| Objectives:The overall incidence rate of thyroid cancer has increased significantly,mostly due to the increased diagnosis of papillary thyroid cancer with 1 centimeter or less in size(papillary thyroid microcarcinomas).Since most papillary thyroid microcarcinomas have favorable prognosis,the increased diagnosis of papillary thyroid microcarcinomas have raised the concerns about possible thyroid cancer overdiagnosis and over-treatment,and have led experts to advocate changes in the diagnosis of thyroid nodules and management strategies of papillary thyroid microcarcinomas.Several significant changes in recommendations for fine needle aspiration and active surveillance were made by the last American Thyroid Association(ATA)guidelines in 2015.Although the guidelines are intended to positively improve the patient management,it is not clear as to what extent the actual medical practice differs from current professional recommendations in China.The objectives of the present study are: 1)to document current practice patterns in the diagnosis and management of papillary thyroid microcarcinomas in China;2)to compare the current practice with those recommended in the current practice guidelines;3)to compare the differences in decision-making between physicians and surgeons.Method : The questionnaire used in the present study was selected from the questionnaire published on the official website of American Thyroid Association,which was about the management of thyroid cancer.The questionnaire in the present study includes subjective impression about the current management of papillary thyroid microcarcinomas,the current patterns in the diagnosis and management of papillary thyroid microcarcinomas and demographic questions,etc.To further clarify the current management patterns,two scenarios of different hypothetical patients were presented with several diagnosis and therapeutic options for selection.The target group of the survey were physicians and surgeons who participated in the 7th Thyroid Oncology National Academic Conference or the 15 th Annual Meeting of Chinese Society of Endocrinology in 2016.The questionnaire was anonymous andimmediately collected when finished.Finally,a descriptive analysis of survey responses was presented.Results : A total of 900 valid questionnaires were retrieved,among which,426 questionnaires were completed by surgeons and 474 were completed by physicians.Nearly half of physicians(48.09%,n=227)and part of surgeons(33.96%,n=144)agreed that there was an overdiagnosis issue regarding papillary thyroid microcarcinoma.39.22% of physicians(n=182)and 34.04% of surgeons(n=145)polled the idea that overtreatment of papillary thyroid microcarcinoma exist.32.81%of physicians(n=145)and 46.76% of surgeons(n=195)believed that the hazard of thyroid microcarcinoma may be underestimated currently.Physicians and surgeons had different opinions on the rate of the use of various examination methods for thyroid nodules(e.g.neck ultrasonography,ultrasound guided fine needle aspiration biopsy of thyroid nodules,and molecular testing of thyroid nodules with indeterminate cytology)as well as the active surveillance for papillary thyroid microcarcinomas(P<0.05).Only 24.76% physicians(n=105)and 34.11% surgeons(n=161)agreed with the ATA guideline recommendation of fine needle aspiration biopsy.As for another recommendation of active surveillance mentioned in the 2015 ATA guideline,half of the physicians(n= 238,50.85%)and surgeons(n= 213,50.47%)agreed with the recommendation that active surveillance should be applied to selected appropriate patients with papillary thyroid microcarcinomas(P>0.05).While,65.78% of surgeons(n=273)and 73.12% of physicians(n=321)indicated that they still had reservations about active surveillance.The main reasons include whether there is any strong evidence about outcomes of the active surveillance approach,whether there is any evidence about outcomes applies to patients from any places except Japan and how to select appropriate patients.Conclusion:The current practices of physicians and surgeons in China don’t exactly coincide with the available guidelines with regard to the diagnosis and treatment of papillary thyroid microcarcinomas.There are also some differences in decision-making between physicians and surgeons.Moreover,efforts are needed to further standardize the practice patterns in the diagnosis and management of papillary thyroid microcarcinomas and to carry out them accordingly. |
