Applying Criteria of Active Surveillance to Low-Risk Papillary Thyroid Cancer Over a Decade: How Many Surgeries and Complications Can Be Avoided?

Abstract

Future programs in the United States should consider increasing the size threshold for active surveillance of PTC to 1.5 cm, since this will allow up to one quarter of patients to be eligible instead of only 6% with a 1 cm size threshold. Without an active surveillance program, the majority of patients with low-risk cancers have thyroidectomy and carry a small risk of permanent complications.

Low‐risk papillary thyroid microcarcinoma: Optimal management toward a more conservative approach

“…The treatment strategy for patients with microPTC should take into account: (a) tumor and US characteristics (size ≤10 mm, borders, location of the tumor, focality, extrathyroidal extension, suspicious cervical lymph nodes, cytology, molecular profile); (b) patient characteristics (demographics, family history, comorbidities, willingness, and compliance to participate in active surveillance); and (c) medical team characteristics (experience and expertize of the treating clinician and multidisciplinary team, quality of neck US) 21,29 …”

“…• Avoidance of adverse events (temporary and permanent vocal cord paralysis, temporary and permanent hypoparathyroidism, postoperative hematoma, surgical scars) and thyroid replacement therapy with levothyroxine and regular blood level monitoring. 9,29 • In cases of tumor size enlargement or lymph node metastasis, delayed surgery may require more extensive intervention. However it is unclear whether lymph node metastasis was already present at initial diagnosis or whether it developed during the time of active surveillance period.…”

“…The treatment strategy for patients with microPTC should take into account: (a) tumor and US characteristics (size ≤10 mm, borders, location of the tumor, focality, extrathyroidal extension, suspicious cervical lymph nodes, cytology, molecular profile); (b) patient characteristics (demographics, family history, comorbidities, willingness, and compliance to participate in active surveillance); and (c) medical team characteristics (experience and expertize of the treating clinician and multidisciplinary team, quality of neck US). 21,29 In addition to the optimization of inclusion and exclusion criteria, the anxiety or resistance of patients (or even physicians) during active surveillance is another valid consideration that is still being studied. 21,53,54 However, a complete explanation is very important in relieving patient fears.…”

Active surveillance for patients with very low‐risk thyroid cancer

“…In this study of 56 patients who met criteria for AS and all of whom underwent immediate surgery, 6 patients developed temporary hypoparathyroidism, 1 developed permanent hypoparathyroidism, 1 had temporary VCP, and 1 patient had permanent VCP. 43 In both series, the reported rates of complications were low, but in the context of patients who do not require surgery (both in the short and potentially long term) these complication rates could be considered unacceptably high, as they could be avoided altogether.…”

Epidemiologie von Schilddrüsen- und Nebennierentumoren

“…Vielfach wird daher, auch aufgrund der exzellenten Prognose und der Risiken bzw. Probleme einer operativen Schilddrüsenentfernung, inzwischen vor Überdiagnose und Übertherapie gewarnt und vor allem bei jüngeren Patienten ein abwartendes therapeutisches Vorgehen ("active surveillance") vorgeschlagen [11,12].…”