A Clinical Framework to Facilitate Risk Stratification When Considering an Active Surveillance Alternative to Immediate Biopsy and Surgery in Papillary Microcarcinoma
A Clinical Framework to Facilitate Risk Stratification When Considering an Active Surveillance Alternative to Immediate Biopsy and Surgery in Papillary Microcarcinoma
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DOI：
10.1089/thy.2015.0178
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发表时间：
2016-01-01
期刊：
影响因子：
6.6
通讯作者：
Tuttle, R. Michael
中科院分区：
文献类型：
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作者：
Brito, Juan P.;Ito, Yasuhiro;Tuttle, R. Michael
背景：2015 年美国甲状腺协会甲状腺癌管理指南认可主动监测管理方法，作为对具有高度可疑超声特征的亚厘米甲状腺结节和经细胞学证实的极低风险乳头状甲状腺癌 (PTC) 立即活检和手术的替代方法。然而，该指南没有就主动监测管理方法的最佳患者选择提供具体建议。本文描述了由纪念斯隆凯特琳癌症中心的甲状腺癌疾病管理团队开发的风险分层临床决策框架，该框架从日本 Kuma 医院吸取的经验教训应用于一组可能患有或已证实患有乳头状微小癌 (PMC) 的患者，这些患者正在美国接受积极监测管理方法的评估。摘要：采用风险分层方法来评估可能或已证实的 PMC 患者，考虑采用主动监测管理方法，需要评估三个相互关联但不同的领域：(i) 肿瘤/颈部超声特征（例如，原发肿瘤的大小、肿瘤在甲状腺内的位置）； (ii) 患者特征（例如年龄、合并症、接受观察的意愿）； (iii) 医疗团队的特点（例如，多学科团队的可用性和经验）。根据对每个领域内关键因素的分析，可能患有或已证实患有 PTC 的患者可以被归类为理想、适当或不适当的主动监测候选者。结论：利用所提出的决策框架进行风险分层将提高临床医生识别最有可能从主动监测管理方案中受益的已证实或可能出现 PMC 的个体患者的能力，同时识别出患有已证实或可能出现 PMC 且更适合接受前期活检和手术管理方法的患者的能力。
Background: The 2015 American Thyroid Association thyroid cancer management guidelines endorse an active surveillance management approach as an alternative to immediate biopsy and surgery in subcentimeter thyroid nodules with highly suspicious ultrasonographic characteristics and in cytologically confirmed very low risk papillary thyroid cancer (PTC). However, the guidelines provide no specific recommendations with regard to the optimal selection of patients for an active surveillance management approach. This article describes a risk-stratified clinical decision-making framework that was developed by the thyroid cancer disease management team at Memorial Sloan Kettering Cancer Center as the lessons learned from Kuma Hospital in Japan were applied to a cohort of patients with probable or proven papillary microcarcinoma (PMC) who were being evaluated for an active surveillance management approach in the United States. Summary: A risk-stratified approach to the evaluation of patients with probable or proven PMC being considered for an active surveillance management approach requires an evaluation of three interrelated but distinct domains: (i) tumor/neck ultrasound characteristics (e.g., size of the primary tumor, the location of the tumor within the thyroid gland); (ii) patient characteristics (e.g., age, comorbidities, willingness to accept observation); and (iii) medical team characteristics (e.g., availability and experience of the multidisciplinary team). Based on an analysis of the critical factors within each of these domains, patients with probable or proven PTC can then be classified as ideal, appropriate, or inappropriate candidates for active surveillance. Conclusion: Risk stratification utilizing the proposed decision-making framework will improve the ability of clinicians to recognize individual patients with proven or probable PMC who are most likely to benefit from an active surveillance management option while at the same time identifying patients with proven or probable PMC that would be better served with an upfront biopsy and surgical management approach.