Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
JAMA Otolaryngol Head Neck Surg. 2022 Feb 1;148(2):99-106. doi: 10.1001/jamaoto.2021.3277.
Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment.
To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size.
DESIGN, SETTING, AND PARTICIPANTS: This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019). Participating hospitals were included from the US (n = 12), Canada (n = 2), Denmark (n = 1), South Korea (n = 1), South Africa (n = 1), and India (n = 1). The records of the first 100 patients per institution for each year who underwent thyroid-directed surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) were reviewed.
Frequency of diagnosis of NIFTP, PTCs, and thyroidectomies during the study period.
Of the 790 papillary thyroid neoplasms captured in the 2019 cohort, 38 (4.8%) were diagnosed as NIFTP. Diagnosis of NIFTP was observed in the US, South Africa, and India. There was minimal difference in the total proportion of PTCs in the 2015 cohort compared with the 2019 cohort (778 [47.1%] vs 752 [44.5%]; difference, 2.6% [95% CI, -16.9% to 22.1%]). The proportion of PTCs eligible for hemithyroidectomy but treated with total thyroidectomy in the 2 cohorts demonstrated a decreasing trend from 2015 to 2019 (341 of 453 [75.3%] vs 253 of 434 [58.3%]; difference, 17.0% [95% CI, -1.2% to 35.2%]).
Results of this cohort study showed that the 2 mitigation strategies for preventing overtreatment of early-stage thyroid cancer have had mixed success. The diagnosis of NIFTP has only been applied to a small proportion of thyroid neoplasms compared with expected rates. However, more patients eligible for hemithyroidectomy received it in 2019 compared with 2015, showing some success with this deescalation strategy.
随着早期甲状腺乳头状瘤检出率的增加而死亡率没有改善，这促使人们开发了预防或减轻过度治疗的策略。
确定 2 种最近开发的限制低危甲状腺癌过度治疗的策略的采用率：（1）一种新的分类，非浸润性滤泡性甲状腺肿瘤伴乳头状核特征（NIFTP），以及（2）对于大小在 4 厘米以下的选定甲状腺乳头状癌（PTC）进行半甲状腺切除术。
设计、地点和参与者：这是一项来自 6 个国家 18 家医院的 2 个队列的 3368 例病理记录的横断面分析，分为 2 个时间段（2015 年和 2019 年）。参与的医院来自美国（n=12）、加拿大（n=2）、丹麦（n=1）、韩国（n=1）、南非（n=1）和印度（n=1）。对每家医院每年前 100 名接受甲状腺定向手术（半甲状腺切除术、全甲状腺切除术或完成甲状腺切除术）的患者的记录进行了回顾。
研究期间 NIFTP、PTC 和甲状腺切除术的诊断频率。
在 2019 年队列中捕获的 790 例甲状腺乳头状瘤中，38 例（4.8%）被诊断为 NIFTP。在美国、南非和印度都发现了 NIFTP 的诊断。与 2019 年相比，2015 年队列中 PTC 的总比例差异很小（778 例[47.1%]与 752 例[44.5%]；差异为 2.6%[95%置信区间，-16.9%至 22.1%]）。在这 2 个队列中，适合行半甲状腺切除术但接受全甲状腺切除术治疗的 PTC 比例从 2015 年到 2019 年呈下降趋势（453 例中有 341 例[75.3%]与 434 例中有 253 例[58.3%]；差异为 17.0%[95%置信区间，-1.2%至 35.2%]）。
这项队列研究的结果表明，预防早期甲状腺癌过度治疗的 2 种缓解策略的效果喜忧参半。与预期相比，只有一小部分甲状腺肿瘤被诊断为 NIFTP。然而，与 2015 年相比，2019 年接受半甲状腺切除术治疗的适合手术的患者比例有所增加，这表明这种降级策略取得了一定的成功。
