Applying Criteria of Active Surveillance to Low-Risk Papillary Thyroid Cancer over a Decade: How Many Surgeries and Complications Can Be Avoided?

Andrew Griffin, Juan P. Brito, Manisha Bahl, Jenny K. Hoang

Research output: Contribution to journalArticle

Abstract

Background: The 2015 American Thyroid Association guidelines acknowledged that "an active surveillance management approach can be considered as an alternative to immediate surgery" in patients with low-risk papillary thyroid carcinoma (PTC). The aim of this study was to determine the proportion of PTC that would meet the criteria for active surveillance and the surgeries and complications that could have been avoided. Methods: A total of 681 patients with thyroid cancer who underwent thyroid surgery from 2003 to 2012 were retrospectively reviewed. A decision-making framework for active surveillance was applied to patients with PTC in nodules measuring ≤1.5 cm on ultrasound. Patients were identified as suitable for active surveillance based on imaging and patient characteristics. These patients were reviewed for management and outcomes. Results: PTC was diagnosed based on fine-needle aspiration histology of Bethesda V or VI in thyroid nodules in 243 patients. Of these, 77 patients had nodules measuring ≤1.5 cm on ultrasound, and 56/77 (23%) patients met the criteria for surveillance: 15/243 (6%) patients met the criteria with a ≤1 cm size threshold, and 41/243 (17%) met the criteria with a 1.1-1.5 cm threshold. Of the 56 patients who met the criteria for active surveillance, 52 underwent total thyroidectomy, and four had a lobectomy. Forty-five (80%) patients had elective central nodal dissection, and 14 had nodal metastases on pathology (all <4 mm). Three patients had permanent complications from surgery, including vocal cord paralysis, hypoparathyroidism, and a chipped tooth from intubation. No patients died or had recurrent disease. Conclusion: Future programs in the United States should consider increasing the size threshold for active surveillance of PTC to 1.5 cm, since this will allow up to one quarter of patients to be eligible instead of only 6% with a 1 cm size threshold. Without an active surveillance program, the majority of patients with low-risk cancers have thyroidectomy and carry a small risk of permanent complications.

Original languageEnglish (US)
Pages (from-to)518-523
Number of pages6
JournalThyroid
Volume27
Issue number4
DOIs
StatePublished - Apr 2017
Externally publishedYes

Fingerprint

Papillary Thyroid cancer
Thyroidectomy
Vocal Cord Paralysis
Hypoparathyroidism
Thyroid Nodule
Fine Needle Biopsy
Thyroid Neoplasms
Intubation
Dissection
Decision Making
Histology
Tooth
Thyroid Gland
Guidelines
Pathology
Neoplasm Metastasis
Neoplasms

Keywords

  • active surveillance
  • overdiagnosis
  • thyroid cancer

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Applying Criteria of Active Surveillance to Low-Risk Papillary Thyroid Cancer over a Decade : How Many Surgeries and Complications Can Be Avoided? / Griffin, Andrew; Brito, Juan P.; Bahl, Manisha; Hoang, Jenny K.

In: Thyroid, Vol. 27, No. 4, 04.2017, p. 518-523.

Research output: Contribution to journalArticle

@article{274897e77e154927903602246ce15b2d,
title = "Applying Criteria of Active Surveillance to Low-Risk Papillary Thyroid Cancer over a Decade: How Many Surgeries and Complications Can Be Avoided?",
abstract = "Background: The 2015 American Thyroid Association guidelines acknowledged that {"}an active surveillance management approach can be considered as an alternative to immediate surgery{"} in patients with low-risk papillary thyroid carcinoma (PTC). The aim of this study was to determine the proportion of PTC that would meet the criteria for active surveillance and the surgeries and complications that could have been avoided. Methods: A total of 681 patients with thyroid cancer who underwent thyroid surgery from 2003 to 2012 were retrospectively reviewed. A decision-making framework for active surveillance was applied to patients with PTC in nodules measuring ≤1.5 cm on ultrasound. Patients were identified as suitable for active surveillance based on imaging and patient characteristics. These patients were reviewed for management and outcomes. Results: PTC was diagnosed based on fine-needle aspiration histology of Bethesda V or VI in thyroid nodules in 243 patients. Of these, 77 patients had nodules measuring ≤1.5 cm on ultrasound, and 56/77 (23{\%}) patients met the criteria for surveillance: 15/243 (6{\%}) patients met the criteria with a ≤1 cm size threshold, and 41/243 (17{\%}) met the criteria with a 1.1-1.5 cm threshold. Of the 56 patients who met the criteria for active surveillance, 52 underwent total thyroidectomy, and four had a lobectomy. Forty-five (80{\%}) patients had elective central nodal dissection, and 14 had nodal metastases on pathology (all <4 mm). Three patients had permanent complications from surgery, including vocal cord paralysis, hypoparathyroidism, and a chipped tooth from intubation. No patients died or had recurrent disease. Conclusion: Future programs in the United States should consider increasing the size threshold for active surveillance of PTC to 1.5 cm, since this will allow up to one quarter of patients to be eligible instead of only 6{\%} with a 1 cm size threshold. Without an active surveillance program, the majority of patients with low-risk cancers have thyroidectomy and carry a small risk of permanent complications.",
keywords = "active surveillance, overdiagnosis, thyroid cancer",
author = "Andrew Griffin and Brito, {Juan P.} and Manisha Bahl and Hoang, {Jenny K.}",
year = "2017",
month = "4",
doi = "10.1089/thy.2016.0568",
language = "English (US)",
volume = "27",
pages = "518--523",
journal = "Thyroid",
issn = "1050-7256",
publisher = "Mary Ann Liebert Inc.",
number = "4",

}

TY - JOUR

T1 - Applying Criteria of Active Surveillance to Low-Risk Papillary Thyroid Cancer over a Decade

T2 - How Many Surgeries and Complications Can Be Avoided?

AU - Griffin, Andrew

AU - Brito, Juan P.

AU - Bahl, Manisha

AU - Hoang, Jenny K.

PY - 2017/4

Y1 - 2017/4

N2 - Background: The 2015 American Thyroid Association guidelines acknowledged that "an active surveillance management approach can be considered as an alternative to immediate surgery" in patients with low-risk papillary thyroid carcinoma (PTC). The aim of this study was to determine the proportion of PTC that would meet the criteria for active surveillance and the surgeries and complications that could have been avoided. Methods: A total of 681 patients with thyroid cancer who underwent thyroid surgery from 2003 to 2012 were retrospectively reviewed. A decision-making framework for active surveillance was applied to patients with PTC in nodules measuring ≤1.5 cm on ultrasound. Patients were identified as suitable for active surveillance based on imaging and patient characteristics. These patients were reviewed for management and outcomes. Results: PTC was diagnosed based on fine-needle aspiration histology of Bethesda V or VI in thyroid nodules in 243 patients. Of these, 77 patients had nodules measuring ≤1.5 cm on ultrasound, and 56/77 (23%) patients met the criteria for surveillance: 15/243 (6%) patients met the criteria with a ≤1 cm size threshold, and 41/243 (17%) met the criteria with a 1.1-1.5 cm threshold. Of the 56 patients who met the criteria for active surveillance, 52 underwent total thyroidectomy, and four had a lobectomy. Forty-five (80%) patients had elective central nodal dissection, and 14 had nodal metastases on pathology (all <4 mm). Three patients had permanent complications from surgery, including vocal cord paralysis, hypoparathyroidism, and a chipped tooth from intubation. No patients died or had recurrent disease. Conclusion: Future programs in the United States should consider increasing the size threshold for active surveillance of PTC to 1.5 cm, since this will allow up to one quarter of patients to be eligible instead of only 6% with a 1 cm size threshold. Without an active surveillance program, the majority of patients with low-risk cancers have thyroidectomy and carry a small risk of permanent complications.

AB - Background: The 2015 American Thyroid Association guidelines acknowledged that "an active surveillance management approach can be considered as an alternative to immediate surgery" in patients with low-risk papillary thyroid carcinoma (PTC). The aim of this study was to determine the proportion of PTC that would meet the criteria for active surveillance and the surgeries and complications that could have been avoided. Methods: A total of 681 patients with thyroid cancer who underwent thyroid surgery from 2003 to 2012 were retrospectively reviewed. A decision-making framework for active surveillance was applied to patients with PTC in nodules measuring ≤1.5 cm on ultrasound. Patients were identified as suitable for active surveillance based on imaging and patient characteristics. These patients were reviewed for management and outcomes. Results: PTC was diagnosed based on fine-needle aspiration histology of Bethesda V or VI in thyroid nodules in 243 patients. Of these, 77 patients had nodules measuring ≤1.5 cm on ultrasound, and 56/77 (23%) patients met the criteria for surveillance: 15/243 (6%) patients met the criteria with a ≤1 cm size threshold, and 41/243 (17%) met the criteria with a 1.1-1.5 cm threshold. Of the 56 patients who met the criteria for active surveillance, 52 underwent total thyroidectomy, and four had a lobectomy. Forty-five (80%) patients had elective central nodal dissection, and 14 had nodal metastases on pathology (all <4 mm). Three patients had permanent complications from surgery, including vocal cord paralysis, hypoparathyroidism, and a chipped tooth from intubation. No patients died or had recurrent disease. Conclusion: Future programs in the United States should consider increasing the size threshold for active surveillance of PTC to 1.5 cm, since this will allow up to one quarter of patients to be eligible instead of only 6% with a 1 cm size threshold. Without an active surveillance program, the majority of patients with low-risk cancers have thyroidectomy and carry a small risk of permanent complications.

KW - active surveillance

KW - overdiagnosis

KW - thyroid cancer

UR - http://www.scopus.com/inward/record.url?scp=85017191532&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017191532&partnerID=8YFLogxK

U2 - 10.1089/thy.2016.0568

DO - 10.1089/thy.2016.0568

M3 - Article

C2 - 28125944

AN - SCOPUS:85017191532

VL - 27

SP - 518

EP - 523

JO - Thyroid

JF - Thyroid

SN - 1050-7256

IS - 4

ER -