Outcomes of active surveillance of EU-TIRADS 5 thyroid nodules

Abstract

Objective: Active surveillance of cytologically proven microcarcinomas has been shown as a safe procedure. However, fine needle aspiration biopsy (FNAB) is not recommended by European Thyroid Association (ETA) and American Thyroid Association (ATA) guidelines for highly suspicious nodules ≤ 10mm. The aim of the study was to assess the outcomes of active surveillance of EU-TIRADS 5 nodules ≤ 10 mm not initially submitted to FNAB. Patients and Methods: 80 patients with at least one EU-TIRADS 5 nodule ≤ 10 mm and no suspicious lymph nodes, accepting active surveillance, were included. Results: Mean baseline diameter and volume were 5.4 mm (± 2.0) and 64.4 mm3 (± 33.5), respectively. After a median follow-up of 36.1 months, a volumetric increase ≥ 50% occurred in 28 patients (35.0%) and a suspicious lymph node in 3 patients (3.8%). 24 patients underwent an FNAB (30.0%) after at least a one year follow-up, of which 45.8% were malignant, 8.3% benign, 33.3% undetermined and 8.3% nondiagnostic. Sixteen patients (20.0%) underwent conversion surgery after a median follow-up of 57.2 months, confirming the diagnosis of papillary carcinoma in 15/16 cases (not described in 1 histology report), all in remission at 6-12 months postoperative follow-up. Conclusion: Applying ETA and ATA guidelines to avoid FNA of EU-TIRADS 5 sub-centimeter nodules and proceeding to active surveillance of such nodules in selected patients is a safe procedure. Thus, US-FNAB could be postponed until the nodule shows signs of progression or a suspicious lymph node appears, with no added risk for the patient.

Can Active Surveillance Management be Developed for Patients With Low-Risk Papillary Thyroid Microcarcinoma? A Preliminary Investigation in a Chinese Population

“…We simulated an ideal monitoring environment with the physician providing intensive reminders for AS and follow-up to evaluate patient adherence with an ideal AS healthcare team. Ultimately, there was satisfactory overall adherence in our cohort, and only 5.2% of patients were considered to have poor adherence (loss to follow-up or noncompliance), which was better than that in Italy (10.8%) (18), similar to that in France (6.3%) (25) and much lower than that in the United States (0.7%) (22). However, although patients were given both oral and written instructions at every visit to return for surveillance, many patients still did not return for AS until a manual reminder was sent by the follow-up doctor.…”

Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature

“…After full text review, 14 studies were included for the final analysis. The results are summarized in the PRISMA flowchart (Figure 1) [7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

“…After full text review, 14 studies were included for the final analysis. The results are summarized in the PRISMA flowchart (Figure 1) [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The authors used the Newcastle-Ottawa Scale (NOS) to certify the quality of each included study.…”

The active surveillance management approach for patients with low risk papillary thyroid microcarcinomas: is China ready?

“…A recent study showed that proceeding to AS without FNAB is a safe procedure in selected patients, and FNAB could be postponed until disease progression 83 . An increased frequency of ultrasound re-examination may be more acceptable to Chinese patients than invasive procedures, because it is inexpensive and convenient.…”