Active Surveillance for Small Papillary Thyroid Cancer: A Systematic Review and Meta-Analysis

Cho, Se Jin; Suh, Chong Hyun; Baek, Jung Hwan; Chung, Sae Rom; Choi, Young Jun; Chung, Ki-Wook; Shong, Young Kee; Lee, Jeong Hyun

doi:10.1089/thy.2019.0159

Cited by 111 publications

(94 citation statements)

References 43 publications

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“…The active surveillance strategy does not merely delay surgery: the likelihood of disease progression diminishes with age, and older patients are therefore less likely to require surgery during their lifespan ( 91 ). Similar results have been reported worldwide ( 92 , 93 ).…”

Section: Follow-up Examinations: What To Look Forsupporting

confidence: 92%

Contemporary Thyroid Nodule Evaluation and Management

Grani

Sponziello

Pecce

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

192

140

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Context Approximately 60% of adults harbor 1 or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The widespread use of diagnostic imaging and improved access to health care favor the discovery of small, subclinical nodules and small papillary cancers. Overdiagnosis and overtreatment is associated with potentially excessive costs and nonnegligible morbidity for patients. Evidence Acquisition We conducted a PubMed search for the recent English-language articles dealing with thyroid nodule management. Evidence Synthesis The initial assessment includes an evaluation of clinical risk factors and sonographic examination of the neck. Sonographic risk-stratification systems (e.g., Thyroid Imaging Reporting and Data Systems) can be used to estimate the risk of malignancy and the need for biopsy based on nodule features and size. When cytology findings are indeterminate, molecular analysis of the aspirate may obviate the need for diagnostic surgery. Many nodules will not require biopsy. These nodules and those that are cytologically benign can be managed with long-term follow-up alone. If malignancy is suspected, options include surgery (increasingly less extensive), active surveillance or, in selected cases, minimally invasive techniques. Conclusion Thyroid nodule evaluation is no longer a 1-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients as frankly as possible to identify an approach that best meets their needs.

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Section: Follow-up Examinations: What To Look Forsupporting

confidence: 92%

Contemporary Thyroid Nodule Evaluation and Management

Grani

Sponziello

Pecce

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

192

140

View full text Add to dashboard Cite

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“…Miyauchi from Kuma Hospital [ 15 ] made it clear from his seminal study of AS that, in his experience, by 10 years after diagnosis 8% of observed PTMs will have enlarged and 3.8% may have been found on sonography to have “novel nodal metastases.” A 2019 systematic review and meta-analysis [ 34 ] of published AS studies quantitated the 5-year risks of size enlargement and lymph node metastasis at 5.3% (CI, 4.4%-6.4%) and 1.6% (CI, 1.1%-2.4%), respectively. If, as the latest ATA guidelines [ 14 ] recommend, unilateral lobectomy alone is sufficient treatment for cT1a N0M0 patients, then, like those managed by AS or ablation, whether by laser [ 22 ], microwave [ 23 ], radiofrequency [ 24 , 25 ] or ethanol, the rates of tumor recurrence will be highly dependent on the availability of reliable high-quality sonography during follow-up [ 15 , 34 ] and a heightened awareness of the dual possibilities [ 4 , 5 , 33 ] of discovering either a further focus of PTM in the remaining thyroid or an NNM, either in the central or a lateral compartment.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of Treating With Ethanol Ablation 15 Adult Patients With cT1aN0 Papillary Thyroid Microcarcinoma

Hay

Lee

Kaggal

et al. 2020

Journal of the Endocrine Society

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Background Currently acceptable management options for patients with adult papillary thyroid microcarcinoma (APTM) range from immediate surgery, either unilateral lobectomy or bilateral lobar resection, to active surveillance (AS). An alternative minimally invasive approach, originally employed for eliminating neck nodal metastases, may be ultrasound-guided percutaneous ethanol ablation (EA). Here we present our experience of definitively treating with EA fifteen patients with APTM. Patients/Methods During 2010-2017 the fifteen cT1aN0M0 patients selected for EA, were aged 36-86 years (median 45 years). Tumor volumes (n=17), assessed by sonography, ranged from 25-375 mm 3 (median 109). 14/15 patients had two ethanol injections on successive days; total volume injected ranging from 0.45 -1.80 cc (median 1.1 cc). All ablated patients were followed with sonography and underwent recalculation of tumor volume and reassessment of tumor perfusion at each follow-up visit. Results The ablated patients have now been followed for 10-100 months (median 64). There were no complications and no ablated patient developed post-procedure recurrent laryngeal nerve dysfunction. All 17 ablated tumors shrunk (median 93%) and Doppler flow eliminated. Median tumor volume reduction in 9 identifiable avascular foci was 82% (range 26-93%). After EA, 8 tumors (47%) disappeared on sonography after a median of 10 months. During follow-up no new PTM foci and no nodal metastases have been identified. Conclusions Definitive treatment of APTM by EA is effective, safe and inexpensive. Our results suggest that, for APTM patients who do not wish neck surgery and are uncomfortable with AS, EA represents a well-tolerated and minimally invasive outpatient management option.

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“…In most clinical guidelines, biopsy is not routinely recommended for nodules <10 mm because it is unclear whether an aggressive biopsy is beneficial in a small-sized asymptomatic thyroid nodule. 16,17 Several studies have shown that the immediate biopsy of small nodules leading to definitive therapy until disease progression has no impact on disease-specific survival; 12,[18][19][20][21] rather, active surveillance without biopsy can be conducted. 22,23 However, the decision as to whether the nodule should undergo either biopsy or surveillance without biopsy varies according to different guidelines and has been an emerging issue in the case of subcentimeter nodules.…”

Section: Discussionmentioning

confidence: 99%

<p>Fine-Needle Aspiration of Subcentimeter Thyroid Nodules in the Real-World Management</p>

Jeong¹,

Kim²,

Lee³

et al. 2020

CMAR

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Background: The Korea Thyroid Association published the revised guidelines for thyroid nodules in 2016. However, whether fine-needle aspiration is accurately performed based on indications and whether the results of this procedure are appropriately addressed according to clinical guidelines, particularly in subcentimeter nodules, are unclear. Methods: We retrospectively analyzed the fine-needle aspiration data of 331 thyroid nodules of patients who were referred to a tertiary hospital clinic for fine-needle aspiration. Each nodule was categorized according to ultrasonography findings based on the recommendations of the Korea Thyroid Association for fine-needle aspiration. Only nodules with a final pathological diagnosis of benign or malignant made using the Bethesda system were included. Results: Up to 32% of thyroid nodules that were not indicated for fine-needle aspiration were aspirated. Regarding subcentimeter nodules, only 28 of 123 (22.8%) aspirated nodules were indicated for fine-needle aspiration. Of the 49 malignant subcentimeter nodules, 33 (67.3%) underwent immediate surgery. Meanwhile, 14 (28.6%) nodules were lost to followup, and two (4.1%) were under active surveillance. Eighteen (36.7%) malignant subcentimeter nodules were not indicated for fine-needle aspiration but underwent surgical resection instead of active surveillance. Conclusion: Despite the recommendations in the revised guidelines, several thyroid nodules that do not meet the indications for FNA are aspirated in real-world practice. To reduce overtreatment, a widespread knowledge of the correct indications for fine-needle aspiration is important in clinical practice, particularly for subcentimeter nodules.

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Active Surveillance for Small Papillary Thyroid Cancer: A Systematic Review and Meta-Analysis

Cited by 111 publications

References 43 publications

Contemporary Thyroid Nodule Evaluation and Management

Contemporary Thyroid Nodule Evaluation and Management

Long-Term Results of Treating With Ethanol Ablation 15 Adult Patients With cT1aN0 Papillary Thyroid Microcarcinoma

<p>Fine-Needle Aspiration of Subcentimeter Thyroid Nodules in the Real-World Management</p>

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