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Roh YH, Chung SR, Yang SJ, Baek JH, Choi YJ, Sung TY, Song DE, Kim TY, Lee JH. Enhancement on CT for preoperative diagnosis of metastatic lymph nodes in thyroid cancer: a comparison across experience levels. Eur Radiol 2024:10.1007/s00330-024-10919-w. [PMID: 38980412 DOI: 10.1007/s00330-024-10919-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/17/2024] [Accepted: 05/25/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To investigate the diagnostic performance and interobserver agreement of quantitative CT parameters indicating strong lymph node (LN) enhancement in differentiated thyroid cancer (DTC), comparing them with qualitative analysis by radiologists of varying experience. MATERIALS AND METHODS This study included 463 LNs from 399 patients with DTC. Three radiologists independently analyzed strong LN enhancement on CT. Qualitative analysis of strong enhancement was defined as LN cortex showing greater enhancement than adjacent muscles on the arterial phase. Quantitative analysis included the mean attenuation value (MAV) of LN on arterial phase (LNA) and venous phase (LNV), LNA normalized to the common carotid artery (NAVCCA), internal jugular vein (NAVIJV), and sternocleidomastoid muscle (NAVSCM), attenuation difference [AD; (LNA - MAVSCM)], and relative washout ratio [((LNA - LNV)/LNA) × 100]. The interobserver agreement and diagnostic performance of the quantitative and qualitative analyses were evaluated. RESULTS Interobserver agreement was excellent for all quantitative CT parameters (ICC, 0.83-0.94) and substantial for qualitative assessment (κ = 0.61). All CT parameters except for LNV showed good diagnostic performance for metastatic LNs (AUC, 0.81-0.85). NAVCCA (0.85, 95% CI: 0.8-0.9) and AD (0.85, 95% CI: 0.81-0.89) had the highest AUCs. All quantitative parameters except for NAVIJV had significantly higher AUCs than qualitative assessments by inexperienced radiologists, with no significant difference from assessments by an experienced radiologist. CONCLUSION Quantitative assessment of LN enhancement on arterial phase CT showed higher interobserver agreement and AUC values than qualitative analysis by inexperienced radiologists, supporting the need for a standardized quantitative CT parameter-based model for determining strong LN enhancement. CLINICAL RELEVANCE STATEMENT When assessing strong LN enhancement in DTC, quantitative CT parameters indicating strong enhancement can improve interobserver agreement, regardless of experience level. Therefore, the development of a standardized diagnostic model based on quantitative CT parameters might be necessary. KEY POINTS Accurate preoperative assessment of LN metastasis in thyroid cancer is crucial. Quantitative CT parameters indicating strong LN enhancement demonstrated excellent interobserver agreement and good diagnostic performance. Quantitative assessment of contrast enhancement offers a more objective model for the identification of metastatic LNs.
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Affiliation(s)
- Yun Hwa Roh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Su Jeong Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Yon Sung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Yoon JH, Choi W, Park JY, Hong AR, Kim HK, Kang HC. Active Surveillance for Low-Risk Papillary Thyroid Carcinoma as an Acceptable Management Option with Additional Benefits: A Comprehensive Systematic Review. Endocrinol Metab (Seoul) 2024; 39:152-163. [PMID: 38417830 PMCID: PMC10901657 DOI: 10.3803/enm.2023.1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/17/2023] [Accepted: 11/23/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGRUOUND Active surveillance (AS) has been introduced as a management strategy for low-risk papillary thyroid carcinoma (PTC) due to its typically indolent nature. Despite this, the widespread adoption of AS has encountered several challenges. The aim of this systematic review was to evaluate the safety of AS related to disease progression and its benefits compared with immediate surgery (IS). METHODS Studies related to AS in patients with low-risk PTC were searched through the Ovid MEDLINE, Embase, Cochrane Library, and KoreaMed databases. Studies on disease progression, surgical complication, quality of life (QoL), and cost-effectiveness were separately analyzed and narratively synthesized. RESULTS In the evaluation of disease progression, the proportions of cases with tumor growth ≥3 mm and a volume increase >50% were 2.2%-10.8% and 16.0%-25.5%, respectively. Newly detected lymph node metastasis was identified in 0.0%-1.4% of patients. No significant difference was found between IS and delayed surgery in surgical complications, including vocal cord paralysis and postoperative hypoparathyroidism. AS was associated with better QoL than IS. Studies on the cost-effectiveness of AS reported inconsistent data, but AS was more cost-effective when quality-adjusted life years were considered. CONCLUSION AS is an acceptable management option for patients with low-risk PTC based on the low rate of disease progression and the absence of an increased mortality risk. AS has additional benefits, including improved QoL and greater QoL-based cost-effectiveness.
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Affiliation(s)
- Jee Hee Yoon
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Wonsuk Choi
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ji Yong Park
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - A Ram Hong
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Hwang H, Choi JY, Yu HW, Moon JH, Kim JH, Lee EK, Kim YK, Lee CY, Cho SW, Chung EJ, Ryu CH, Ryu J, Yi KH, Park DJ, Lee KE, Park YJ, Kim SJ, Jung YS. Surgical Outcomes in Patients With Low-risk Papillary Thyroid Microcarcinoma From MAeSTro Study: Immediate Operation Versus Delayed Operation After Active SurveillanceA Multicenter Prospective Cohort Study. Ann Surg 2023; 278:e1087-e1095. [PMID: 36912439 DOI: 10.1097/sla.0000000000005841] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To investigate surgical, and clinical outcomes in patients with low-risk papillary thyroid microcarcinoma (PTMC) according to treatment options [immediate operation (IOP) vs delayed operation after active surveillance (AS) (DOP)]. BACKGROUND AS has been adopted as an alternative to immediate surgery in patients with low-risk PTMC. Although some patients undergo surgery during AS, there is little information on surgical, and clinical outcomes after delayed operation after AS. METHODS A multicenter prospective cohort study including 1177 patients was conducted at 3 tertiary hospitals in Korea from June 2016 to January 2020. Patients with low-risk PTMC were enrolled. The participants were self-assigned into AS or IOP, and during AS, the patients underwent surgery if there were signs of disease progression or if the patient's choice changed. RESULTS A total of 516 patients underwent operation; 384 (74.4%) in the IOP group and 132 (25.6%) in the DOP group. Compared with the IOP group, the DOP group was significantly associated with a larger tumor size ( P =0.002), higher rates of lymphatic invasion ( P =0.002), and multifocality ( P =0.008). However, the rates of total thyroidectomy, postoperative hypoparathyroidism and vocal cord palsy did not differ significantly between the groups ( P = 0.283, P =0.184, and P =0.284, respectively). Of the 132 patients in the DOP group, disease progression was present in 39 (29.5%) patients. The DOP group with disease progression had a significantly higher rate of lymph node metastasis ( P =0.021) and radioiodine therapy ( P =0.025) than the DOP group without disease progression. CONCLUSIONS These results suggest that AS might be considered an alternative treatment option for patients with low-risk PTMC regarding the extent of thyroidectomy and postoperative complications in the DOP group. To assess oncologic outcomes, long-term follow-up will be needed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02938702.
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Affiliation(s)
- Hyeonuk Hwang
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Chang Yoon Lee
- Department of Radiology, National Cancer Center, Goyang, Republic of Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology, National Cancer Center, Goyang, Republic of Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology, National Cancer Center, Goyang, Republic of Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, National Cancer Center, Goyang, Republic of Korea
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Issa PP, Munshi R, Albuck AL, Omar M, Abu Alhuda RF, Metz T, Hussein M, Shama M, Lee GS, Toraih E, Kandil E. Recommend with caution: A meta-analysis investigating papillary thyroid carcinoma tumor progression under active surveillance. Am J Otolaryngol 2023; 44:103994. [PMID: 37607459 DOI: 10.1016/j.amjoto.2023.103994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/08/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is an indolent disease with favorable outcomes. The non-surgical treatment approach known as active surveillance (AS) has been introduced as an alternative treatment instead of the traditional thyroidectomy. However, 10-15 % of PTC tend to progress. We sought to determine factors predicting the progression of PTC under AS. METHODS A systematic search was performed in January 2022 using PubMed, Embase, Google Scholar, Web of Science, and ScienceDirect. PRISMA guidelines were used by multiple reviewers to extract study characteristics (author name, publication date, journal name, country, institution, and study design), as well as main outcomes and measures. A combination of utilization of thyroid replacement therapy, baseline tumor size and volume, follow-up tumor size and volume, and the presence of lymph node metastasis and its distribution, as well as surveillance duration, were the main measures of this study. RESULTS Nine studies with 4166 patients were included, of which 354 showed tumor progression during AS (15 %; 95%CI = 7 % - 23 %). The average follow-up period was 41.58 months. The mean tumor maximum diameter was 8.54 mm (95%CI = 7.04-10.03). Tumor progression was most commonly secondary to an increase in volume by ≥50 % (75 %; 95%CI = 68 % - 80 %), then increase in diameter by ≥3 mm (41 %; 95%CI = 13 % - 76 %), and finally the development of lymph node metastasis (13 %; 95%CI = 9 % - 19 %). Approximately only 2 % of all patients thus developed new lymph node metastasis. Patient age, sex, and tumor size were not associated with higher risks of tumor progression. 12 % of AS patients eventually underwent surgery, though only 40 % (95%CI = 27 % - 53 %) of these patients displayed tumor progression. CONCLUSIONS Our meta-analysis determined a tumor progression rate of 15 % in patients who underwent AS management, 13 % of which (2 % of all patients) developed lymph node metastasis. We found no protective or risk factors for tumor progression, and that almost half of all patients who underwent delayed surgery did so for reasons other than tumor progression. While not biopsying small (<1 cm) or very low suspicious nodules is already recommended, AS may be an appropriate treatment option in patients appropriately counseled, considering the low risk of advanced tumor progression but also the considerable patient population who fail to adhere to treatment. Alternatively, in aim of preventing overtreatment in patients who would rather take proactive measures against their low-risk carcinoma, minimally-invasive ablation techniques may be an attractive option.
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Affiliation(s)
- Peter P Issa
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America; School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Ruhul Munshi
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Aaron L Albuck
- School of Medicine, Tulane University, New Orleans, LA, United States of America
| | - Mahmoud Omar
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Ruba F Abu Alhuda
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Tyler Metz
- School of Medicine, Tulane University, New Orleans, LA, United States of America
| | - Mohammad Hussein
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Mohamed Shama
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Grace S Lee
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Eman Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America; Genetics Unit, Department of Histology and Cell Biology, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America.
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5
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Kazusaka H, Sugitani I, Toda K, Sen M, Saito M, Nagaoka R, Yoshida Y. Patient-Reported Outcomes in Patients with Low-Risk Papillary Thyroid Carcinoma: Cross-Sectional Study to Compare Active Surveillance and Immediate Surgery. World J Surg 2023; 47:1190-1198. [PMID: 36282283 DOI: 10.1007/s00268-022-06786-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND This cross-sectional study compared patient-reported outcomes of low-risk papillary thyroid carcinoma (PTC, T1N0M0) between patients who underwent active surveillance (AS) and those who received immediate surgery, METHODS: Using the State-Trait Anxiety Inventory, Short-Form 36 version 2, and a visual analog scale for neck symptoms, 249 patients under AS and 32 patients underwent immediate surgery were compared. To match the difference in time from the onset of treatment to the survey, we conducted propensity score matching. We also investigated factors affecting anxiety in patients under AS in multiple linear regression analysis. RESULTS In the entire group, patients under AS had significantly longer time from the onset to the survey than patients underwent immediate surgery (7.9 vs. 4.0 years). After matching, AS group showed significantly better trait anxiety and mental component summary (MCS) compared to surgery group, while surgery group showed better role-social component summary. AS group also had significantly better MCS than the Japanese norm-based score. Surgery group displayed worse neck symptoms than AS group. Among AS group, trait anxiety and time from the onset were significant predictors of state anxiety. Compared with the group with < 5 years since starting AS, the group with ≥ 5 years of follow-up showed a significantly better state anxiety only in patients with better trait anxiety. CONCLUSIONS Low-risk PTC patients under AS showed better trait anxiety and mental health than surgery group. After a certain period, the anxiety of patients under AS seems to be improved, especially in patients with better trait anxiety.
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Affiliation(s)
- Hiroko Kazusaka
- Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
- Division of Head and Neck, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kazuhisa Toda
- Division of Head and Neck, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masaomi Sen
- Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Marie Saito
- Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Ryuta Nagaoka
- Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yusaku Yoshida
- Department of Endocrine Surgery, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Scherer HC, Fernandes PM, Scheffel RS, Zanella AB, Maia AL, Dora JM. Papillary Thyroid Microcarcinoma: Insights from a Cohort of 257 Thyroidectomized Patients. Horm Metab Res 2023; 55:161-168. [PMID: 36796412 DOI: 10.1055/a-2008-0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Papillary thyroid microcarcinoma management evolved, and less aggressive strategies are now considered. Questions, however, remain on these tumors' behavior, particularly on developing countries' real ground healthcare scenarios. Our aim is to gather insights on the natural history of papillary thyroid microcarcinoma on patients treated with thyroidectomy in Brazil. Consecutive patients diagnosed with papillary thyroid microcarcinoma had their clinical characteristics, interventions, and outcomes described. Patients were classified as incidental or nonincidental based on the diagnosis after or before surgery, respectively. A sum of 257 patients were included, 84.0% of which were women, and the mean age was of 48.3±13.5 years. The mean tumor size was of 0.68±0.26 cm, 30.4% were multifocal, 24.5% had cervical metastasis, and 0.4% distant metastasis. The nonincidental and incidental tumors differed in tumor size (0.72±0.24 and 0.60±0.28 cm, respectively, p=0.003) and in presence of cervical metastasis (31.3% and 11.9%, respectively, p<0.001). Male sex, nonincidental diagnosis, and younger age were independent predictors of cervical metastasis. After 5.5 years (P25-75 2.5-9.7) of follow-up, only 3.8% of patients had persistent structural disease (3.4% cervical). Predictors of persistent disease at multivariate analysis included cervical metastasis and multicentricity. In conclusion, incidental and nonincidental papillary thyroid microcarcinoma patients of the population studied displayed excellent outcomes. Cervical metastasis and multicentricity were frequent findings and prognostic factors for persistent disease.
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Affiliation(s)
| | | | - Rafael Selbach Scheffel
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Borsatto Zanella
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Endocrinology, Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jose Miguel Dora
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Sasaki T, Miyauchi A, Fujishima M, Ito Y, Kudo T, Noda T, Sano T, Kishi T, Nakamura T. Comparison of Postoperative Unfavorable Events in Patients with Low-Risk Papillary Thyroid Carcinoma: Immediate Surgery Versus Conversion Surgery Following Active Surveillance. Thyroid 2023; 33:186-191. [PMID: 36205580 PMCID: PMC9986002 DOI: 10.1089/thy.2022.0444] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Active surveillance (AS) for low-risk papillary thyroid microcarcinoma (PTMC) was initiated at Kuma Hospital in 1993 and has gradually spread worldwide. We previously demonstrated that AS is associated with a much lower incidence of unfavorable events than immediate surgery (IS). However, conversion surgery (CS) raises concerns about increased surgical complications due to advanced disease. In this study, we conducted a comparative analysis of unfavorable events after IS and CS. Methods: Between 2005 and 2019, 4635 patients clinically diagnosed with low-risk PTMC at Kuma Hospital were enrolled. Of these, 2896 underwent AS (AS group), and the remaining 1739 underwent IS (IS group). To date, 242 patients (0.8%) in the AS group have undergone CS for various reasons (CS group). Results: The incidence of unfavorable events, such as levothyroxine administration after surgery, postoperative hematoma, transient/persistent hypoparathyroidism, and transient/persistent vocal cord paralysis, did not differ between the CS and IS groups. None of the patients in the CS group had permanent vocal cord paralysis; however, this occurred in 15 patients (0.9%) in the IS group and was caused by accidental injury in 4 patients and carcinoma invasion in 11 patients. The incidence of surgery, levothyroxine administration, postoperative hematoma, transient/permanent hypoparathyroidism, and vocal cord paralysis was significantly higher (p < 0.001) in the IS group than in the AS group. There were no differences in the incidence of lymph node recurrence and overall mortality between the AS and IS groups. None of the patients in the AS and IS groups showed distant metastasis or died from thyroid carcinoma. Conclusions: There were no differences in the incidence of unfavorable events between the CS group and the IS group. Although none of the CS and AS groups had permanent vocal cord paralysis, accidental injury of the recurrent laryngeal nerve occurred in four patients (0.2%) in the IS group. The IS group had a significantly higher incidence of unfavorable events than the AS group. The prognoses of patients in both the AS and IS groups were excellent. Therefore, we recommend AS as the first-line management for low-risk PTMC.
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Affiliation(s)
- Takahiro Sasaki
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
- Address correspondence to: Takahiro Sasaki, MD, Department of Head and Neck Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dori, Kobe 650-0011, Japan
| | | | | | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | - Takumi Kudo
- Department of Internal Medicine, Kuma Hospital, Kobe, Japan
| | - Takuya Noda
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
| | - Tsutomu Sano
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
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Sun Y, Sun W, Xiang J, Zhang H. Nomogram for predicting central lymph node metastasis in T1-T2 papillary thyroid cancer with no lateral lymph node metastasis. Front Endocrinol (Lausanne) 2023; 14:1112506. [PMID: 36817601 PMCID: PMC9930606 DOI: 10.3389/fendo.2023.1112506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Whether routine central lymph node dissection (CLND) is necessary for T1-T2 papillary thyroid carcinoma (PTC) patients without certain lateral lymph node metastases (LLNM) remains controversial. This study aims to construct a nomogram that predicts central lymph node metastasis (CLNM) for T1-T2 PTC patients without LLNM. METHODS We retrospectively reviewed adult T1-T2 PTC patients with no LLNM retrieved from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. We also collected data from patients treated at the First Hospital of China Medical University between February and April 2021 for external validation. Logistic regression model was used to construct a risk prediction model nomogram. The receiver-operating characteristic (ROC) curve, calibration plot, and decision curve analyses (DCA) were used for assessing the nomogram. RESULTS 5,094 patients from the SEER database and 300 patients from our department were finally included in this study. Variables such as age, gender, race, tumor size, multifocality, and minimal extrathyroidal extension (mETE) were found to be associated with CLNM and were subsequently incorporated into our nomogram. The C-index of our constructed model was 0.704, while the internal and external validation C-indexes were 0.693 and 0.745, respectively. The nomogram was then evaluated using calibration and decision curve analyses. CONCLUSION A visualized nomogram was successfully developed to predict CLNM in T1-T2 PTC patients without LLNM and assist clinicians in making personalized clinical decisions.
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Leboulleux S, Lamartina L, Lecornet Sokol E, Menegaux F, Leenhardt L, Russ G. SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules : Follow-up: How and how long? ANNALES D'ENDOCRINOLOGIE 2022; 83:407-414. [PMID: 36283461 DOI: 10.1016/j.ando.2022.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid, with benign non-progressive nodules that do not warrant specific treatment. The clinician's objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians, surgeons, and other specialists. Therefore, this consensus statement was established jointly by 3 societies: the French Society of Endocrinology (SFE), French Association of Endocrine Surgery (AFCE) and French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). This section deals with the follow-up of thyroid nodules, low-grade tumors and microcarcinomas.
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Affiliation(s)
- Sophie Leboulleux
- Service d'Endocrinologie, Hôpitaux Universitaires de Genève, 4 Rue Gabrielle Perret-Gentil, 1205 Genève, Switzerland.
| | - Livia Lamartina
- Endocrine Oncology, Gustave Roussy and University Paris Saclay, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | | | - Fabrice Menegaux
- Endocrine Surgery Department, Pitié-Salpêtrière Hospital APHP, Institute of Cancer IUC, Sorbonne University GRC N°16, 83 Boulevard de l'Hôpital, 75013 Paris, France; Centre de Pathologie et d'Imagerie, 14 Avenue René Coty, 75014 Paris, France
| | - Laurence Leenhardt
- Thyroid and Endocrine Tumors Department, Pitié Salpêtrière Hospital, APHP, Institute of Cancer IUC, Sorbonne University, 83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Gilles Russ
- Centre de Pathologie et d'Imagerie, 14 Avenue René Coty, 75014 Paris, France; Thyroid and Endocrine Tumors Department, Pitié-Salpêtrière Hospital APHP, Institute of Cancer IUC, Sorbonne University GRC N°16, 83 Boulevard de l'Hôpital, 75013 Paris, France
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10
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Chou R, Dana T, Haymart M, Leung AM, Tufano RP, Sosa JA, Ringel MD. Active Surveillance Versus Thyroid Surgery for Differentiated Thyroid Cancer: A Systematic Review. Thyroid 2022; 32:351-367. [PMID: 35081743 PMCID: PMC11265616 DOI: 10.1089/thy.2021.0539] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Active surveillance has been proposed as an appropriate management strategy for low-risk differentiated thyroid cancer (DTC), due to the typically favorable prognosis of this condition. This systematic review examines the benefits and harms of active surveillance vs. immediate surgery for DTC, to inform the updated American Thyroid Association guidelines. Methods: A search on Ovid MEDLINE, Embase, and Cochrane Central was conducted in July 2021 for studies on active surveillance vs. immediate surgery. Studies of surgery vs. no surgery for DTC were assessed separately to evaluate relevance to active surveillance. Quality assessment was performed, and evidence was synthesized narratively. Results: Seven studies (five cohort studies [N = 5432] and two cross-sectional studies [N = 538]) of active surveillance vs. immediate surgery, and seven uncontrolled treatment series of active surveillance (N = 1219) were included. One cross-sectional study was rated fair quality, and the remainder were rated poor quality. In patients with low risk (primarily papillary), small (primarily ≤1 cm) DTC, active surveillance, and immediate surgery were associated with similar, low risk of all-cause or cancer-specific mortality, distant metastasis, and recurrence after surgery. Uncontrolled treatment series reported no cases of mortality in low-risk DTC managed with active surveillance. Among patients managed with active surveillance, rates of tumor growth were low; rates of subsequent surgery varied and primarily occurred due to patient preference rather than tumor progression. Four cohort studies (N = 88,654) found that surgery associated with improved all-cause or thyroid cancer mortality compared with nonsurgical management, but findings were potentially influenced by patient age and tumor risk category and highly susceptible to confounding by indication; eligibility for, and receipt of, active surveillance; and timing of surgery was unclear. Conclusions: In patients with small low-risk (primarily papillary) DTC, active surveillance and immediate surgery may be associated with similar mortality, risk of recurrence, and other outcomes, but methodological limitations preclude strong conclusions. Studies of no surgery vs. surgery are difficult to interpret due to clinical heterogeneity and potential confounding factors and are unsuitable for assessing the utility of active surveillance. Research is needed to clarify the benefits and harms of active surveillance and determine outcomes in nonpapillary DTC, larger (>1 cm) cancers, and older patients.
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Affiliation(s)
- Roger Chou
- The Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Tracy Dana
- The Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Megan Haymart
- Division of Metabolism, Endocrinology, and Diabetes and Hematology/Oncology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Angela M. Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ralph P. Tufano
- Division of Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, USA
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Matthew D. Ringel
- Divison of Endocrinology, Diabetes, and Metabolism and Cancer Biology Program, The Ohio State University College of Medicine and Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
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11
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Schumm MA, Shu ML, Kim J, Tseng CH, Zanocco K, Livhits MJ, Leung AM, Yeh MW, Sacks GD, Wu JX. Perception of risk and treatment decisions in the management of differentiated thyroid cancer. J Surg Oncol 2022; 126:247-256. [PMID: 35316538 DOI: 10.1002/jso.26858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES The recent de-escalation of care for differentiated thyroid cancer (DTC) has broadened the range of initial treatment options. We examined the association between physicians' perception of risk and their management of DTC. METHODS Thyroid specialists were surveyed with four clinical vignettes: (1) indeterminate nodule (2) tall cell variant papillary thyroid cancer (PTC), (3) papillary thyroid microcarcinoma (mPTC), and (4) classic PTC. Participants judged the operative risks and likelihood of structural cancer recurrence associated with more versus less aggressive treatments. A logistic mixed effect model was used to predict treatment choice. RESULTS Among 183 respondents (13.4% response rate), 44% were surgical and 56% medical thyroid specialists. Risk estimates and treatment recommendation varied markedly in each case. Respondents' estimated risk of 10-year cancer recurrence after lobectomy for a 2.0-cm PTC ranged from 1% to 53% (interquartile range [IQR]: 3%-12%), with 66% recommending lobectomy and 34% total thyroidectomy. Respondents' estimated 5-year risk of metastastic disease during active surveillance of an 0.8-cm mPTC ranged from 0% to 95% (IQR: 4%-15%), with 36% choosing active surveillance. Overall, differences in perceived risk reduction explained 10.3% of the observed variance in decision-making. CONCLUSIONS Most of the variation in thyroid cancer treatment aggressiveness is unrelated to perceived risk of cancer recurrence.
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Affiliation(s)
- Max A Schumm
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Michelle L Shu
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Jiyoon Kim
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Kyle Zanocco
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Masha J Livhits
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA.,Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Greg D Sacks
- Department of Surgery, New York University Langone Health, New York, New York, USA
| | - James X Wu
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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12
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Jin M, Kim HI, Ha J, Jeon MJ, Kim WG, Lim DJ, Kim TY, Chung JH, Shong YK, Kim TH, Kim WB. Tumor Volume Doubling Time in Active Surveillance of Papillary Thyroid Microcarcinoma: A Multicenter Cohort Study in Korea. Thyroid 2021; 31:1494-1501. [PMID: 34225475 DOI: 10.1089/thy.2021.0094] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Some papillary thyroid microcarcinomas (PTMCs) may progress with tumor enlargement or development of new lymph node (LN) metastasis during active surveillance (AS). This study evaluated the relevant predictors of disease progression, especially new cervical LN metastasis. Methods: This was a long-term follow-up study conducted using a previous multicenter cohort of AS in Korea. After excluding 54 (14.2%) patients with a short follow-up duration, 326 PTMC patients were evaluated for tumor kinetics, including changes in tumor volume (TV) and TV doubling time (TVDT). Results: During a median follow-up duration of 4.9 years, 17 (5.2%, 95% confidence intervals [CI] 2.7-7.6%) patients showed a maximal diameter increase of ≥3 mm after a median of 4.0 years follow-up, while 9 (2.8%, CI 1.0-4.5%) developed new LN metastasis after a median of 2.2 years follow-up. New cervical LN metastasis occurred exclusively of a maximal diameter increase of ≥3 mm. The prevalence of new development of LN metastasis was higher in patients with TVDT <5 years (7.4%) than in those with TV ≥50% (3.2%). Furthermore, only TVDT <5 years was significantly associated with LN metastasis (p = 0.002). In univariate and multivariate analyses, TVDT <5 years was an independent risk factor for disease progression with respect to new development of LN metastasis (hazard ratio [HR] = 6.51, CI 1.73-24.50; p = 0.002) and tumor enlargement (HR = 20.89, CI 5.78-75.48; p < 0.001). Finally, 86 (22.6%) patients underwent delayed surgery, and the most common reason was patient anxiety. Conclusions: TVDT <5 years is a predictor of disease progression during AS in terms of new LN metastasis development as well as tumor enlargement. Determination of TVDT in the early phase of AS could help in predicting disease progression, tailoring follow-up intensity of AS and in determining if early surgical intervention is needed.
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Affiliation(s)
- Meihua Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye In Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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13
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Feng Y, Min Y, Chen H, Xiang K, Wang X, Yin G. Construction and validation of a nomogram for predicting cervical lymph node metastasis in classic papillary thyroid carcinoma. J Endocrinol Invest 2021; 44:2203-2211. [PMID: 33586026 DOI: 10.1007/s40618-021-01524-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/29/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Patients with papillary thyroid carcinoma (PTC) frequently present a relatively poor prognosis when they coexist with cervical lymph node metastasis (LNM). Moreover, it remains controversial whether prophylactic lymph node dissection (LND) should be performed for patients without clinically lymph node metastasis. Thus, we hereby develop a nomogram for predicting the cervical LNM (including central and lateral LNM) in patients with PTC. METHODS We retrospectively reviewed the clinical characteristics of adult patients with PTC in the surveillance, epidemiology, and end results (SEER) database between 2010 and 2015 and in our Department of Breast and Thyroid Surgery in the Second Affiliated Hospital of Chongqing Medical University between 2019 and 2020. RESULT A total of 21,972 patients in the SEER database and 747 patients in our department who met the inclusion criteria were enrolled in this study. Ultimately, six clinical features including age, gender, race, extrathyroidal invasion, multifocality, and tumor size were identified to be associated with cervical LNM in patients with PTC, which were screened to develop a nomogram. This model had satisfied discrimination with a concordance index (C-index) of 0.733, supported by both internal and external validation with a C-index of 0.731 and 0.716, respectively. A decision curve analysis was subsequently made to evaluate the feasibility of this nomogram for predicting cervical LNM. Besides, a positive correlation between nomogram score and the average number of lymph node metastases was observed in all groups. CONCLUSION This visualized multipopulational-based nomogram model was successfully established. We determined that various clinical characteristics were significantly associated with cervical LNM, which would be better helping clinicians make individualized clinical decisions for PTC patients.
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Affiliation(s)
- Y Feng
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Rd, Yuzhong Dist, Chongqing, 404100, People's Republic of China
| | - Y Min
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Rd, Yuzhong Dist, Chongqing, 404100, People's Republic of China
| | - H Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Rd, Yuzhong Dist, Chongqing, 404100, People's Republic of China
| | - K Xiang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Rd, Yuzhong Dist, Chongqing, 404100, People's Republic of China
| | - X Wang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Rd, Yuzhong Dist, Chongqing, 404100, People's Republic of China
| | - G Yin
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Rd, Yuzhong Dist, Chongqing, 404100, People's Republic of China.
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14
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Ghai S, O'Brien C, Goldstein DP, Sawka AM. Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance. Insights Imaging 2021; 12:130. [PMID: 34529219 PMCID: PMC8446145 DOI: 10.1186/s13244-021-01072-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/07/2021] [Indexed: 01/25/2023] Open
Abstract
Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly studied in prospective observational studies. Ultrasound is the primary imaging modality for case selection. While researchers have put forward selection criteria for PTCs based on size, absence of suspicious lymph nodes and tumor location, there are limited reported data highlighting inherent ultrasound limitations and guidelines for case selection and follow-up. We report our experience including imaging limitations encountered in the ongoing AS prospective observational study for PTCs measuring < 2 cm at our institute. We define disease progression as an increase in size of > 3 mm in the largest dimension of nodule or evidence of metastatic disease or extrathyroidal extension. Accurate, consistent and reproducible measurements of PTCs are essential in risk stratifying patients for the option of AS or disease progression. Interobserver discrepancy, shadowing from coarse calcification and background parenchyma heterogeneity or thyroiditis can limit accurate PTC size assessment and therefore hinder patient eligibility evaluation or AS follow-up. Following the ACR Thyroid Imaging, Reporting and Data System (TI-RADS) protocol of three-axes technique to measure a thyroid nodule enables reproducibility of measurements. In patients with multi-nodular goiter, accurate identification and labeling of the PTC is important to avoid mistaking with adjacent benign nodules at follow-up. Ultrasound assessment for extrathyroid extension of PTC, and relationship of PTC to trachea and the anatomic course of the recurrent laryngeal nerve are important considerations in evaluation for AS eligibility.
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Affiliation(s)
- Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada. .,1PMB-283, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
| | - Ciara O'Brien
- Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Princess Margaret Cancer Centre, Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
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15
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Jeon MJ, Kang YE, Moon JH, Lim DJ, Lee CY, Lee YS, Kim SW, Kim MH, Kim BH, Kang HC, Shong M, Cho SW, Kim WB. Protocol for a Korean Multicenter Prospective Cohort Study of Active Surveillance or Surgery (KoMPASS) in Papillary Thyroid Microcarcinoma. Endocrinol Metab (Seoul) 2021; 36:359-364. [PMID: 33752303 PMCID: PMC8090471 DOI: 10.3803/enm.2020.890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A Korean Multicenter Prospective cohort study of Active Surveillance or Surgery (KoMPASS) for papillary thyroid microcarcinomas (PTMCs) has been initiated. The aim is to compare clinical outcomes between active surveillance (AS) and an immediate lobectomy for low-risk PTMCs. We here outline the detailed protocol for this study. METHODS Adult patients with a cytopathologically confirmed PTMC sized 6.0 to 10.0 mm by ultrasound (US) will be included. Patients will be excluded if they have a suspicious extra-thyroidal extension or metastasis of a PTMC or multiple thyroid nodules or other thyroid diseases which require a total thyroidectomy. Printed material describing the prognosis of PTMCs, and the pros and cons of each management option, will be provided to eligible patients to select their preferred intervention. For the AS group, thyroid US, thyroid function, and quality of life (QoL) parameters will be monitored every 6 months during the first year, and then annually thereafter. Disease progression will be defined as a ≥3 mm increase in maximal diameter of a PTMC, or the development of new thyroid cancers or metastases. If progression is detected, patients should undergo appropriate surgery. For the lobectomy group, a lobectomy with prophylactic central neck dissection will be done within 6 months. After initial surgery, thyroid US, thyroid function, serum thyroglobulin (Tg), anti-Tg antibody, and QoL parameters will be monitored every 6 months during the first year and annually thereafter. Disease progression will be defined in these cases as the development of new thyroid cancers or metastases. CONCLUSION KoMPASS findings will help to confirm the role of AS, and develop individualized management strategies, for low-risk PTMCs.
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Affiliation(s)
- Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Yea Eun Kang
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon,
Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Dong Jun Lim
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Chang Yoon Lee
- Department of Radiology, National Cancer Center, Goyang,
Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul,
Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Min-Hee Kim
- Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan,
Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun,
Korea
| | - Minho Shong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon,
Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
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