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Zhong F, Wu L, Liu Z, Li W, Zhao S. Nomogram model for the diagnosis of solitary nodular pulmonary mucinous adenocarcinoma. Sci Rep 2024; 14:18085. [PMID: 39103468 PMCID: PMC11300590 DOI: 10.1038/s41598-024-69138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/31/2024] [Indexed: 08/07/2024] Open
Abstract
The objective of this study was to develop a nomogram model based on the natural progression of tumor and other radiological features to discriminate between solitary nodular pulmonary mucinous adenocarcinoma and non-mucinous adenocarcinomas. A retrospective analysis was conducted on 15,655 cases of lung adenocarcinoma diagnosed at our institution between January 2010 and June 2023. Primary nodular invasive mucinous adenocarcinomas and non-mucinous adenocarcinomas with at least two preoperative CT scans were included. These patients were randomly assigned to training and validation sets. Univariate and multivariate analyses were employed to compare tumor growth rates and clinical radiological characteristics between the two groups in the training set. A nomogram model was constructed based on the results of multivariate analysis. The diagnostic value of the model was evaluated in both the training and validation sets using calibration curves and receiver operating characteristic curves (ROC). The study included 174 patients, with 58 cases of mucinous adenocarcinoma and 116 cases of non-mucinous adenocarcinoma. The nomogram model incorporated the maximum tumor diameter, the consolidation/tumor ratio (CTR), and the specific growth rate (SGR) to generate individual scores for each patient, which were then accumulated to obtain a total score indicative of the likelihood of developing mucinous or non-mucinous adenocarcinoma. The model demonstrated excellent discriminative ability with an area under the receiver operating characteristic curve of 0.784 for the training set and 0.833 for the testing set. The nomogram model developed in this study, integrating SGR with other radiological and clinical parameters, provides a valuable and accurate tool for differentiating between solitary nodular pulmonary mucinous adenocarcinoma and non-mucinous adenocarcinomas. This prognostic model offers a robust and objective basis for personalized management of patients with pulmonary adenocarcinomas.
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Affiliation(s)
- Feiyang Zhong
- Department of Radiology, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
- Nankai University, Tianjin, China
| | - Lijun Wu
- Department of Radiology, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Zhenxing Liu
- Department of Neurology, Yiling Hospital of Yichang City, Yichang, Hubei, China
| | - Wenping Li
- Department of Radiology, The Sixth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Shaohong Zhao
- Department of Radiology, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
- Nankai University, Tianjin, China.
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Kim CA, Baek SH, Yoo J, Chung SR, Baek JH, Chung KW, Kim WB, Jeon MJ, Kim WG. Tumor Growth Kinetics Based on Initial Tumor Volume Doubling Time in Active Surveillance of Low-Risk Papillary Thyroid Carcinoma. Thyroid 2024; 34:846-855. [PMID: 38757584 DOI: 10.1089/thy.2024.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background: During active surveillance (AS) of low-risk papillary thyroid carcinomas (PTCs), the majority remain stable, while some exhibit either an increase or a decrease in tumor diameter or tumor volume (TV). We aimed to evaluate the clinical outcomes and relevant parameters influencing tumor growth kinetics of low-risk PTCs. Methods: This retrospective cohort study evaluated clinical parameters of 402 patients with low-risk PTC sized <2 cm, with a follow-up duration over 3 years. Changes in maximum tumor diameter, TV, and initial TV doubling time (i-TVDT) calculated within 3 years were assessed. A significant change in TV was defined as a change of 75% or more. Results: Of the 402 patients with low-risk PTC, 93.3% (375/402) were diagnosed with papillary thyroid microcarcinoma. During a median follow-up of 5 years, 3.4% (14/402) of patients developed new cervical lymph node (LN) metastasis, and 8.2% (33/402) experienced a maximal diameter increase of ≥3 mm. The i-TVDT of <5 years emerged as an independent risk factor for both maximal diameter growth and new LN metastasis (p < 0.001 and p = 0.04, respectively). Based on TV changes and i-TVDT during AS, we identified four statistically significant tumor kinetic patterns (p < 0.001): Stable (±75% change in TV), Rapid growth (TV increase >75% and i-TVDT <5 years), Slow growth (TV increase >75% and i-TVDT ≥5 years), and Shrinkage (TV decrease >75%). Most of the PTCs remained stable (67.7%), but 17.2% were rapidly growing, with a median onset of growth of 2.0 years. Slowly growing PTCs, comprising 10.9%, grew at a median of 4.3 years. A minority, 4.2%, exhibited shrinkage. In total, 115 (28.6%) patients underwent delayed surgery >12 months after initiating AS. The reasons for delayed surgery included patient preference (51/115, 44.3%), disease progression (31/115, 27.0%), and suspected disease progression, which was referred to as tumor growth not meeting the criteria of an increase of ≥3 mm in maximal tumor diameter (17/115, 14.8%). Conclusion: An i-TVDT of <5 years serves as an important prognostic indicator for disease progression, including tumor growth and new LN metastasis. The four tumor kinetic patterns based on TV changes and i-TVDT assist in guiding personalized decisions early in AS.
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Affiliation(s)
- Chae A Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Hee Baek
- Department of Clinical Epidemiology and Biostatics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jungmin Yoo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kim CA, Yoo J, Oh HS, Jeon MJ, Chung SR, Baek JH, Kim WB, Shong YK, Kim WG. Undercover active surveillance of small highly suspicious thyroid nodules without fine needle aspiration. Endocrine 2024; 84:615-624. [PMID: 37995012 DOI: 10.1007/s12020-023-03601-6] [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: 08/15/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Active surveillance (AS) is an alternative treatment approach for small, low-risk papillary thyroid microcarcinoma (PTMC). This study aimed to assess the clinical outcomes of small, highly suspicious nodules lacking initial cytological confirmation. METHODS This study included 112 patients with highly suspicious nodules measuring ≤ 10 mm who underwent serial ultrasound at Asan Medical Center, Korea, between 2010 and 2023. RESULTS The median participant age was 51.9 years, and 74.1% were female. The median maximal tumor diameter and tumor volume (TV) were 4.5 (interquartile range [IQR] 3.7-5.2, range 2.2-9.3) mm and 25.2 (IQR 13.1-49.2) mm3, respectively. During a median follow-up period of 4.8 years, four (3.6%) patients showed a ≥ 3 mm increase in maximal diameter, and two (1.8%) developed new lymph node (LN) metastasis. Disease progression was associated with a TV doubling time (TVDT) of < 5 years and a ≥ 75% increase in TV (p = 0.017 and p < 0.005, respectively). Furthermore, 34.8% of patients underwent fine needle aspiration (FNA), primarily at their own request, yielding 46.2%, 5.1%, 41.0%, and 12.8 % malignant, benign, indeterminate, and non-diagnostic results, respectively. Of 18 patients with PTMC, 8 (44.4%) underwent surgery and 10 continued AS, with no LN metastasis during AS and no postoperative recurrence. CONCLUSION Small, highly suspicious nodules had a low disease progression rate during AS without FNA. Disease progression was associated with a TVDT of < 5 years and a ≥ 75% increase in TV. FNA can be performed more conservatively than it currently is in patients with highly suspicious nodules measuring ≤ 10 mm.
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Affiliation(s)
- Chae A Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jungmin Yoo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye-Seon Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Wang Z, Ji X, Zhang H, Sun W. Clinical and molecular features of progressive papillary thyroid microcarcinoma. Int J Surg 2024; 110:2313-2322. [PMID: 38241301 PMCID: PMC11019976 DOI: 10.1097/js9.0000000000001117] [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: 08/22/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
In recent decades, the prevalence of thyroid cancer has risen substantially, with papillary thyroid microcarcinoma (PTMC) constituting over 50% of cases. Although most PTMCs exhibit indolent growth and a favorable prognosis, some present an increased risk of recurrence and an unfavorable prognosis due to high-risk characteristics such as lymph node metastasis, extrathyroidal extension, and distant metastasis. The early identification of clinically progressing PTMC remains elusive. In this review, the authors summarize findings from PTMC progression-related literature, highlighting that factors such as larger tumor size, cervical lymph node metastasis, extrathyroidal extension, younger age, higher preoperative serum thyroid-stimulating hormone levels, family history, and obesity positively correlate with PTMC progression. The role of multifocality in promoting PTMC progression; however, remains contentious. Furthermore, recent studies have shed light on the impact of mutations, such as BRAF and TERT mutations, on PTMC progression. Researchers have identified several mRNAs, noncoding RNAs, and proteins associated with various features of PTMC progression. Some studies propose that peripheral and tumor tissue-infiltrating immune cells could serve as biomarkers for the clinical progression of PTMC. Collectively, these clinical and molecular features offer a rationale for the early detection and the development of precision theranostic strategies of clinically progressive PTMC.
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Affiliation(s)
| | | | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
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Zhao GZ, Zhang MB. Ultrasound-guided radiofrequency ablation for the treatment of papillary thyroid carcinoma: a review of the current state and future perspectives. Ultrasonography 2024; 43:79-87. [PMID: 38310872 PMCID: PMC10915119 DOI: 10.14366/usg.23091] [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: 05/15/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024] Open
Abstract
Papillary thyroid carcinoma (PTC) is a highly prevalent cancer that typically exhibits indolent behavior and is associated with a favorable prognosis. The treatment of choice is surgical intervention; however, this approach carries the risk of complications, including scarring and loss of thyroid function. Although active surveillance can mitigate the risk of PTC overtreatment, the possibility of tumor growth and metastasis can elicit anxiety among patients. Ultrasoundguided thermal ablation has emerged as a safe and effective alternative for individuals who are ineligible for or decline surgery. This article provides a review of the clinical research on radiofrequency ablation as a treatment for PTC, offering a thorough examination of its efficacy, safety, and future perspectives.
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Affiliation(s)
- Guo-zheng Zhao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Ultrasound, Air Force Medical Center, Beijing, China
| | - Ming-bo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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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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7
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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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Lee JY, Kim JH, Kim YK, Lee CY, Lee EK, Moon JH, Choi HS, Yul H, Cho SW, Kim SJ, Lee KE, Park DJ, Park YJ. US Predictors of Papillary Thyroid Microcarcinoma Progression at Active Surveillance. Radiology 2023; 309:e230006. [PMID: 37906009 DOI: 10.1148/radiol.230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background Active surveillance (AS) is an accepted strategy for patients with low-risk papillary thyroid microcarcinoma (PTMC). While previous studies have evaluated the prognostic value of US features, results have been inconsistent. Purpose To determine if US features can help predict tumor progression in patients with low-risk PTMC undergoing AS. Materials and Methods This prospective study enrolled 1177 participants with PTMC from three hospitals between June 2016 and January 2021. Participants were self-assigned to either immediate surgery or AS, and those with two or more US examinations in the absence of surgery were included in the analysis. A χ2 test was used to compare estimated tumor progression rate at 4 years between participants stratified according to US features. Multivariable Cox regression analysis was used to assess the association of clinical and US features with overall tumor progression and specific progression criteria. Results Among 699 participants included in the analysis, 68 (mean age, 49 years ± 12 [SD]; 40 female participants) showed tumor progression (median follow-up, 41.4 months ± 16 [SD]). Tumor progression was associated with the US features of diffuse thyroid disease (DTD) (hazard ratio [HR], 2.3 [95% CI: 1.4, 3.7]; P = .001) and intratumoral vascularity (HR, 1.7 [95% CI: 1.0, 3.0]; P = .04) and the participant characteristics of male sex (HR, 2.8 [95% CI: 1.7, 4.6]; P < .001), age less than 30 years (HR, 2.9 [95% CI: 1.2, 6.8]; P = .01), and thyroid-stimulating hormone level of 7 µU/mL or higher (HR, 6.9 [95% CI: 2.7, 17.4]; P < .001). The risk of tumor progression was higher for participants with DTD (14%, P = .001) or intratumoral vascularity (14%, P = .02) than for participants without these features (6%). DTD and intratumoral vascularity were associated with tumor enlargement (HR, 2.7 [95% CI: 1.4, 5.1]; P = .002) and new lymph node metastasis (HR, 5.0 [95% CI: 1.3, 19.4]; P = .02), respectively. Conclusion DTD and intratumoral vascularity were associated with an increased risk of tumor progression in participants with PTMC undergoing AS. Clinical trial registration no. NCT02938702 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Reuter and the review "International Expert Consensus on US Lexicon for Thyroid Nodules" by Durante et al in this issue.
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Affiliation(s)
- Ji Ye Lee
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Ji-Hoon Kim
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Yeo Koon Kim
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Chang Yoon Lee
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Eun Kyung Lee
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Jae Hoon Moon
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Hoon Sung Choi
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Hwangbo Yul
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Sun Wook Cho
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Su-Jin Kim
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Kyu Eun Lee
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Do Joon Park
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
| | - Young Joo Park
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.)
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10
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Hwang H, Choi JY, Moon JH, Lee EK, Park YJ, Kim SJ, Jung YS. Response to Letter to the Editor on Surgical Outcomes in Patients With Low-Risk Papillary Thyroid Microcarcinoma From MAeSTro Study: Immediate Operation Versus Delayed Operation Following Active Surveillance: A Multicenter Prospective Cohort Study. ANNALS OF SURGERY OPEN 2023; 4:e311. [PMID: 37746619 PMCID: PMC10513147 DOI: 10.1097/as9.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Hyeonuk Hwang
- From the 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
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, National Cancer Center, Goyang, 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
- From the 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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11
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Ahmadi S, Alexander EK. Active Surveillance for Low-Risk Differentiated Thyroid Cancer. Endocr Pract 2023; 29:148-153. [PMID: 36270610 DOI: 10.1016/j.eprac.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 02/07/2023]
Abstract
Less aggressive treatment options, including hemithyroidectomy and active surveillance, have been accepted as treatment options for low-risk small, differentiated thyroid carcinoma (DTC). Multiple studies have shown a low rate of cancer growth and lymph node metastases and no evidence of distant metastases during active surveillance of low-risk small DTC. However, not all patients with low -risk small DTC are ideal or appropriate candidate for active surveillance. Patients with thyroid cancer adjacent to either the trachea or recurrent laryngeal nerve or those with evidence of extrathyroidal extension, a high-risk molecular profile, lymph node, or distant metastases are considered inappropriate candidates for active surveillance. In addition, there are other essential factors that clinicians should consider while recommending active surveillance, including patient financial and insurance status; availability of high-quality neck ultrasounds and experienced radiologists, endocrinologists, and surgeons; and patient preference, level of anxiety, and willingness to undergo prolonged surveillance and follow-up imaging.
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Affiliation(s)
- Sara Ahmadi
- Department of Medicine, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Erik K Alexander
- Department of Medicine, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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12
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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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13
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Thyroid-Stimulating Hormone, Age, and Tumor Size are Risk Factors for Progression During Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma in Adults. World J Surg 2023; 47:392-401. [PMID: 36182976 PMCID: PMC9803751 DOI: 10.1007/s00268-022-06770-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Active surveillance (AS) of low-risk papillary thyroid microcarcinoma (PTMC) was initiated at Kuma Hospital in 1993 and is gradually spreading worldwide. We assessed the effect of thyroid-stimulating hormone (TSH) levels on PTMC enlargement in patients on AS. METHODS We enrolled 2705 patients with cytologically diagnosed PTMC who had undergone AS between January 2005 and July 2019. Patients with Graves disease were excluded. The median AS period was 5.5 years (range 1.0-15.7 years). Tumor enlargement was defined as a size increase ≥3 mm. Chi-square test, Kaplan-Meier method, log-rank test, Cox proportional hazard, and logistic regression were used to compare variables. RESULTS Ninety-two patients (3.4%) experienced tumor enlargement; the 5-, 10-, and 15-year enlargement rates were 3.0%, 5.5%, and 6.2%, respectively. Young age (<40 years, p < 0.001), large tumor size (≥9 mm, p = 0.017), and high detailed TSH score (≥3, higher than the lower normal limit, p = 0.011) were significant factors relating to tumor enlargement in the multivariate analysis. In a subset of patients aged <40 years, a low detailed TSH score (<3) was an independent factor against tumor enlargement (p = 0.039). Only 22 patients (0.8%) experienced novel lymph node metastasis; the 5-, 10-, and 15-year node metastasis rates were very low, at 0.9%, 1.1%, and 1.1%, respectively. CONCLUSIONS Young patients with PTMC are more likely to experience tumor growth. Mild TSH suppression to achieve a low normal range may prevent carcinoma enlargement; however, prospective studies are needed to draw more reliable conclusions.
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14
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Ho AS, Bastien AJ, Sacks WL. Thyroid Cancer Active Surveillance: The Devil You Know or The Devil You Don't. Thyroid 2022; 32:1279-1280. [PMID: 36205589 DOI: 10.1089/thy.2022.0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Allen S Ho
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Amanda J Bastien
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wendy L Sacks
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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15
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Tuttle RM, Fagin J, Minkowitz G, Wong R, Roman B, Patel S, Untch B, Ganly I, Shaha A, Shah J, Li D, Bach A, Girshman J, Lin O, Cohen M, Cohen JM, Cracchiolo J, Ghossein R, Sabra M, Boucai L, Fish S, Morris L. Active Surveillance of Papillary Thyroid Cancer: Frequency and Time Course of the Six Most Common Tumor Volume Kinetic Patterns. Thyroid 2022; 32:1337-1345. [PMID: 36178355 PMCID: PMC9700377 DOI: 10.1089/thy.2022.0325] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The change in size of the papillary thyroid cancer (PTC) nodule during active surveillance has traditionally been characterized as either stable, increasing, or decreasing based on changes in maximal tumor diameter or tumor volume. More recently, it has been observed that the changes in tumor size observed during observation are more complex with tumor volume kinetic patterns that can be characterized either as stable (Pattern I), early increase in volume (Pattern II), later increase in volume (Pattern III), early increase in volume followed by stability (Pattern IV), stability followed by an increase in volume (Pattern V), or a decrease in tumor volume (Pattern VI). Methods: The frequency, time course, and clinical correlates of these six tumor volume kinetic patterns were analyzed in a cohort of 483 patients with low-risk PTC up to 1.5 cm in maximal diameter followed with active surveillance at our center for a median of 3.7 years. Results: The cumulative incidence of an increase in tumor volume for the entire cohort was 15.9% [confidence interval (CI) 11.8-20.0] at 5 years. At 5 years, most tumors demonstrated stability (78.8%, Pattern I) with 10.0% showing early growth (Pattern II), 4.1% late growth (Pattern III), 1.9% growth then stability (Pattern IV), 0.6% stability then growth (Pattern V), and 5.6% with a decrease in tumor volume (Pattern VI). Tumor volume doubling time during exponential growth significantly differed across the kinetic patterns, with median values of 2.4, 7.1, and 3.3 years for Patterns II, III, and IV, respectively (p < 0.01). Similarly, the time to a change in tumor volume was significantly different across the kinetic patterns, with median values of 1.5, 3, 1.6, 4.7, and 4.1 years for Patterns II, III, IV, V, and VI, respectively (analysis of variance, p < 0.01). Clinical correlates at baseline were not associated with tumor volume kinetic pattern. Conclusions: These six kinetic tumor volume patterns provide a comprehensive description of the changes in PTC tumor volume observed during the first 5 years of active surveillance.
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Affiliation(s)
- Robert Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - James Fagin
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gerald Minkowitz
- Department of Surgery Education, Columbia University Irving Medical Center, New York, New York, USA
| | - Richard Wong
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Benjamin Roman
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Snehal Patel
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brian Untch
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ashok Shaha
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jatin Shah
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Duan Li
- Radiology and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ariadne Bach
- Radiology and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jeffrey Girshman
- Radiology and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oscar Lin
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc Cohen
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jean-Marc Cohen
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer Cracchiolo
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ronald Ghossein
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mona Sabra
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Laura Boucai
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephanie Fish
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Luc Morris
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Grussendorf M, Ruschenburg I, Brabant G. Malignancy rates in thyroid nodules: a long-term cohort study of 17,592 patients. Eur Thyroid J 2022; 11:e220027. [PMID: 35635802 PMCID: PMC9254276 DOI: 10.1530/etj-22-0027] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Ultrasound diagnosis of thyroid nodules has greatly increased their detection rate. Their risk for malignancy is estimated between 7 and 15% in data from specialized centers which are used for guidelines recommendations. This high rate causes considerable anxiety to patients upon first diagnosis. Here, we retrospectively analyzed the malignancy rate of sonographically diagnosed nodules larger than 1 cm from a primary/secondary care center when long-term longitudinal follow-up was included. Patients/methods In the study, 17,592 patients were diagnosed with a thyroid nodule larger than 1 cm, of whom 7776 were assessed by fine-needle aspiration cytology (FNAC) and 9816 by sonography alone. 9568 patients were initially discharged due to innocent results of FNAC and/or ultrasound. In 1904 patients, definitive histology was obtained, and 6731 cases were included in the long-term follow-up (up to 23 years, median 5 years). Results Malignancy was histologically confirmed in 189 patients (1.1% of all) when excluding accidentally diagnosed papillary microcarcinomas. 155 were diagnosed during the first year of management, 25 in years 2-5 of follow-up, 9 in years 6-10 and nil in 1165 patients followed beyond 10 years. Conclusions The malignancy rate of thyroid nodules from primary/secondary care was much lower than that previously reported. During follow-up for more than 5 years, their rate rapidly dropped to less than 1/1000 cases. This low malignancy rate may help to reassure patients first confronted with the diagnosis of a thyroid nodule, substantially reduce their anxiety and avoid unwarranted diagnostic and therapeutic procedures.
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Affiliation(s)
- M Grussendorf
- Department of Internal Medicine, University Hospital, Düsseldorf, Germany
| | - I Ruschenburg
- MVZ Wagnerstibbe Center for Cytology and Pathology, Einbeck, Germany
| | - G Brabant
- Department of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
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Yang H, Park H, Ryu HJ, Heo J, Kim JS, Oh YL, Choe JH, Kim JH, Kim JS, Jang HW, Kim TH, Kim SW, Chung JH. Frequency of TERT Promoter Mutations in Real-World Analysis of 2,092 Thyroid Carcinoma Patients. Endocrinol Metab (Seoul) 2022; 37:652-663. [PMID: 35864728 PMCID: PMC9449103 DOI: 10.3803/enm.2022.1477] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGRUOUND Telomerase reverse transcriptase (TERT) promoter mutations are associated with increased recurrence and mortality in patients with thyroid carcinoma. Previous studies on TERT promoter mutations were retrospectively conducted on a limited number of patients. METHODS We prospectively collected data on all consecutive patients who underwent thyroid carcinoma surgery between January 2019 and December 2020 at the Samsung Medical Center, Seoul, Korea. We included 2,092 patients with thyroid carcinoma. RESULTS Of 2,092 patients, 72 patients (3.4%) had TERT promoter mutations. However, the frequency of TERT promoter mutations was 0.5% in papillary thyroid microcarcinoma (PTMC) ≤1 cm and it was 5.8% in papillary thyroid carcinoma (PTC) >1 cm. The frequency of TERT promoter mutations was significantly associated with older age at diagnosis (odds ratio [OR], 1.12; P<0.001), larger primary tumor size (OR, 2.02; P<0.001), and aggressive histological type (OR, 7.78 in follicular thyroid carcinoma; OR, 10.33 in poorly differentiated thyroid carcinoma; OR, 45.92 in anaplastic thyroid carcinoma; P<0.001). Advanced T stage, advanced N stage, and distant metastasis at diagnosis were highly prevalent in mutated thyroid cancers. However, initial distant metastasis was not present in patients with TERT promoter mutations in PTMC. Although the C228T mutation was more highly detected than the C250T mutation (64 cases vs. 7 cases), there were no significant clinicopathological differences. CONCLUSION This study is the first attempt to investigate the frequency of TERT promoter mutations in a real-world setting. The frequency of TERT promoter mutations in PTC was lower than expected, and in PTMC, young patients, and female patients, the frequency was very low.
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Affiliation(s)
- Heera Yang
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunju Park
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jin Ryu
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Heo
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Department of Pathology and Translational Genomics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Won Jang
- Department of Medical Education, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Corresponding author: Jae Hoon Chung. Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3434, Fax: +82-2-3410-3849, E-mail:
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Correction to: Tumor Volume Doubling Time in Active Surveillance of Papillary Thyroid Microcarcinoma: A Multicenter Cohort Study in Korea, by Jin, et al. Thyroid 2021;31(10):1494-1501; doi: 10.1089/thy.2021.0094. Thyroid 2022; 32:604. [PMID: 35447042 DOI: 10.1089/thy.2021.0094.correx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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