Active surveillance in papillary thyroid carcinoma: not easily accepted but possible in Latin America

Abstract

Objectives: 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. Subjects and methods: 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. Results: 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. Conclusion: Although not easily accepted in our cohort of patients, AS would be safe and easily applicable in experienced centers.

Active surveillance in low risk papillary thyroid carcinoma

“…We referred to this type of surveillance as “undercover”, and in some cases also as “retrospective”. The outcomes of these cases were similar to those with prospective AS[ 8 ] (Figure 2 ). Currently, the Kuma Hospital recommends AS as the first line option in the management of patients with low-risk PMC[ 30 ].…”

“…Thyroid nodules that are incidentally detected by ¹⁸F-FDG PET, are smaller than 1 cm in diameter, and have ultrasound criteria of malignancy could also benefit from FNAB in the rare cases in which the diagnosis of intrathyroidal metastases affects treatment of the primary cancer[ 16 , 39 ]. A recent Argentinian publication about the experience of AS in Latin America[ 8 ] included a subgroup of patients in which PTC diagnosis was established after ultrasonographic surveillance of a single thyroid nodule that grew after a previous ultrasonographic follow-up, or a second FNAB changed the original benign cytological diagnosis. We referred to this type of surveillance as “undercover”, and in some cases also as “retrospective”.…”

“…Data from the first researchers that carried out AS trials in PMCs from Japan, and later from diverse countries around the world, have demonstrated that this approach is a safe alternative for managing low risk papillary PTCs[ 3 , 6 ]. However, the implementation of AS in clinical practice is strongly influenced by psychosocial factors, particularly in less economically developed countries in which, as we previously showed, only around one quarter of patients appear to accept this modality[ 5 , 7 , 8 ].…”

Routine Chest Computed Tomography at Presentation Does Not Identify Distant Metastasis in cT1aN0 Papillary Thyroid Carcinoma

“…Low-risk PTMC patients include those without high-risk features such as clinical distant metastasis (M), lymph node metastasis (N), and significant extrathyroid extension (Ex) to the adjacent structures such as the trachea and recurrent laryngeal nerve. Implementation of these guidelines has generated favorable results as demonstrated not only from Japan (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) but also from the United States (13), Latin America (14,15), Korea (16,17), and Italy (18). In this context, evaluations conducted through imaging studies at the initiation of active surveillance are important for determination of high-risk features.…”

Active surveillance of thyroid microcarcinomas

“…In this issue of Archives of Endocrinology and Metabolism, Smulever and Pitoia also reported their remarkable experience with the proposal of active surveillance for a consecutive series of 136 subjects with thyroid papillary microcarcinomas (14). Just 34 (25%) of the patients actually accepted the active surveillance.…”