Treatment of Thyroid Tumor

Transcription

1

2 Treatment of Thyroid Tumor

3

4 Hiroshi Takami Editor-in-Chief Yasuhiro Ito Hitoshi Noguchi Akira Yoshida Takahiro Okamoto Editors Treatment of Thyroid Tumor Japanese Clinical Guidelines

5 Editor-in-Chief Hiroshi Takami Ito Hospital Jinguumae Shibuya-ku, Tokyo, Japan Editors Yasuhiro Ito Department of Surgery Kuma Hospital Shimoyamate-dori Chuo-ku, Kobe, Japan Akira Yoshida Department of Breast and Endocrine Surgery, Kanagawa Cancer Center Nakao, Asahi-ku Yokohama, Japan Hitoshi Noguchi Noguchi Thyroid Clinic and Hospital Foundation 6-33 Noguchinaka-machi Beppu, Japan Takahiro Okamoto Department of Endocrine Surgery Tokyo Women s Medical University 8-1 Kawada-cho, Shinjuku-ku Tokyo, Japan This English translation is based on the Japanese original KOJYOSEN SHUYO SHINRYO GUIDELINE 2010 Japan Association of Endocrine Surgeons, Japanese Society of Thyroid Surgery 2010 Originally published in Japan in 2010 and all rights reserved by KANEHARA & CO., LTD. ISBN ISBN (ebook) DOI / Springer Tokyo Heidelberg New York Dordrecht London Library of Congress Control Number: Springer Japan 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (

6 Foreword Creating clinical guidelines is a modern trend. It is clearly bene fi cial to collect published studies pertaining to a given theme, evaluate their credibility, and then present recommended treatment options in the form of evidence-based guidelines. Thus, a Japanese Clinical Guideline for the Treatment of Thyroid Tumor was desired by many clinicians. On the other hand, there were counter-arguments and lively debates on the wisdom of creating such a guideline in light of Japan s restrictions on the use of radioisotopes and the fact that this is a relatively common disease with wide discrepancies in preferred treatment, even among specialists. Eventually, however, the consensus was in favor of creating an evidence-based Japanese guideline, and a joint effort was made by the Japanese Society of Endocrine Surgery and the Japanese Society of Thyroid Surgery. The editing committee was chaired by Dr. Akira Yoshida and co-chaired by Prof. Takahiro Okamoto. Prof. Masahiro Yoshida of the Japan Council for Quality Healthcare served as committee advisor. The four of us met on a summer evening 2 years ago and had an intense discussion, after which a committee of 31 members was chosen and, with their concerted efforts and diligence, a guideline was completed over a span of 2 years. I give my sincere thanks to all the committee members, as well as to the Japan Medical Library Association, for their comprehensive search for documents. Though guidelines can be classi fi ed into evidence-based and consensus-based guidelines, this edition is a blend of the two. An evidence-based guideline can be more accurate and exhaustive, but where evidence was absent or insuf fi cient, the consensus of the committee was adopted. It would be my greatest pleasure if this guideline were to be utilized by numerous clinicians to improve the quality of care and treatment outcome. It is also necessary to receive feedback from the fi eld and re fl ect this in subsequent editions. Periodic v

7 vi Foreword revisions will be necessary. Abridged handbooks, online editions, and foreign language information exchange must follow. Lastly, I would like to thank Ms. Hitomi Sasaki of Kanehara Publishing for her devoted assistance. October 2010 Hiroshi Takami President and Director of the Japan Association of Endocrine Surgeons President and Director of the Japanese Society of Thyroid Surgery

8 Preface There are several thyroid tumor treatment guidelines in the West that have established positions in clinical practice and gone through several editions. However, in Japan, where radioisotope facilities are of limited availability, treatment plans for differentiated thyroid cancer differ from those of foreign countries, and overseas clinical guidelines cannot be adopted without changes. Also, although thyroid tumor is a common disease in endocrine practice, its management can differ even among specialists. For these reasons, the need to develop an original guideline for Japan became widely recognized. The environment surrounding thyroid surgery was also evolving with the establishment of independent accreditation for endocrine and thyroid surgeons, creating an urgent need for a guideline to complement the certification apparatus. Under these circumstances, an editing committee for the Clinical Guideline for the Treatment of Thyroid Tumor was established in October 2008, and it began as a working group. The objective of this group was to create an evidence-based Japanese guideline and make it public. The editing committee was composed primarily of surgeons and otorhinolaryngologists of the Japanese Society of Endocrine Surgery and the Japanese Society of Thyroid Surgery but also included a broad spectrum of specialists in nuclear medicine, pathology, and nonsurgical medicine in the field. Prof. Masahiro Yoshida of the Japan Council for Quality Healthcare joined us as an advisor and provided a great deal of valuable input. In the year and a half after the committee was organized, the members met seven times to prepare a draft. The timeline is outlined below. 1st Editorial Meeting. October 15, The general structure was discussed and each team started proposing clinical questions. 2nd Editorial Meeting. January 24, Clinical questions and columns (important issues that were difficult to pose as clinical questions) were chosen. A search of documents pertaining to the clinical questions was commissioned to the Japan Medical Library Association. The resulting documents were distributed to each team. Each team evaluated the documents and composed a structured abstract. vii

9 viii Preface 3rd Editorial Meeting, June 27, Progress in the structured abstracts was reported by each team. Various issues in the creation of a guideline were discussed. A summary and commentary for the clinical questions were created based on the structured abstracts. 4th Editorial Meeting, September 26, Evaluation of the recommendations and commentary (about half of the total). Discussion of issues in need of consensus. 5th Editorial Meeting, December 12, Evaluation of the recommendations and commentary presented after the 4th meeting. More discussion of issues in need of consensus. 6th Editorial Meeting, February 13, Recommendation ratings to be divided into six grades. Evaluation of the recommendation ratings of each clinical question. Discussion of diagnostic and treatment algorithms. 7th Editorial Meeting, April 11, Evaluation of remaining clinical questions. Approval of commentary. Approval of diagnostic and treatment algorithms. Draft completed. Where evidence was insufficient, a consensus of the committee was used and an effort was made to make the guideline as complete and comprehensive as possible. Still, there are sections where the consensus was not fully accepted among the members and further revisions will be required in the future. That the first edition guideline was completed in such a short period owes much to the selfless devotion of the committee members who strongly recognized the need for a guideline. We offer our sincere gratitude to the committee members. Editorial Committee of the Clinical Guideline for the Treatment of Thyroid Tumor Yokohama, Japan Tokyo, Japan October 2010 Akira Yoshida Takahiro Okamoto

10 Preface to the English Version This is the English version of the 1st edition of Guidelines for Management of Thyroid Tumor established by the Japanese Society of Thyroid Surgery and the Japanese Society of Endocrine Surgeons. There are some leading guidelines for thyroid tumor in Western countries. In Japan, however, the circumstances surrounding the management and treatment of thyroid tumor differ significantly from those of Western countries because the use of radioactive iodine (RAI) is limited by legal restrictions. This causes differences in therapeutic strategies for thyroid tumor, particularly for well-differentiated thyroid carcinoma, between Western countries and Japan. However, it is also notable that treatment results for thyroid carcinoma in Japan have generally been excellent in spite of such conditions. In recent years, therapeutic experience and outcome data of thyroid tumor in Japan have been accumulated and it is time not only to establish independent guidelines but also to transmit them to the rest of the world by publishing an English version. As indicated above, treatment strategies for thyroid tumor in Japan differ substantially from those in Western guidelines, and they definitely have their own advantages and disadvantages. We are willing to suggest our management and treatment of thyroid tumor as alternatives for conventional approaches by introducing them in the guidelines. Also, we think that any disadvantages can be offset by partially assimilating the advantages of Western guidelines over time. Ultimately, we hope that the strategies for the management and treatment of thyroid tumor in Western countries and Japan will find an optimal compromise, leading to the best possible treatment for patients all over the world in the not-so-distant future. Kobe, Japan Beppu, Japan November 2010 Yasuhiro Ito Hitoshi Noguchi ix

11

12 Contents Introduction... 1 Akira Yoshida Part I Epidemiology CQ1. What Are the Risk Factors for Thyroid Cancer? Masahisa Saikawa and Haruki Akasu CQ2. Is There a Difference in Prognosis Between Adult Thyroid Cancer and Juvenile Thyroid Cancer or Juvenile Follicular Cancer? Masahisa Saikawa and Haruki Akasu Column 1. Genetics of Thyroid Cancer Masahisa Saikawa and Haruki Akasu Column 2. Prevalence of Various Histological Types of Thyroid Cancer Masahisa Saikawa and Haruki Akasu Column 3. Anaplastic Transformation of Differentiated Carcinoma Masahisa Saikawa and Haruki Akasu Column 4. Incidence, Morbidity, and Mortality of Thyroid Carcinoma in Japan Masahisa Saikawa and Haruki Akasu Part II Diagnosis and Non-Surgical Management CQ3. What Is the Frequency (Probability of Cancer Before Examination) of Thyroid Cancer xi

13 xii Contents CQ4. What Are the Factors That Increase the Likelihood of Malignancy and What Is the Odds Ratio and Risk Ratio? CQ5. What Are the Physical Signs and Symptoms That Increase the Likelihood of Thyroid Cancer and What Are the Sensitivity and Specificity? CQ6. What Are the Imaging Studies Most Suitable for the Diagnosis of Thyroid Carcinoma and What Are Their Sensitivity, Specificity, and Likelihood Ratio? CQ7. What Are the Blood Chemistry Data That Increase the Likelihood of Thyroid Malignancy and What Are Their Sensitivity, Specificity, and Likelihood Ratio? CQ8. What Are the Sensitivity and Specificity of Aspiration Cytology? CQ9. What Are the Sensitivity and Specificity of Ultrasonography, CT, MRI, Laryngoscopy, and Bronchoscopy in the Preoperative Evaluation of Thyroid Cancer Invasion to the Trachea, Esophagus, and the Recurrent Laryngeal Nerve? CQ10. How Is the Natural History of Nodules Diagnosed as Benign (Growth and Reduction Rates)? CQ11. Does TSH Suppression Therapy Reduce the Size of Tumors Diagnosed as Benign? CQ12. What Is the Intra-Observer Variation in the Pathological Diagnosis of Follicular Carcinoma?... 79

14 Contents xiii CQ13. What Is the Efficacy of Percutaneous Ethanol Injection Therapy for Autonomously Functioning Thyroid Nodules? CQ14. Do Cystic Nodules Decrease in Volume by Aspiration and Drainage of Content Fluid and Percutaneous Ethanol Injection Therapy? CQ15. What Is the Likelihood That Multinodular Goiter Will Be Surgically Resected After Observation? Column 5. Indication for Surgery of Nodular Goiter Column 6. Diagnosis of Anaplastic Carcinoma Part III Papillary Carcinoma CQ16. What Is the Most Appropriate and Convenient Risk Classification System for Predicting the Prognosis of Patients with Papillary Carcinoma? CQ17. Does Total (or Near Total) Thyroidectomy Improve the Prognosis of Papillary Carcinoma Patients Compared to Lobectomy or Lobectomy Isthmectomy? CQ18. Does Central Compartment Dissection Improve the Prognosis of Papillary Carcinoma Patients? CQ19. Does Dissection of the Lateral Compartment Improve the Prognosis of Papillary Carcinoma Patients? CQ20. When Can Papillary Microcarcinoma (Papillary Carcinoma Measuring 1 cm or Less) Be Observed Without Immediate Surgery?

15 xiv Contents Column 7. What Is the Acceptable Incidence for Persistent Recurrent Laryngeal Nerve Paralysis and Persistent Hypoparathyroidism as Complications of Thyroid Surgery? Column 8. The Controversy Regarding the Extent of Thyroidectomy for Papillary Carcinoma and Actual Practice in Japan Column 9. Lobectomy and Paratracheal Node Dissection Part IV Follicular Tumor Introduction Kaoru Kobayashi, Akira Yoshida, and Takehito Igarashi CQ21. Is It Possible to Diagnose Follicular Carcinoma on Preoperative FNA or Intraoperative Frozen Section Diagnosis? Kaoru Kobayashi, Akira Yoshida, and Takehito Igarashi CQ22. Does Classification of Follicular Carcinoma According to the Degree of Invasiveness (Widely Invasive and Minimally Invasive Types) Reflect the Prognosis? Kaoru Kobayashi, Akira Yoshida, and Takehito Igarashi CQ23. When Is Completion Total Thyroidectomy Recommended as a Second Surgery for Patients Who Underwent Hemithyroidectomy and Were Diagnosed as Having Follicular Carcinoma on Postoperative Pathological Examination? Kaoru Kobayashi, Akira Yoshida, and Takehito Igarashi CQ24. Does Total Thyroidectomy with Radioactive Iodine Ablation and TSH Suppression Therapy Improve Patient Prognosis with Widely Invasive Follicular Carcinoma Compared to Only Limited Thyroidectomy? Kaoru Kobayashi, Akira Yoshida, and Takehito Igarashi CQ25. Does Prognosis of Oxyphilic (Hurthle Cell) Follicular Carcinoma Differ from That of Conventional Follicular Carcinoma? Kaoru Kobayashi, Akira Yoshida, and Takehito Igarashi