Position paper from the Japan Thyroid Association task force on the management of low-risk papillary thyroid microcarcinoma (T1aN0M0) in adults

  • Horiguchi Kazuhiko
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
  • Yoshida Yusaku
    Department of Breast and Endocrine Surgery, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
  • Iwaku Kenji
    Sapporo Thyroid Clinic (Ito Hospital), Sapporo 060-0042, Japan
  • Emoto Naoya
    Diabetes & Thyroid Clinic, Sakura Chuo Hospital, Sakura 285-0014, Japan
  • Kasahara Toshihiko
    Department of Internal Medicine, Kuma Hospital, Kobe 650-0011, Japan
  • Sato Junichiro
    Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
  • Shimura Hiroki
    Department of Laboratory Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
  • Shindo Hisakazu
    Department of Surgery, Yamashita Thyroid Hospital, Fukuoka 812-0034, Japan
  • Suzuki Satoru
    Department of Thyroid and Endocrinology, Division of Internal Medicine, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
  • Nagano Hidekazu
    Department of Molecular Diagnosis, Graduate school of Medicine, Chiba University, Chiba 260-8670, Japan
  • Furuya Fumihiko
    Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi 409-3998, Japan
  • Makita Noriko
    Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
  • Matsumoto Fumihiko
    Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
  • Manaka Katsunori
    Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
  • Mitsutake Norisato
    Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
  • Miyakawa Megumi
    Department of Internal Medicine, Miyakawa Hospital, Kawasaki 210-0802, Japan
  • Yokoya Susumu
    Thyroid and Endocrine Center, Fukushima Medical University, Fukushima 960-1295, Japan
  • Sugitani Iwao
    Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo 113-8603, Japan

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抄録

<p>The incidence of thyroid carcinoma has been increasing worldwide. This is interpreted as an increase in the incidental detection of papillary thyroid microcarcinomas (PTMCs). However, mortality has not changed, suggesting overdiagnosis and overtreatment. Prospective clinical trials of active surveillance for low-risk PTMC (T1aN0M0) have been conducted in two Japanese institutions since the 1990s. Based on the favorable outcomes of these trials, active surveillance has been gradually adopted worldwide. A task force on the management of PTMC in adults organized by the Japan Thyroid Association therefore conducted a systematic review and has produced the present position paper based on the scientific evidence concerning active surveillance. This paper indicates evidence for the increased incidence of PTMC, favorable surgical outcomes for low-risk PTMC, recommended criteria for diagnosis using fine needle aspiration cytology, and evaluation of lymph node metastasis (LNM), extrathyroidal extension (ETE) and distant metastasis. Active surveillance has also been reported with a low incidence of disease progression and no subsequent recurrence or adverse events on survival if conversion surgery was performed at a slightly advanced stage. Active surveillance is a safe and valid strategy for PTMC, because it might preserve physical quality of life and reduce 10-year medical costs. However, some points should be noted when performing active surveillance. Immediate surgery is needed for PTMC showing high-risk features, such as clinical LNM, ETE or distant metastasis. Active surveillance should be performed under an appropriate medical team and should be continued for life.</p>

収録刊行物

  • Endocrine Journal

    Endocrine Journal 68 (7), 763-780, 2021

    一般社団法人 日本内分泌学会

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