The patients in the active surveillance program were followed with physical exam, neck ultrasound and chest X-rays every 6 to 12 months after diagnosis. These patients were evaluated for increase in cancer size, development of spread to the lymph nodes and spread to other parts of the body. The follow-up was 7.3 – 7.9 years. If progression of the cancer was seen or the patient changed their mind, surgery was performed.
The authors found that the 5- and 10-year rates of progression were similar in patients with papillary thyroid cancer < 1cm compared with those with 1-2 cm cancers during active surveillance. A total of 11 patients with 1-2 cm cancers had surgery after active surveillance and none had the cancer come back. Of the patients with 1-2 cm cancers who had immediate surgery, 8 had the cancer come back. The rate of cancer coming back was significantly higher for cancers ≥1.5 cm than <1.5 cm in this group.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study showed that patients with 1-2 cm papillary thyroid cancers had similar progression rates to patients with <1 cm cancers during active surveillance. Additionally, delayed surgery was not associated with any harm in these patients. These findings are important as they show that active surveillance of small thyroid cancers, especially those <15 mm in size, is safe. Expanding active surveillance to larger cancers would decrease the number of thyroid surgeries and subsequent complications. However, more research is still needed to determine exactly which thyroid cancer patients are ideal for active surveillance, considering age, other health issues and the expertise of treatment team.
— Maria Papaleontiou, MD