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Avoiding Surgery for Low-Risk Thyroid Cancer

Thyroid; ePub 2017 Jan 26; Griffin, Brito, et al

Increasing the size threshold for active surveillance of papillary thyroid carcinoma (PTC) to 1.5 cm would allow more patients with low-risk cancer to be considered for this less aggressive approach, thus avoiding potential complications, according to an analysis involving nearly 700 individuals.

Participants had thyroid cancer and underwent thyroid surgery between 2003 and 2012. A decision-making framework for active surveillance was retrospectively applied to those whose nodules were ≤1.5 cm.

243 patients had PTC diagnosed based on FNA histology of Bethesda V or VI in thyroid nodules. Among them, 6% had nodules measuring ≤1 cm size, whereas nearly one-fourth had nodules measuring ≤1.5 cm. In the latter group:

  • 52 underwent total thyroidectomy and 4 had lobectomy.
  • 45 patients had elective central nodal dissection.
  • 14 had nodal metastases on pathology (all <4 mm).
  • 3 had permanent complications from surgery.

Citation:

Griffin A, Brito J, Bahl M, Hoang J. Applying criteria of active surveillance to low-risk thyroid papillary cancer over a decade: How many surgeries and complications can be avoided? [Published online ahead of print January 26, 2017]. Thyroid. doi:10.1089/thy.2016.0568.

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