Overdiagnosis of Thyca: Article calls for Pathologist Consensus Conference

From the American Society of Clinical Pathology, an article by Dr. Robin Vollmer, in this month;s journal. The full article can only be accessed by paying a fee or with a membership.

Brief Quotes from the article (Jan, 2014):

"... Although there is general agreement about( these) good outcomes, agreement disappears when it comes to the defining histologic features of well-differentiated thyroid cancers, especially papillary carcinoma, and such disagreements have been repeatedly documented as significant interobserver differences in diagnosis. In this setting, some pathologists have lowered their thresholds for diagnosing papillary carcinomas..."

"...Is this “overdiagnosis”? If one examines the fatality of the thyroid carcinomas that comprise this “epidemic,” then both Davies and Welch’s results and the results of this study suggest that the answer is yes. "

The author reviews a number of opinions from expert pathologists and then writes:

"...Esserman and Thompson issue a call to “acknowledge the spectrum of cancer behavior and the need to reclassify ‘indolent’ lesions with a term other than ‘cancer.’” Given the above results and opinions, as well as variances in attitudes between pathologists about the diagnoses of papillary carcinomas, it may be time to assemble a consensus conference regarding diagnosis, terminology, and outcomes for thyroid carcinomas. "

From the Abstract:

Methods: This study uses National Cancer Institute’s Surveillance, Epidemiology and End Results data and derives hazard functions in order to examine the fatality in thyroid cancer.

Results: The study documents forms of rapidly evolving and fatal tumors as well as forms of tumor that evolve more slowly to cause death. It demonstrates that the incidences of nonfatal forms of thyroid cancer have risen dramatically in the years from 1975 to 1999—mostly due to papillary carcinomas—but that the incidences of fatal forms of thyroid cancer have remained nearly constant.

Conclusions: The results of this study support the notion that many thyroid cancers are part of a reservoir of nonfatal tumors that are increasingly being overdetected and overdiagnosed

Edited January 8, 2014 at 10:58 am

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