Active surveillance of low-risk papillary thyroid cancer: A meta-analysis

Saravana-Bawan, Bianka; Bajwa, Amandeep; Paterson, John G.; McMullen, Todd

doi:10.1016/j.surg.2019.03.040

Cited by 92 publications

(57 citation statements)

References 30 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

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“…In addition, the medical community has recently tended to be more conservative for the management of low-risk PTC. 15,16 If appropriately used, active surveillance for lowrisk tumors, especially for papillary thyroid microcarcinoma (PTMC), is a safe management strategy that offers favorable outcomes and preserves quality of life at low cost. 16 To improve the diagnosis of CLNM of PTC, researchers have increasingly attempted to predict CLNM with clinicopathologic characteristics and ultrasonographic features of primary PTC or PTMC.…”

Section: Introductionmentioning

confidence: 99%

Value of Combining Clinical Factors, Conventional Ultrasound, and Contrast-Enhanced Ultrasound Features in Preoperative Prediction of Central Lymph Node Metastases of Different Sized Papillary Thyroid Carcinomas

Wang

Nie

Wang

et al. 2021

CMAR

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Purpose Early and accurate preoperative diagnosis of central lymph node metastasis (CLNM) is crucial to improve surgical management of patients with clinical lymph node-negative papillary thyroid carcinoma (PTC). Towards improving diagnosis of CLNM, we assessed the value of combining preoperative clinical characteristics, conventional ultrasound, and contrast-enhanced ultrasound (CEUS) in preoperative prediction of CLNM of different sized PTCs. Patients and Methods Patients were divided according to tumor size: a PTC group (>10 mm) and a papillary thyroid microcarcinoma (PTMC) group (≤10 mm). We retrospectively analyzed the clinical and ultrasonographic features of 120 PTC patients and 165 PTMC patients. Multivariate logistic regression analysis was used to screen independent risk factors and establish prediction models. Receiver operating characteristic curves were used to determine the best cut-off values for continuous variables and assess the performance of prediction models. Results Independent risk predictors of CLNM for the PTC group were extrathyroidal extension in CEUS (OR=7.923), tumor size >14 mm (OR=5.491), and multifocality (OR=3.235). For the PTMC group, the independent risk factors were the distance from the thyroid capsule =0 mm (OR=4.629), male (OR=3.315), tumor size >5 mm (OR=3.304), and microcalcification (OR=2.560). The predictive model of combined method had better performance in predicting CLNM of PTC compared with models based on CEUS and conventional ultrasound alone (area under the curve: 0.832 vs 0.739, P =0.0011; 0.832 vs 0.678, P =0.0012). For PTMC, comparing with CEUS, the combined method and conventional ultrasound performed better than CEUS alone in predicting CLNM (area under the curve: 0.783 vs 0.636, P =0.0016; 0.738 vs 0.636, P =0.0196). Conclusion The predictive models of combined method obtained from significant preoperative clinical and ultrasonographic features can potentially improve the preoperative diagnosis and individual treatment of CLNM in patients with PTC and PTMC. CEUS may be helpful in predicting CLNM of PTC, but CEUS would be ineffective in predicting CLNM of PTMC.

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“…The incidence of PTCs has been continually increasing; however, the mortality rate has not changed substantially, which is probably because the majority of PTCs diagnosed incidentally are low-risk papillary thyroid microcarcinomas (PTMCs). Except for tumors with high-risk features such as extrathyroidal extension, clinically evident LNM(+)and special aggressive types, active surveillance appears to be safe [34] and can replace immediate surgery for low-risk PTC [35]. In general, active surveillance begins when patients are diagnosed with low-risk PTC by ultrasound examination of neneedle aspiration biopsy (FNAB).…”

Section: Discussionmentioning

confidence: 99%

A Novel Prognostic Nomogram Based on Metastasis-Related Genes Signature for Predicting the Progression-free Interval in Patients With Papillary Thyroid Carcinoma

Cao

et al. 2021

Preprint

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Background: The recurrence rate for papillary thyroid carcinoma (PTC) after surgery is high, which is a significant issue for patients regarding with low-grade malignancy. We built a novel predictive model with metastasis-related genes (MTGs) and relevant clinical parameters for predicting progression-free interval (PFI) after surgery for PTC.Methods: We performed a bioinformatic analysis of integrated PTC datasets with the MTGs to identify differentially expressed MTGs (DE-MTGs). Then we generated PFI-related DE-MTGs and established a 14-gene signature using Lasso-Penalty regression. Finally, we established a signature and clinical parameters-based nomogram for predicting the PFI of PTC . We then validated the efficacy of the signature in marking off high risk patients; the nomogram's performance in predicting PFI was also evaluated with receiver operating characteristic (ROC) curve and Harrell's concordance index (C-index).Results: We identified 155 DE-MTGs related to PFI in PTC. The functional enrichment analysis showed that the DE-MTGs were associated with important oncogenic process. Consequently, we found a novel 14-gene signature. The 14-gene signature could distinguish patients with poorer prognosis and predicted PFI accurately. The signature was a significant independent prognostic factor in PTC. Finally, we built a nomogram by including the signature and relevant clinical factors. Validation analysis showed that the nomogram’s efficacy was superior to the current clinical risk evaluating system in predicting the recurrence of PTC. Conclusions: The 14-gene signature and nomogram were closely associated with PTC prognosis and may help clinicians improve the individualized prediction of PFI, especially for high-risk patients after surgery.

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Active surveillance of low-risk papillary thyroid cancer: A meta-analysis

Cited by 92 publications

References 30 publications

Contemporary Thyroid Nodule Evaluation and Management

Contemporary Thyroid Nodule Evaluation and Management

Value of Combining Clinical Factors, Conventional Ultrasound, and Contrast-Enhanced Ultrasound Features in Preoperative Prediction of Central Lymph Node Metastases of Different Sized Papillary Thyroid Carcinomas

A Novel Prognostic Nomogram Based on Metastasis-Related Genes Signature for Predicting the Progression-free Interval in Patients With Papillary Thyroid Carcinoma

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