Active Surveillance of Small Metastatic Lymph Nodes as an Alternative to Surgery in Selected Patients with Low-Risk Papillary Thyroid Cancer: A Retrospective Cohort Study

Jerkovich, Fernando; Abelleira, Erika; Bueno, Fernanda; Guerrero, Leidy; Pitoia, Fabián

doi:10.1089/thy.2022.0302

Cited by 9 publications

(16 citation statements)

References 15 publications

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“…Our results suggest that patients with PTC and suspicious locoregional LNs up to 20 mm of the largest diameter, 18F FDG PET (-), and without history of rapid disease progression can be followed with AS. Our findings are consistent with previous studies that have reported LN growth rates between 14% and 24% ( 8 , 9 , 11 , 14 ). All of these series included patients with a profile similar to ours, although there are some interesting differences.…”

Section: Discussionsupporting

confidence: 94%

“…All of these series included patients with a profile similar to ours, although there are some interesting differences. Considering that one of the concerns in this setting is the rapid growth and invasion into adjacent structures, some series excluded patients with aggressive histologic subtypes ( 7 , 8 ). In our series, 4 (12.6%) patients had tall cell or hobnail subtype PTC and were not excluded because 3 (75%) initially had intermediate risk of recurrence solely because of the subtype, and the other presented with a single sub-centimeter lung metastasis that was effectively treated with surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Because another major concern is the potential relation between locoregional disease and the development of distant metastases ( 1 , 9 ), some studies excluded patients who initially had distant disease ( 8 , 11 ), whereas others included them ( 9 ). In this study, we included patients who had been effectively treated for distant metastases, and even though we only had 1 patient fulfilling these criteria, no patients of this cohort developed distant metastases during follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding this issue, the 2015 American Thyroid Association (ATA) guidelines recommend that the best decision is made through a collaborative team approach involving surgeons, endocrinologists, radiologists, the patient, and the family ( 10 ). Several observational studies have suggested that low-volume locoregional structural disease has an indolent course, with rates of progression between 9% and 35%, and can be managed through AS ( 8 , 9 , 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Active surveillance is a feasible and safe strategy in selected patients with papillary thyroid cancer and suspicious cervical lymph nodes detected after thyroidectomy

Solórzano,

Lustig,

Mosso

et al. 2024

Archives of Endocrinology and Metabolism

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Objective: After initial treatment, up to 30% of patients with papillary thyroid cancer (PTC) have incomplete response, mainly cervical lymph node (LN) disease. Previous studies have suggested that active surveillance (AS) is a possible option for these patients. Our aim was to report the results of AS in patients with PTC and cervical LN disease. Materials and methods: In this retrospective observational study, we included adult patients treated and followed for PTC, who presented with cervical LN disease and were managed with AS. Growth was defined as an increase ≥ 3mm in either diameter. Results: We included 32 patients: 27 (84.4%) women, age of 39 ± 14 years, all initially treated with total thyroidectomy, and 22 (69%) with therapeutic neck dissection. Cervical LN disease was diagnosed 1 year (0.3-12.6) after initial management, with a diameter of 9.0 mm (6.0-19.0). After a median AS of 4.3 years (0.6-14.1), 4 (12.5%) patients had LN growth: 2 (50%) of whom were surgically removed, 1 (25%) was effectively treated with radiotherapy, and 1 (25%) had a scheduled surgery. Tg increase was the only predictive factor of LN growth evaluated as both the delta Tg (p < 0.0366) and percentage of Tg change (p < 0.0140). None of the included patients died, had local complications due to LN growth or salvage therapy, or developed distant metastases during follow-up. Conclusions: In selected patients with PTC and suspicious cervical LNs diagnosed after initial treatment, AS is a feasible and safe strategy as it allows effective identification and treatment of the minority of patients who progress.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Active surveillance is a feasible and safe strategy in selected patients with papillary thyroid cancer and suspicious cervical lymph nodes detected after thyroidectomy

Solórzano,

Lustig,

Mosso

et al. 2024

Archives of Endocrinology and Metabolism

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“…The incidence of papillary thyroid cancer has increased rapidly [ 1 , 2 ]. Surgery plays an important role in the treatment of thyroid patients, while clinical follow-up observation is also feasible, especially for pantiens with low-risk papillary thyroid cancer [ 3 , 4 ]. Despite the advancements in the preoperative diagnostic tools, papillary thyroid cancer can still be misdiagnosed, even with an ultrasound-guided fine-needle aspiration biopsy, the gold standard [ 2 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Kidney cancer with thyroid metastasis combined with thyroid carcinoma, a case report

et al. 2023

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Background Thyroid cancer is the most common malignant tumor of the endocrine system. There have been some reports on kidney cancer with thyroid metastasis. However, kidney cancer has rarely been detected during thyroid cancer surgery. Case presentation We present a rare case of kidney cancer with thyroid metastasis, combined with thyroid carcinoma. A 66-year-old woman was admitted to our hospital in September 2021 due to enlarged left thyroid nodules for two years. The patient was diagnosed with a left thyroid nodule on physical examination in 2012. Extended radical resection of the thyroid cancer was performed. Intraoperatively, two thyroid lesions were identified. Thus, the patient was definitively diagnosed with kidney cancer with thyroid metastasis and papillary thyroid carcinoma. Furthermore, two metastatic nodules due to kidney cancer and one metastatic lymph node lesion due to thyroid cancer were found in the loose connective tissue adjacent to the thyroid. Conclusions Kidney cancer with thyroid metastasis and thyroid carcinoma rarely co-occur, and it is difficult to identify the primary tumor. Although clinical examination methods are increasingly updated, the past medical history and physical examination are still very important.

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Management of radioiodine refractory differentiated thyroid cancer: the Latin American perspective

Pitoia

Scheffel

Califano

et al. 2023

Rev Endocr Metab Disord

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Active Surveillance of Small Metastatic Lymph Nodes as an Alternative to Surgery in Selected Patients with Low-Risk Papillary Thyroid Cancer: A Retrospective Cohort Study

Cited by 9 publications

References 15 publications

Active surveillance is a feasible and safe strategy in selected patients with papillary thyroid cancer and suspicious cervical lymph nodes detected after thyroidectomy

Active surveillance is a feasible and safe strategy in selected patients with papillary thyroid cancer and suspicious cervical lymph nodes detected after thyroidectomy

Kidney cancer with thyroid metastasis combined with thyroid carcinoma, a case report

Management of radioiodine refractory differentiated thyroid cancer: the Latin American perspective

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