Nonoperative, Active Surveillance of Larger Malignant and Suspicious Thyroid Nodules.
J Clin Endocrinol Metab
; 109(8): 1996-2002, 2024 Jul 12.
Article
em En
| MEDLINE
| ID: mdl-38349208
ABSTRACT
CONTEXT Active surveillance for papillary thyroid cancer (PTC) meeting criteria for surgical resection is uncommon. Which patients may prove reasonable candidates for this approach is not well defined. OBJECTIVE:
This work aimed to examine the feasibility and safety of active surveillance for patients with known or suspected intrathyroidal PTC up to 4â cm in diameter.METHODS:
A retrospective review was conducted of all consecutive patients who underwent nonoperative active surveillance of suspicious or malignant thyroid nodules over a 20-year period from 2001 to 2021. We included patients with an initial ultrasound-fine-needle aspiration confirming either (a) Bethesda 5 or 6 cytology or (b) a "suspicious" Afirma molecular test. The primary outcomes and measures included the rate of adverse oncologic outcomes (mortality and recurrence), as well as the cumulative incidence of size/volume growth.RESULTS:
Sixty-nine patients were followed with active surveillance for 1 year or longer (average 55 months), with 26 patients (38%) having nodules 2â cm or larger. No patients were found to develop new-incident occurrence of lymph node or distant metastasis. One patient, however, demonstrated concern for progression to a dedifferentiated cancer on repeat core biopsy 17 years after initial start of nonoperative selection. A total of 21% of patients had an increase in maximum diameter more than 3 mm, while volume increase of 50% or greater was noted in 25% of patients. Thirteen patients ultimately underwent delayed (rescue) surgery, and no disease recurrence was noted after such treatment. Age and initial nodule size were not predictors of nodule growth.CONCLUSION:
These data expand consideration of active surveillance of PTC in select patients with intrathyroidal suspected malignancy greater than 1â cm in diameter. Rescue surgery, if required at a later time point, appears effective.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Glândula Tireoide
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Nódulo da Glândula Tireoide
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Conduta Expectante
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Câncer Papilífero da Tireoide
Tipo de estudo:
Prognostic_studies
/
Screening_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Clin Endocrinol Metab
/
J. clin. endocrinol. metab
/
Journal of clinical endocrinology and metabolism
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Estados Unidos