The frequency of applying active surveillance initially increased significantly from 8% in 1993 to 63% in 1996, then it remained stable until 2007, when it started to increase again. There was a marked increase of up to 90% in the final period after 2014, when the first reports regarding the safety of active surveillance were published. There was a significant difference in the frequency of active surveillance use among surgeons, some surgeons recommending active surveillance in most patients during the entire period, while other surgeons performed surgery in most patients and adopted active surveillance only in the final period. Among surgeons, the active surveillance rate increased from 30% in the first period to 83% in the final period.
All endocrinologists showed a high rate of applying active surveillance compared to surgeons during the entire study period (86% vs. 58% for the entire period). In the final period, the use of active surveillance among endocrinologists was 97%.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This analysis showed that close observation without surgery (active surveillance) could be successfully implemented for low risk small papillary thyroid cancers at Kuma Hospital in Japan. However, it required a significant amount of time to be accepted by most surgeons and endocrinologists. Critical for active surveillance is the presence of significant thyroid ultrasound expertise. Large medical centers with high-quality ultrasound surveillance capacity for appropriate patient selection and early detection of cancer progression may be more appropriate to adopt this method.
— Alina Gavrila, MD, MMSC