Jama Sub -journal: Only 46%of the thyroid "cancer" surgery is confirmed!Maybe a good phenomenon?

*For medical professionals for reading reference

Is the thyroid cancer over -diagnosis and treatment?

Recently, the "Xiaomin is here" incident has allowed thyroid cancer to occupy the public's attention again. On the one hand, due to the low degree of malignancy in most of the thyroid cancer and the improvement of early screening rates, patients' prognosis is generally better, and the public even calls it "like cancer"; on the other hand, the incidence and mortality rate of thyroid cancer is "Disposal", the "over -diagnosis and treatment" of thyroid cancer is often in the "storm center" of the academic world.

On July 14, a study published in Jama OtoLARYNGOLOGY-Headneck Surgery pointed out that as many as 40%of thyroid nodule surgery is derived from asymptomatic nodules, and these nodules are usually discovered by accidental discovery during imaging examinations. Essence In these cases, only 46%of people discovered cancer [1].

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More than half of the thyroid surgery is "cutting a loneliness"? Although the detection rate of cancer in this study is higher than previous reports, researchers said that this is a "favorable change"? What is going on?

46%of the patients with thyroid cancer,

There are differences in MODs in various countries

The study aims to explore the detection mode (MOD) of the thyroid lesions of surgical resection, and whether there is geographical differences; it also describes the proportion of cancer found in people -related symptoms, as well as asymptomatic cancer on the size of the size Whether there are differences.

Researchers evaluated 1328 patients from 16 centers from 4 countries (average age 52 ± 15 years; 993 cases, 75%of women), of which 34%(448 cases) appeared thyroid -related symptoms. There are also 40.8%(542 cases) of thyroid -related symptoms (asymptomatic), but instead of discovery (20%, 270 cases), and patients required to screen at the diagnosis grade (6%, 77 cases), radiation department occasionally discovered (20%, 270 cases), and patients required to screen ( 1%, 18 cases) or clinician screening (13%, 177 cases) underwent surgery.

MOD distribution of thyroid nodules

Among these patients with surgery, the radiology department has the highest proportion of accidental discovery. Among them, the number of thyroid nodules that have occasionally discovered by the chest computer fault scan (CT) accounted for 31%(82 cases), followed by the positive electronic launch fault scan. 18%(48 cases); then the neck CT, (16%, 43 cases), and the neck magnetic resonance imaging (16%, 42 cases).

The pathological analysis of thyroid nodular resection showed that 46%(613/1328) was thyroid cancer, of which only 183 (30%) were diagnosed through symptoms. In contrast, 310 cancers (51%) found among asymptomatic patients.

Diagnostic distribution of thyroid cancer divided by trigger events

Most of the asymptomatic patients are less than symptomatic groups (average 2.1cm vs 3.2cm). And the proportion of tumor (9%) greater than 4cm in the asymptomatic group is significantly lower than that of the symptom group (29%); among the asymptomatic patients, 60%of the tumor is less than 2cm and 39%greater than 2cm.

Asymptomatic group and symptoms of thyroid cancer

Regional analysis shows that the proportion of nodules found among the symptoms of South Africa and Denmark, with 79%and 54%, respectively. In contrast, in the United States and Canada, thyroid surgery is more commonly used for asymptomatic nodules. The symptomatic detection rates in the United States and Canada are similar, 30%, significantly lower than South Africa and Denmark. Denmark's strict thyroid resection indications and the limited medical resources of South Africa may explain why these countries have a low surgical rate of non -symptoms.

MOD distribution of thyroid MOD

In general, this retrospective analysis finds that most of the thyroid cancer is found in asymptomatic patients. Although asymptomatic cancer is less than that of symptoms, asymptomatic tumors are also detected, which is consistent with historical data. There are great differences in the practice of MOD between different countries.

The author bluntly said that the foundation of thyroid nodules in non -symptom patients still cause a large number of thyroid surgery, rather than the increase in the real incidence of thyroid cancer. At the same time, comments pointed out that because these asymptomatic nodules usually represent small cancer, active monitoring may be better than surgery. Therefore, the research results emphasize the need to improve awareness to prevent excessive treatment of these cases.

Is the excessive diagnosis pot buckle? How to "throw"?

In recent years, the incidence of thyroid cancer in adults has risen, and statistics after age standardized show that the incidence of thyroid cancer in adults from 2006-2016 has increased by 50%, which has increased the largest among all cancers. [2]

According to the latest statistics of the magistrate CA [3], nearly 1.1 million survivors of thyroid cancer are currently in the United States, and 43,800 people will be diagnosed as thyroid cancer in 2022. Thyroid cancer has replaced colorectal cancer as the third largest cancer in American women.

The "China Cancer Data 2016" released by Academician Herje's team recently showed that from 2000 to 2016, the incidence of thyroid cancer in China increased by 20 times in 16 years, and the number of new cases in 2016 was 20.2 10,000 cases. Thyroid cancer has also quietly become the fourth common malignant tumor in Chinese women.

In 2016, China's incidence and mortality rate with the highest incidence and mortality rate

The incidence of thyroid cancer has a high incidence, but the mortality rate has not risen, and the spearheads point directly to "excessive diagnosis" and "excessive treatment" -n State published by the Lancet DiabeteSEDECRINOLOGY in June 2020, 1998 -All cases of thyroid cancer reported by the 15-84-year-old people during the 2012 period were analyzed and found that more than 830,000 female thyroid cancer was excessive diagnosis, of which about 87%of female thyroid cancer cases were related to excessive diagnosis, which was about 39, which was about 39 Wan Women [5]. But in this study, we have also seen the improvement of this "strange": First, the cancer detection rate of thyroid surgery specimens in this study is 46%, which is higher than the 34%of the previous research reports, reflecting the past ten in the past ten In the middle of the year, the molecular detection played a role -choosing a nodule that is more likely to be malignant, and then surgery.

Thirdly, the average size of the nodules in this study is not as small as the asymptomatic nodules that are commonly reported, or it indicates that there are fewer and less subtraction of surgical treatment.

In order to further reduce unnecessary surgery, researchers have called for more research and popular science to evaluate the safety and effectiveness of the monitoring methods of patients with low risk thyroid nodules to reduce the risk of excessive treatment and identify the early identification that it will benefit from the early days to the early days. Intervention patients.

For asymptomatic symptoms, what can doctors do in the thyroid nodules that are only discovered by accident? We can take a look at the suggestions given by the magazine CA:

1. First of all, preliminary assessment of patients with thyroid nodules should be performed by accident, including complete medical history, physical examination, thyroid functional examination, thyroid ultrasound, and suspicious lesion stomach puncture pumping tissue examinations , Fnab);

2. The clear benign nodules are mainly followed up, and the clear malignant nodules should be surgical;

3. In the case of uncertain diagnosis of cell pathology, repeat FNAB, continuous observation follow -up, and molecular testing when necessary may guide the clinic; for nodules that continue to be uncertain, surgical resection is still the ultimate standard diagnosis. It

4. The tiny and thyroid cancer discovered by accident can be monitored, and its feasibility and safety still need to be further studied.

For the average person, although there is no need to excessive and routinely perform thyroid cancer screening, the following types of high -risk groups still need to be vigilant:

1. History of radiation irradiation or radioactive contact in childhood;

2. There are painful lumps on the neck and greater sexual lumps, and even with hoarseness or breathing without breathing;

3. The past history or family history of the following diseases: differentiated thyroid cancer, thyroid marrow -like cancer, or multiple endocrine adenoma disease 2, family multi -polypatis, certain thyroid cancer syndrome, etc.

references:

[1]Sajisevi M,et al.Evaluating the Rising Incidence of Thyroid Cancer and Thyroid Nodule Detection Modes:A Multinational,Multi-institutional Analysis.JAMA Otolaryngol Head Neck Surg.2022 Jul 14.doi:10.1001/jamaoto.2022.1743.Epub ahead of propmid: 35834240.

[2]Global Burden of Disease Cancer Collaboration.Global,Regional,and National Cancer Incidence,Mortality,Years of Life Lost,Years Lived With Disability,and Disability-Adjusted Life-Years for 29 Cancer Groups,1990 to 2016A Systematic Analysis for the Global Burden of Disease Study.jama Oncol.2018 Jun 2.Doi: 10.1001/Jamaoncol.2018.2706

[3]Miller KD,Nogueira L,Devasia T,Mariotto AB,Yabroff KR,Jemal A,Kramer J,Siegel RL.Cancer treatment and survivorship statistics,2022.CA Cancer J Clin.2022 Jun 23.doi:10.3322/caac. 21731.epub ahead of propmid: 35736631.

[4] Zheng RS, ZHANG SW, ZENG HM, Wang SM, Sun KX, Chen R, Li L, Wei WQ, He J.Cancer Incision and Mortality in China, 2016 [j] .jncc, 2022,2 (1): 1-9.doi: https: //doi.org/10.1016/j.jncc.2022.02.002. [5] mengmeng li, et al., (2020) .global trends in thyroid carIDERTACT of Overdiagnosisisisis. THE Lancet Diabetesendocrinology, Doi: 10.1016/S2213-8587 (20) 30115-7

[6] Fisher, S.B., Perrier, N.D. (2018) .the Incidental Thyroid Nodule.ca Cancer J Clin.2018 Mar; 68 (2): 97-105.Doi: 10.3322/CAAC.21447.21447.

The first release of this article: the medical world tumor channel

Author of this article: lily

Review of this article: Yu Jiangyong Beijing Hospital

Editor in charge: Sweet

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