Active Surveillance in Thyroid Microcarcinoma in a Latin-American Cohort

Sanábria, Álvaro

doi:10.1001/jamaoto.2018.1663

Cited by 47 publications

(30 citation statements)

References 6 publications

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“…Regarding tumor progression, we recognize the short study period. Nevertheless, the initial results are similar to those reported in series with a longer follow-up time involving other populations [4][5][6][7]. A recent review of previous studies showed the absence of distant metastases in approximately 2500 patients with low-risk PTMC submitted to active surveillance, and only 1 % of the patients developed lymph node metastases apparent on US [3].…”

Section: Discussionsupporting

confidence: 79%

“…Since we had only one case of tumor progression, it was not possible to analyze predictive factors. As the most commonly found predictor, patient age has been related to the risk of tumor growth, which is higher in young individuals [4][5][6][7]. Interestingly, as observed in three of our patients, tumor reduction has also been reported in other series at a frequency ranging from 5-15 % [5, 6, 20, 21].…”

Section: Discussionsupporting

confidence: 77%

“…In each patient, the initial US and those obtained during active surveillance were performed by the same examiner. Considering that the tumors had a maximum size of 1.2 cm, increases of ≥ 3 mm in diameter or ≥ 50 % in volume, as adopted in all previous studies [4][5][6][7][8], would not be attributed to intraobserver variation [12].…”

Section: Follow-up and Tumor Progressionmentioning

confidence: 98%

“…In this situation, active surveillance has been considered when FNA is obtained and is suspicious or diagnostic of non-aggressive papillary thyroid carcinoma (PTC) [1,3]. Indeed, studies have shown a low frequency of progression of lowrisk papillary thyroid microcarcinomas (PTMC) in adults [3][4][5][6][7][8]. However, most of these studies involved Japanese and Korean populations, which accounted for more than 80 % of the patients studied [3].…”

Section: Introductionmentioning

confidence: 99%

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Active Surveillance in Adults with Low-Risk Papillary Thyroid Microcarcinomas: A Prospective Study

2019

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The acceptance and results of active surveillance in patients with low-risk papillary thyroid microcarcinomas (PTMC) are unknown in populations other than the Japanese population. This was the objective of the present prospective study. We selected patients ≥20 years who had thyroid nodules ≤1.2 cm with intermediate or high suspicion for malignancy on ultrasonography (US), not located near the recurrent laryngeal nerve and without extrathyroidal invasion or apparent lymph node metastases, whose cytology was suspicious (Bethesda V) or diagnostic (Bethesda VI) of papillary thyroid carcinoma. Patients who opted for active surveillance were followed up by biannual US. Fifteen patients (18.7%) readily opted for surgery and 12 (15%) for active surveillance. Fifty-three patients (66.2%) delegated the decision or wished to know the doctor’s preference before deciding. After the doctor had declared his/her preference for active surveillance, 50 patients decided to have this management and three to have surgery. Only 1/70 patients exhibited tumor progression (growth associated with a suspicion of extrathyroidal invasion) after 30 months of follow-up. Two patients decided to have surgery during follow-up, although the indication was not defined by the study. A>50% reduction in tumor volume was observed in three patients. The study shows that active surveillance can be well accepted if doctors were convinced that it is the best option for patients with low-risk PTMC. At least the short-term results reproduced those observed in other populations, with tumor progression being uncommon.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 77%

Section: Follow-up and Tumor Progressionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Active Surveillance in Adults with Low-Risk Papillary Thyroid Microcarcinomas: A Prospective Study

2019

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“…As a confirmation, several studies evaluating the lowrisk papillary thyroid microcarcinomas (mPTC) in adults (19)(20)(21)(22)(23) have shown that tumor growth is uncommon and that the development of apparent lymph node metastases is even rarer. So far there are no reports of the occurrence of distant metastases (Table 2).…”

Section: Papillary Thyroid Microcarcinomasmentioning

confidence: 94%

Thyroid nodules ≤ 1 cm and papillary thyroid microcarcinomas: Brazilian experts opinion

Rosário¹,

Ward²,

Graf³

et al. 2019

Archives of Endocrinology and Metabolism

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The indolent evolution of low-risk papillary thyroid microcarcinoma (mPTC) in adult patients and the consequences of thyroidectomy require a revision of the management traditionally recommended. Aiming to spare patients unnecessary procedures and therapies and to optimize the health system in Brazil, we suggest some measures. Fine-needle aspiration of nodules ≤ 1 cm without extrathyroidal extension on ultrasonography should be performed only in nodules classified as "very suspicious" (i.e., high suspicion according to ATA, high risk according to AACE, TI-RADS 5) and in selected cases [age < 40 years, nodule adjacent to the trachea or recurrent laryngeal nerve (RLN), multiple suspicious nodules, presence of hypercalcitoninemia or suspicious lymph nodes]. Active surveillance (AS) rather than immediate surgery should be considered in adult patients with low-risk mPTC. Lobectomy is the best option in patients with unifocal low-risk mPTC who are not candidates for AS because of age, proximity of the tumor to the trachea or RLN, or because they opted for surgery. The same applies to patients who started AS but had a subsequent surgical indication not due to a suspicion of tumor extension beyond the gland or multicentricity. Molecular tests are not necessary to choose between AS and surgery or, in the latter case, between lobectomy and total thyroidectomy. The presence of RAS or other RAS-like mutations or BRAFV600E or other BRAF V600E-like mutations should not modify the management cited above; however, the rare cases of mPTC exhibiting high-risk mutations, like in the TERT promoter or p53, are not candidates for AS.

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Active Surveillance for Thyroid Cancer

Iorio

ShonkaJr

2021

Innovations in Modern Endocrine Surgery

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Active Surveillance in Thyroid Microcarcinoma in a Latin-American Cohort

Cited by 47 publications

References 6 publications

Active Surveillance in Adults with Low-Risk Papillary Thyroid Microcarcinomas: A Prospective Study

Active Surveillance in Adults with Low-Risk Papillary Thyroid Microcarcinomas: A Prospective Study

Thyroid nodules ≤ 1 cm and papillary thyroid microcarcinomas: Brazilian experts opinion

Active Surveillance for Thyroid Cancer

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