Abstract
To determine the percentage of patients with papillary thyroid carcinoma (PTC) who accepted active surveillance as an alternative to surgery in our clinical practice and to describe the clinical characteristics and outcomes of patients with Bethesda category V and VI thyroid nodules who chose active surveillance. We included 136 PTC patients from the Hospital de Clínicas, University of Buenos Aires without (i) US extrathyroidal extension, (ii) tumors adjacent to the recurrent laryngeal nerve or trachea, and/or (iii) US regional lymph-node metastasis or clinical distant metastasis. PTC progression was defined as the presence of i) a tumor larger than ≥ 3 mm, ii) novel appearance of lymph-node metastasis, and iii) serum thyroglobulin doubling time in less than one year. For patients with these features, surgery was recommended. Only 34 (25%) of 136 patients eligible for active surveillance accepted this approach, and around 10% of those who accepted abandoned it due to anxiety. The frequency of patients with tumor enlargement was 17% after a median of 4.6 years of follow-up without any evidence of nodal or distant metastases. Ten patients who underwent surgical treatment after a median time of 4 years of active surveillance (AS) had no evidence of disease after a median of 3.8 years of follow-up after surgery. Although not easily accepted in our cohort of patients, AS would be safe and easily applicable in experienced centers.
Highlights
Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy, accounting for about 1% of all cancers [1]
We evaluated 136 patients with a diagnosis of PCMs eligible for active surveillance who attended our hospital before the indication of a surgical treatment
Active surveillance was adopted due to i) the patients election to be monitored with observational management (n = 31; 91%), ii) high surgical risk (n = 2; 6%), and iii) surgical issues that needed to be addressed prior to the thyroid surgery (n = 1, 3%)
Summary
Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy, accounting for about 1% of all cancers [1]. More than 50% of this increase is linked to the identification of intrathyroidal papillary microcarcinomas (PMCs) [3]. The origin of this upward trend in the incidence of PMCs has not been elucidated, possibly due to the wider use of diagnostic imaging technology combined with greater access to health care and patients’ improved socioeconomic conditions [4,5]. Most PTCs are non-palpable, and their diagnosis arises from ultrasonographic incidental findings or from the anatomopathological study of removed thyroid glands due to benign pathology [3,6]. Several authors warned about the medical costs of thyroid cancer treatment, which might expand to US$ 3.5 billion by 2030 in the United States [10]
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