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Active surveillance trends in low-risk thyroid cancer vary by endocrinologist, surgeon

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May 10, 2018

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: ito01@kuma-h.or.jp.

Disclosures : The authors report no relevant financial disclosures.