. Clin Endocrinol (Oxf). 2017; 86:845–851.

11. Dahabreh IJ, Chung M, Balk EM, Yu WW, Mathew P, Lau J, et al. Active surveillance in men with localized prostate cancer: a systematic review. Ann Intern Med. 2012; 156:582–590.

12. Chen RC, Rumble RB, Loblaw DA, Finelli A, Ehdaie B, Cooperberg MR, et al. Active surveillance for the management of localized prostate cancer (cancer care Ontario guideline): American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2016; 34:2182–2190.

13. Edge SB. American Joint Committee on Cancer. Chapter 8, Thyroid cancer. AJCC cancer staging manual. 7th ed. New York: Springer;2010. p. 87–96.

14. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19:1167–1214.

15. Youngwirth LM, Adam MA, Scheri RP, Roman SA, Sosa JA. Patients treated at low-volume centers have higher rates of incomplete resection and compromised outcomes: analysis of 31,129 patients with papillary thyroid cancer. Ann Surg Oncol. 2016; 23:403–409.

16. Ito Y, Uruno T, Nakano K, Takamura Y, Miya A, Kobayashi K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003; 13:381–387.

17. Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2010; 34:28–35.

18. Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014; 24:27–34.

19. Sugitani I, Toda K, Yamada K, Yamamoto N, Ikenaga M, Fujimoto Y. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg. 2010; 34:1222–1231.

20. Kwon H, Oh HS, Kim M, Park S, Jeon MJ, Kim WG, et al. Active surveillance for patients with papillary thyroid microcarcinoma: a single center's experience in Korea. J Clin Endocrinol Metab. 2017; 102:1917–1925.

21. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016; 26:1–133.

22. Yi KH. The revised 2016 Korean Thyroid Association guidelines for thyroid nodules and cancers: differences from the 2015 American Thyroid Association guidelines. Endocrinol Metab (Seoul). 2016; 31:373–378.

23. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf). 2014; 81:Suppl 1. 1–122.

24. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: 2016 update. Endocr Pract. 2016; 22:622–639.

25. Brito JP, Ito Y, Miyauchi A, Tuttle RM. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid. 2016; 26:144–149.

26. Ito Y, Oda H, Miyauchi A. Insights and clinical questions about the active surveillance of low-risk papillary thyroid microcarcinomas [review]. Endocr J. 2016; 63:323–328.

27. Tuttle RM, Fagin JA, Minkowitz G, Wong RJ, Roman B, Patel S, et al. Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance. JAMA Otolaryngol Head Neck Surg. 2017; 143:1015–1020.

28. Haser GC, Tuttle RM, Urken ML. Challenges of active surveillance protocols for low-risk papillary thyroid microcarcinoma in the United States. Thyroid. 2016; 26:989–990.

29. Ha SM, Kim JK, Baek JH. Detection of malignancy among suspicious thyroid nodules <1 cm on ultrasound with various thyroid image reporting and data systems. Thyroid. 2017; 27:1307–1315.

30. Kim C, Baek JH, Ha E, Lee JH, Choi YJ, Song DE, et al. Ultrasonography features of medullary thyroid cancer as predictors of its biological behavior. Acta Radiol. 2017; 58:414–422.

31. Kwon H, Kim WG, Sung TY, Jeon MJ, Song DE, Lee YM, et al. Changing trends in the clinicopathological features and clinical outcomes of medullary thyroid carcinoma. J Surg Oncol. 2016; 113:152–158.

32. Han JM, Bae Kim W, Kim TY, Ryu JS, Gong G, Hong SJ, et al. Time trend in tumour size and characteristics of anaplastic thyroid carcinoma. Clin Endocrinol (Oxf). 2012; 77:459–464.

33. Alhashemi A, Goldstein DP, Sawka AM. A systematic review of primary active surveillance management of low-risk papillary carcinoma. Curr Opin Oncol. 2016; 28:11–17.

34. Nilubol N, Kebebew E. Should small papillary thyroid cancer be observed? A population-based study. Cancer. 2015; 121:1017–1024.

35. Fukuoka O, Sugitani I, Ebina A, Toda K, Kawabata K, Yamada K. Natural history of asymptomatic papillary thyroid microcarcinoma: time-dependent changes in calcification and vascularity during active surveillance. World J Surg. 2016; 40:529–537.

36. Hirokawa M, Kudo T, Ota H, Suzuki A, Miyauchi A. Pathological characteristics of low-risk papillary thyroid microcarcinoma with progression during active surveillance. Endocr J. 2016; 63:805–810.

37. Carter G, Clover K, Britton B, Mitchell AJ, White M, McLeod N, et al. Wellbeing during active surveillance for localised prostate cancer: a systematic review of psychological morbidity and quality of life. Cancer Treat Rev. 2015; 41:46–60.

38. Venderbos LD, van den Bergh RC, Roobol MJ, Schroder FH, Essink-Bot ML, Bangma CH, et al. A longitudinal study on the impact of active surveillance for prostate cancer on anxiety and distress levels. Psychooncology. 2015; 24:348–354.

39. Oda H, Miyauchi A, Ito Y, Yoshioka K, Nakayama A, Sasai H, et al. Incidences of unfavorable events in the management of low-risk papillary microcarcinoma of the thyroid by active surveillance versus immediate surgery. Thyroid. 2016; 26:150–155.

40. Lang BH, Wong CK. A cost-effectiveness comparison between early surgery and non-surgical approach for incidental papillary thyroid microcarcinoma. Eur J Endocrinol. 2015; 173:367–375.

41. Oda H, Miyauchi A, Ito Y, Sasai H, Masuoka H, Yabuta T, et al. Comparison of the costs of active surveillance and immediate surgery in the management of low-risk papillary microcarcinoma of the thyroid. Endocr J. 2017; 64:59–64.

42. Venkatesh S, Pasternak JD, Beninato T, Drake FT, Kluijfhout WP, Liu C, et al. Cost-effectiveness of active surveillance versus hemithyroidectomy for micropapillary thyroid cancer. Surgery. 2017; 161:116–126.

43. Kim TY, Kim WB, Song JY, Rhee YS, Gong G, Cho YM, et al. The BRAF mutation is not associated with poor prognostic factors in Korean patients with conventional papillary thyroid microcarcinoma. Clin Endocrinol (Oxf). 2005; 63:588–593.

44. Sugitani I, Fujimoto Y, Yamada K. Association between serum thyrotropin concentration and growth of asymptomatic papillary thyroid microcarcinoma. World J Surg. 2014; 38:673–678.