For properly selected patients with small PTC nodules active surveillance is a viable management option associated with a very low rate of short-term progression
Based on recent data from Japanese researchers highlighting the safety and acceptability of an observational approach to papillary microcarcinoma, the Thyroid Center Disease Management Team at Memorial Sloan-Kettering Cancer Center, in New York, NY, implemented an active surveillance program as a standard of care alternative to immediate surgical resection in selected patients with intrathyroidal papillary thyroid carcinoma (PTC). Expectant observation proved to be an attractive management option associated with a very low rate of short-term progression. Moreover, it suggested that once patients are recruited into an active surveillance program, early retention rates are high.
This surveillance study was presented at the 83rd Annual Meeting of the American Thyroid Association, in San Juan, Puerto Rico, on October 17, 2013.
The study demonstrates that active surveillance is an acceptable and applicable treatment strategy for properly selected patients with PTC in the United States, despite active surveillance not being widely adopted as a standard of care outside of Japan, as highlighted by recent publications. This resistance is likely in part due to clinical reports of a small subset of patients who present with clinically advanced disease and the perception that non-surgical management would not appeal to North American patients, their families, and referring medical practitioners.
Over a period of 18 months, 104 patients were referred for consideration of active surveillance, of which 81% were considered clinically favorable candidates. Of these, 74 patients (88%) agreed to undergo observation. These properly selected adult patients had small thyroid nodules confirmed as intrathyroidal papillary thyroid carcinoma or suspicious for PTC on fine-needle aspiration up to a dimension of 1.5 cm.
According to the study abstract, “Patients with intrathyroidal tumors (PTC or suspicious for PTC) <1.5 cm in maximal dimension were considered for active surveillance (neck ultrasound 6 monthly until stable for 2 years, then annually). Indications for surgical resection included confirmed tumor enlargement by ≥3 mm in any dimension, thyroid capsular invasion, identification of metastases, or patient preference in the absence of disease progression.”
After a median follow-up period of 12 months, 95% of the participants remained on active surveillance with no evidence of disease progression to date. Three patients elected to undergo surgical resection despite disease stability, and one patient proceeded to the surgery due to confirmed tumor enlargement. Patients who elected to undergo surgical resection despite being stable during active surveillance did so out of fear of metastatic disease, desire for definitive treatment to achieve a sense of closure, influence of family, friends and local physicians, and simplification of follow-up.
The study authors concluded that, “in properly selected patients with small thyroid nodules cytologically confirmed as PTC or suspicious for PTC, expectant observation is an attractive management option associated with a very low rate of short-term progression. Moreover, once patients are recruited into an active surveillance program, early retention rates are high.”