In healthy patients with papillary thyroid microcarcinomas, active surveillance may be a feasible and safe alternative to immediate surgery, according to study results published in The Journal of Clinical Endocrinology & Metabolism.

There is controversy regarding optimal management of low-risk thyroid carcinomas, with active surveillance emerging as a potential alternative to surgery. However, there is little consensus on which patients should qualify for this less invasive treatment option. To evaluate the feasibility of active surveillance in individuals of varying ages and frailty levels, researchers conducted an observational study of 93 patients who had a single Thy4 or Thy5 thyroid nodule according to the Italian consensus for thyroid cytology that was ≤1.3 cm in diameter with no suspicious laterocervical lymph nodes by neck ultrasonography. Patients underwent neck ultrasound at 6- to 12-month intervals. The researchers defined disease progression as the appearance of abnormal lymph nodes or nodule enlargement during follow-up. Patients with disease progression were referred for surgery.

Of all patients, 55% (n=51) were Thy4 cytologic class and 45% (n=42) were Thy5. After a mean follow-up of 19 months (range, 6-54 months), 3 patients (3%) had clinical disease progression and required surgery. An additional 19 patients (20%) opted out of the study for personal reasons.

The results indicated that for the 3 patients who showed progression (all with Thy4 nodules), delayed surgery did not have an effect on the treatment results, which were successful. Only 1 of these patients required radioiodine ablation.

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The researchers found that 15 patients (16%) showed an increasing papillary thyroid microcarcinoma volume ranging from 50% to 251%. However, only 2 cases showed a consistent 3-mm increase in all dimensions.

The researchers noted that the nonrandomized study was conducted at a tertiary care referral center for thyroid cancer in Italy, which may not reflect everyday clinical management of patients with papillary thyroid microcarcinomas.

“To our knowledge this is the first reported experience on this specific topic, after [some] Japanese studies, showing that a conservative approach, accepted so far only in Japan, is feasible,” wrote the researchers. “Only 3% of [patients with papillary thyroid microcarcinomas] demonstrated disease progression and delayed surgery did not impact on the excellent results of the treatment, even when radioiodine treatment was required.”

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Reference

Molinaro E, Campopiano MC, Pieruzzi L, et al. Active surveillance in papillary thyroid microcarcinomas is feasible and safe: experience at one single Italian center [published online October 25, 2019]. J Clin Endocrinol Metab. doi:10.1210/clinem/dgz113