In pediatric patients and young adults, many thyroid cancers may not proliferate or progress into more aggressive carcinomas, according to study findings published in JAMA Otolaryngology Head Neck Surgery.
Investigators of this study sought to determine the natural progression of thyroid cancer in young patients with suspected thyroid cancer or diagnosed thyroid cancer undergoing screening with ultrasonography.
Researchers categorized thyroid carcinoma in these patients into 3 groups: >10% tumor reduction, tumor change of -10% to +10% in diameter, and >10% increase in the diameter of the tumor.
A total of 116 patients were included in this analysis. The researchers observed no significant differences among the 3 groups with regard to age, gender, observation period, tumor diameter, or serum levels of thyroglobulin and thyrotropin. Changes in tumor volume did not correlate linearly with the median 0.488-year observation period (Pearson R=0.121; 95% CI, -0.062 to 0.297). Despite this, the investigators found that the coefficient of growth was negatively associated with tumor diameter during the examination (Spearman ρ=-0.183; 95% CI, -0.354 to -0.001). This finding indicated growth arrest following the proliferation phase of the tumor.
The short observation period of 0.488 years represents the main limitation of this study. Additionally, only 2-dimensional images were available for comparison, limiting the ability to view tumors in a potentially more accurate 3-dimensional landscape. Finally, the individuals included in this study were located in Japan and had experienced a nuclear accident, which limits the generalizability of these findings.
In addition to the study’s results, the investigators remind clinicians that it is important to avoid “overdiagnosis and overtreatment [and] to monitor the natural course of suspected noninvasive thyroid cancer in young patients without immediate diagnosis.”
Midorikawa S, Ohtsuru A, Murakami M, et al. Comparative analysis of the growth pattern of thyroid cancer in young patients screened by ultrasonography in Japan after a nuclear accident: the Fukushima health management survey [published online November 16, 2017]. JAMA Otolaryngol Head Neck Surg. doi:10.1001/jamaoto.2017.213