Challenges of Active Surveillance Protocols for Low-Risk Papillary Thyroid Microcarcinoma in the United States

Thyroid ◽  
2016 ◽  
Vol 26 (7) ◽  
pp. 989-990 ◽  
Author(s):  
Grace C. Haser ◽  
R. Michael Tuttle ◽  
Mark L. Urken
Keyword(s):  
United States ◽  
Active Surveillance ◽  
The United States ◽  
Low Risk ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma

Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma: A Multi-Center Cohort Study in Korea

Thyroid ◽  
2018 ◽  
Vol 28 (12) ◽  
pp. 1587-1594 ◽  
Author(s):  
Hye-Seon Oh ◽  
Jeonghoon Ha ◽  
Hye In Kim ◽  
Tae Hyuk Kim ◽  
Won Gu Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Active Surveillance ◽  
Low Risk ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma

scholarly journals Pregnancy During Active Surveillance of Papillary Thyroid Microcarcinoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A868-A868
Author(s):  
Pedro Weslley Rosario ◽  
Gabriela Franco Mourão
Keyword(s):  
Tumor Growth ◽  
Tumor Progression ◽  
Active Surveillance ◽  
Low Risk ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Childbearing Age ◽  
Thyroid Microcarcinoma ◽  
Tumor Focus ◽  
History Of

Abstract Introduction: Most patients diagnosed with papillary thyroid microcarcinoma (microPTC) classified as low risk and therefore eligible for active surveillance (AS) are women. Although age is a predictor of tumor progression (more frequent among young people), young adults are “appropriate” candidates for AS. Consequently, a proportion of patients with low-risk microPTC eligible for AS are women of childbearing age and knowledge of the effect of pregnancy on tumor progression is therefore important. In the Japanese population, Ito et al. observed this progression in only 8% of pregnancies. None of the series on the outcomes of AS in western populations has so far reported the behavior of microPTC in women who became pregnant during AS. Methods: We have submitted patients with low-risk microPTC to AS. Our management has been not to interrupt AS, i.e., not to indicate surgery when the patient wishes to become pregnant. We report here the results of five patients who became pregnant during AS and their follow-up up to 6 months after delivery. Results: The patients were 26 to 36 years old (median 29 years) when they became pregnant. None of them had a history of radiation exposure, one had a family history of PTC, one had associated Hashimoto’s thyroiditis, and all of them had only one tumor focus and were considered “appropriate” (but not “ideal”) candidates for AS. In fact, when pregnancy was diagnosed, the patients continued to exhibit the criterion for AS according to our initial protocol (tumor ≤ 1.2 cm, no apparent lymph node metastases [LNM] or extrathyroidal extension [ETE] on ultrasonography [US]). All women were monitored by monthly measurement of TSH and levothyroxine (L-T4) was administered during pregnancy to maintain TSH between 0.1 and 1 mIU/L. US was performed when pregnancy was diagnosed (between 6 and 9 weeks of gestation), around 22 weeks, at the end of pregnancy, and 6 months after delivery. During the evaluations, none of the patients had apparent LNM or ETE on US. None of the patients exhibited tumor growth, defined as an increase in diameter ≥ 3 mm. Tumor growth ≥ 50% was observed in only one patient, with a small reduction after delivery. Conclusions: Our preliminary results suggest that pregnancy is not associated with a high risk of progression of low-risk microPTC and that the desire to get pregnant or pregnancy should not be an exclusion factor for AS. References: Effects of Pregnancy on Papillary Microcarcinomas of the Thyroid Re-Evaluated in the Entire Patient Series at Kuma Hospital. Ito Y, Miyauchi A, Kudo T et al. Thyroid 2016; 26:156-60 AND Active Surveillance in Adults with Low-Risk Papillary Thyroid Microcarcinomas: A Prospective Study. Rosario PW, Mourão GF, Calsolari MR. Horm Metab Res. 2019; 51:703-8.

US-guided Microwave Ablation of Low-Risk Papillary Thyroid Microcarcinoma: Longer-Term Results of a Prospective Study

2020 ◽  
Vol 105 (6) ◽  
pp. 1791-1800 ◽  
Author(s):  
Wen-Wen Yue ◽  
Lu Qi ◽  
Dan-Dan Wang ◽  
Shou-Jun Yu ◽  
Xi-Ju Wang ◽  
...  
Keyword(s):  
Prospective Study ◽  
Distant Metastasis ◽  
Microwave Ablation ◽  
Large Population ◽  
Low Risk ◽  
Papillary Thyroid Microcarcinoma ◽  
Function Evaluation ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma

Abstract Background Papillary thyroid microcarcinoma (PTMC) has become a main cause of the extremely high incidence of thyroid carcinoma. This study aimed to evaluate the longer-term effectiveness of ultrasound (US)-guided microwave ablation (MWA) for treatment of low-risk PTMC with a large population. Methods This prospective study was approved by ethics committee of our institution. MWA was performed under US-guidance for 119 unifocal PTMC patients without clinically cervical or distant metastasis. The target ablation zone exceeded the tumor edge judged by contrast-enhanced US to avoid marginal residue and recurrence. US and thyroid function evaluation were followed at 1, 3, 6, and 12 months after treatment and every 6 to 12 months thereafter. Any adverse event associated with MWA was evaluated. Results The follow-up duration after MWA was 37.2 ± 20.9 months (range 12-101 months). Tumor volume decreased significantly from 1.87 ± 1.03 mL immediately after MWA to 0.01 ± 0.04 mL at the final evaluation (P < 0.001), with a mean volume reduction ratio of 99.4 ± 2.2% and 107 cases (93.9%) got complete remission. A patient was detected with cervical lymph node metastasis at 26-month follow-up and underwent 1 additional MWA treatment successfully. No distant metastasis was observed. All the acquired histological pathology results confirmed the absence of residual or recurrent tumor cells after MWA. No delayed complications associated with MWA were encountered for all patients. Conclusions Percutaneous MWA is technically feasible for complete PTMC destruction and showed well longer-term effectiveness; thus, it seems to be an effective nonsurgical therapy to complement the current recommendation for selected low-risk PTMC patients.

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