scholarly journals Active Surveillance of Papillary Thyroid Microcarcinoma: Where Do We Stand?

2019 ◽  
Vol 8 (6) ◽  
pp. 298-306 ◽  
Author(s):  
Min Ji Jeon ◽  
Won Gu Kim ◽  
Ki-Wook Chung ◽  
Jung Hwan Baek ◽  
Won Bae Kim ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Surgical Intervention ◽  
Three Dimensional ◽  
Volume Measurement ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Major Drawback ◽  
Thyroid Microcarcinoma ◽  
Immediate Surgery

The recent sharp increase in thyroid cancer incidence is mainly due to increased detection of small papillary thyroid microcarcinoma (PTMC). Due to the indolent nature of the disease, active surveillance (AS) of low-risk PTMCs is suggested as an alternative to immediate surgery to reduce morbidity from surgery. For appropriately selected PTMC patients, AS can be a good management option and surgical intervention can be safely delayed until progression occurs. Many considerations must be taken into account at the time of initiation of AS, including radiological tumor characteristics and clinical characteristics of the patient. A specialized medical team should be assembled to monitor patients during AS with an appropriate follow-up protocol. The fact that some patients require surgery for disease progression after long-term follow-up is a major drawback of the current AS protocol. Evaluation of tumor kinetics by three-dimensional tumor volume measurement during the initial 2–3 years of AS may be helpful for discrimination of PTMCs that need early surgical intervention. In this review, we will discuss the clinical outcomes of surgical intervention and AS, considerations during AS, and unresolved questions about AS.

scholarly journals OR28-06 Assessment of Long Term Quality of Life According to Treatment Options in Low Risk Papillary Thyroid Microcarcinoma Patients - Active Surveillance or Immediate Surgery, (A Follow up Interim Analysis of Maestro)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Soo Myoung Shin ◽  
Sung Hye Kong ◽  
Junsun Ryu ◽  
Min Joo Kim ◽  
Sun Wook Cho ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Active Surveillance ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Long Term Follow Up ◽  
Immediate Surgery

Abstract Background: The Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) started in June 2016. As a follow-up study of comparing the quality of life (QoL) of the active surveillance (AS) and immediate surgery (OP) groups at 8 months (9.3±4.8 and 7.1±4.2 months, respectively), here we aimed to compare the QoL between the AS and OP groups after 18 months (22.8±4.0 and 22.3±4.3 months, respectively) of follow-up. Methods: QoL of 108 participants who chose AS, 101 who underwent OP, twelve who changed from AS to OP was evaluated using a thyroid-specific QoL questionnaire at diagnosis and during follow-up (median 23 months). Results: The mean ages of the participants in the AS and OP groups were 47.7±11.0 and 45.1±10.0 years (p=0.075), respectively. At baseline, better physical (8.2±1.4 vs. 7.6±1.8, p=0.032), psychological (7.4±1.2 vs. 6.7±1.6, p=0.010), and total health (7.4±1.0 vs. 6.7±1.3, p=0.005) were observed in the AS group than in the OP group. After a mean follow up of 22.7±4.2 months, better physical (8.1±1.5 vs. 7.4±1.7, p=0.008), psychological (7.7±1.3 vs. 7.0±1.5, p=0.002), and total health (7.5±1.2 vs. 6.8±1.3, p=0.001) were observed in the AS group than in the OP group, whereas spiritual health was comparable between the two groups: compared with the AS group, the OP group experienced more alterations in appetite, sleep, menstrual cycle, voice, motor skill, weight, appearance, cold or heat tolerance, and body swelling. Furthermore, better QOL scores were observed in the AS group in self-concept, personal relationships, sexual life, work motivation, productivity and quality of work, feeling of isolation, driving, doing household chores, preparing meals and doing leisure activities after long term follow up. Conclusion: Patients who underwent AS had better QOL even after long term follow up. Low risk papillary thyroid microcarcinomas do not influence survival, however surgery related deterioration of QOL lasted long and did not improve even in late post-operative stages when patients were fully recovered from surgery. Keywords: Quality of life; papillary thyroid microcarcinoma; active surveillance; immediate surgery

Effect of Initial Treatment Choice on 2-year Quality of Life in Patients with Low-risk Papillary Thyroid Microcarcinoma

2020 ◽  
Author(s):  
Jae Hoon Moon ◽  
Chang Hwan Ryu ◽  
Sun Wook Cho ◽  
June Young Choi ◽  
Eun-Jae Chung ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Disease Progression ◽  
Active Surveillance ◽  
Initial Treatment ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Immediate Surgery

Abstract Context The long-term quality of life (QoL) in patients with low-risk papillary thyroid microcarcinoma (PTMC) underwent active surveillance (AS) and immediate surgery is unclear. Objective The aim of this study was to investigate the effect of initial treatment choice on 2-year QoL in patients with low-risk PTMC Design, Setting, and Participants We analyzed 2652 QoL surveys from 1055 subjects enrolled in ongoing multicenter prospective cohort study on active surveillance of PTMC, in which the median follow-up duration was 24.4 months. Major Outcome Measure We evaluated QoL of patients with low-risk PTMC according to their treatment modality using generalized estimating equation. Results Six hundred and seventy-four subjects (male = 161; mean age = 48.8 ± 11.9 years) with low-risk PTMC chose AS while 381 subjects (male = 75; mean age = 45.7 ± 10.4 years) chose immediate surgery, including lobectomy/isthmusectomy (L/I) and total thyroidectomy (TT). Among the 817 subjects who completed baseline QoL surveys, 2-year QoL was good in order of AS (n = 500), L/I (n = 238), and TT (n = 79) groups after adjustment for age, sex, baseline tumor size, and baseline QoL scores. Among the 101 subjects who changed their treatment from AS to surgery during the follow-up period, 35 subjects who changed treatment due to disease progression had better QoL than 66 subjects who had no disease progression. Conclusions This study identified QoL as a major issue in choosing an initial treatment of low-risk PTMC and highlighted the possibility of using AS as the primary treatment.

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.

Active Surveillance as First-Line Management of Papillary Microcarcinoma

2019 ◽  
Vol 70 (1) ◽  
pp. 369-379 ◽  
Author(s):  
Yasuhiro Ito ◽  
Akira Miyauchi
Keyword(s):  
Thyroid Carcinoma ◽  
Active Surveillance ◽  
Distant Metastasis ◽  
Clinical Evidence ◽  
The United States ◽  
Papillary Thyroid ◽  
Extrathyroid Extension ◽  
First Line ◽  
Thyroid Microcarcinoma ◽  
Immediate Surgery

Papillary thyroid microcarcinoma (PMC) is defined as papillary thyroid carcinoma ≤10 mm. Active surveillance of PMC without high-risk features, such as clinical node metastasis, distant metastasis, and clinical evidence of significant extrathyroid extension, was initiated in two Japanese hospitals in the mid-1990s. This strategy was incorporated into guidelines in Japan in 2010 and in the United States in 2015. In studies conducted by the two hospitals, most PMCs grew very slowly or did not grow, and none of the patients during active surveillance showed distant metastasis or died of thyroid carcinoma. Furthermore, none of the patients who underwent surgery after progression signs were detected showed significant recurrence. Therefore, we conclude that active surveillance should be the first line in management of low-risk PMC, because it is safer and less costly than immediate surgery. Active surveillance helps in avoiding adverse events of surgery and is an economical strategy.

scholarly journals Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance?

2016 ◽  
Vol 4 (11) ◽  
pp. 933-942 ◽  
Author(s):  
Sophie Leboulleux ◽  
R Michael Tuttle ◽  
Furio Pacini ◽  
Martin Schlumberger
Keyword(s):  
Active Surveillance ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma
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