20-year-old story of how active surveillance strategy for mikroparkomami thyroid low risk (PMC) was admitted to the hospital in Japan, where the practice has been recognized for the first time.
Active surveillance was originally proposed in Kuma Hospital in Kobe, and it is currently practiced by most endocrinologists and surgeons at the institution, but for making takes time, Ito, Yasuhiro, MD, Surgery Department at Kuma Hospital and his colleagues explain in their article, published in the April issue of "thyroid gland".
"It is expected that this information will contribute to a more rapid adoption of active surveillance to other hospitals in Japan and around the world", - they note, adding that active surveillance as a management strategy recommended the Japan Association of Endocrine Surgeons / Japan Society of thyroid surgery in their guidelines in 2011.
The American Thyroid Association has also recommended this strategy in 2015, but is still reluctance to apply the approach in the United States and in other parts of the world, the researchers said.
Once identified as malignant, thyroid nodules traditionally subjected immediate biopsy and surgery.
Japanese researchers evaluated the trends in the adoption of an active surveillance strategy, including data on 4023 patients cytologically diagnosed with low-risk PMC hospital in Qom from 1993 to 2016.
When prominent surgeons first recommend active surveillance in 1993, there was no evidence of safety and appropriateness of the practice, and used it only 30% of the 1993-1997, they explain.
In the two decades since the frequency of active surveillance in 1998-2002 increased to 51%, and in 2003-2006, it dropped to 42% and then rose to "striking" the heights of 88% in 2014-2016.
As for the types of physicians caring for these patients, the researchers note that the majority of cases in the hospital were treated by surgeons prior to 2007, but then they were treated with an increasing number of endocrinologists.
Using active surveillance was significantly higher among Endocrinology compared to surgery (86% versus 58%, P <0.0001).
The authors note that this difference may include a higher risk to patients related to the surgery. "Interestingly, the frequency of use of active surveillance endocrinologists was much higher than that of the surgeons. This may be partly due to the fact that endocrinologists often refer their patients with MVP to the peculiarities of surgeons and surgeons often recommend surgery for these cases. "
However, the technique appears to be aligned in the last period of time, estimated in the study years 2014-2016. During which the patients were assigned to actively monitor at the same speed, whether the endocrinologist or surgeon initial treatment.
The authors also note other important considerations in favor of active surveillance, including the possible risks of surgery that, although uncommon, can include permanent paralysis of the vocal cord and permanent hypoparathyroidism, even when the experienced surgeons.
A larger study, complementary data from Memorial Cancer Center Sloan-Kettering, New York, included 300 patients with low-risk thyroid papillary carcinoma (tumor diameter ≤ 1,5 cm).
As previously reported Medscape Medical News, the use of three-dimensional measurement of tumor volume has allowed earlier detection of growth compared with the US in all cases in the study.
Tumor growth diameter of 3 mm or more was observed in 3.8% of patients on average for 25 months with a total frequency of 2.5% within 2 years and 12.1% within 5 years. It is important to note that during active surveillance, regional or distant metastases did not develop.
Another significant obstacle to confidence in the active surveillance is the lack of more precise diagnostic markers. "We simply have no molecular markers to personalize this approach to determine whether a small loss turn into a larger aggressive lesion may", - he explained.