Thyroid microcarcinomas are more likely than larger cancers to be discover by ultrasound and less likely to be associated with surgery scheduled for known thyroid cancer, according to findings from a large, population base study that include patient report data. “Our findings emphasize the need to curb unnecessary diagnosis and treatment of thyroid microcarcinomas,” Megan R. Haymart, MD,associate professor of medicine, metabolism, endocrinology and diabetes at the University of Michigan, told Endocrine Today.
“To prevent overdiagnosis, neck or thyroid ultrasound should not be order in patients unless they have symptoms or signs of thyroid enlargement. The evaluation of nodules smaller than 1 cm should be according to clinical guideline recommendations; also furthermore, fine-needle aspiration biopsy of these small nodules should be avoid. Finally, if cancer is less than 1 cm and there are no worrisome lymph nodes or high risk features; active surveillance should be consider.”
Differentiated thyroid cancer
Haymart and colleagues use the Georgia and Los Angeles County Surveillance; Epidemiology and End Results (SEER) registries between 2014 and 2015 to identify 4,185 adults with newly diagnose differentiate thyroid cancer; also mail them surveys between February 2017 and October 2018 asking about circumstances of their thyroid nodule discovery; whether they underwent fine needle aspiration [FNA] biopsy and reasons for thyroid surgery (response rate, 63%).
“Specifically, respondents were ask about the discovery of their thyroid nodule with the following options: didn’t know about nodule, felt it myself, doctor felt it, had a thyroid ultrasound; find on imaging test other than thyroid ultrasound, such as CT scan,” the researchers wrote. “They were also ask about history of FNA biopsy of their nodule prior to thyroid surgery with yes or no answer options.”
Multivariable logistic regression
“Recently, there has been a campaign to avoid unnecessary treatment in patients with small thyroid cancer and to establish programs for active surveillance. Although not all have been supportive of active surveillance in the management of thyroid cancer; there is a need for practice change in the management of thyroid nodules in the United States. Neck or thyroid ultrasound should not be ordered in patients without symptoms or signs from thyroid enlargement.”
The researchers note that the evaluation of small thyroid nodules; which should be conduct according to 2015 American Thyroid Association guidelines, and FNA biopsy of small thyroid nodules should be avoided. “Until change in nodule detection and management is implement, decreasing small thyroid cancer incidence will be challenging; also female patients will remain uniquely susceptible to overdiagnosis and potential overtreatment,” the researchers wrote.