Decision-making in Surgery or Active Surveillance for Low Risk Papillary Thyroid Cancer During the COVID-19 Pandemic

Abstract

We describe our experience conducting a prospective observational cohort study on the management of small, low risk papillary thyroid cancer during the COVID-19 pandemic. Our study participants are given the choice of active surveillance (AS) or surgery, and those in the AS arm are followed at the study center, whereas surgical patients undergo usual care. During the pandemic we have transitioned from in-person research patient visits to largely virtual care of patients under AS. As of 30 October 2020, we had enrolled 181 patients enrolled in our study (including 25 during the pandemic), of which 92.3% (167/181) consented to telephone communication and 79.0% (143/181) consented to secure videoconferencing communication. Prior to the pandemic, 74.5% (117/157) of our patients chose AS over surgery, whereas during the pandemic, 96.0% (24/25) chose AS. Of the 133 study patients who were under AS within the timeframe from 12 March 2020, to 30 October 2020, the percentage of patients who missed appointments was 8.3% (11/133, for neck ultrasound and physician visits, respectively) and delayed appointments was 23.3% (31/133). This preliminary data suggests that prospective observational research on AS of thyroid cancer can safely continue during the pandemic.

Impact of COVID-19 Pandemic on Intervals and Outcomes of Repeated Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma

“…Besides, sticking to the same clinical practice guidelines, TACE was performed by experienced operators with similar TACE formula and follow-up protocol in our study. Therefore, the results of our study could provide reference value for the operators on decision making, especially when the COVID-19 poses a risk to the public health ( 28 ).…”

Thyroid surgery during the COVID-19 pandemic: results from a systematic review

“…Our paper is the first study aimed at systematically review the experience of thyroid surgeries facing the risk of transmission of SARS-CoV-2 infection. While nine studies [22][23][24][25][26][27][28][29][30] were finally included for revision, only one study [21] addressed the possibility to safely continue prospective observational research on active surveillance of low-risk papillary thyroid cancer during the COVID-19 pandemic.…”

“…Among the studies finally excluded, there were four studies without details on thyroid surgery (one set in Vietnam [16], one in Italy [17], one International [18], one in Italy-UK [19]), one relative Fig. 1 Flowchart of study selection process to an operated case of PTC [20], one regarding potential surgical candidates who underwent active surveillance [21]. Nine English language studies had appropriate data for systematic review [22][23][24][25][26][27][28][29][30].…”

Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance

“…In this ongoing study, we include patients 18 years of age or older, with thyroid nodules that are PTC or suspicious for PTC on fine needle biopsy and < 2 cm in maximum diameter in the absence of nodal metastasis, extrathyroidal extension, other significant indications for thyroid or parathyroid surgery or tumors based on location that would be considered at high risk of invasion into the trachea or recurrent laryngeal nerves (RLN). As of October 30, 2020, one hundred and eighty-two patients had been enrolled in the study [140 females, 42 males; mean age 52 years] [11].…”

“…An acute angle of abutment is offered AS, and obtuse angle of abutment should be referred for surgery. Similarly, a PTC measuring ≥ 7 mm with a rim of thyroid between it and the RLN may remain in AS; if there is loss of the thyroid rim or protrusion of the nodule into TEG, the patient should be referred to surgery.Figures 5,6,7,8,11,12 are examples of patients who did not meet AS criteria in our study and were referred for surgical excision.…”