Active surveillance advised in patients with large thyroid nodules

A recent study recommends active surveillance of papillary thyroid cancer (PTC) in some patients with intrathyroidal suspected malignancy >1 cm in diameter. Rescue surgery may be beneficial.

Researchers followed 69 patients with active surveillance for at least 1 year (average 55 months). Of these, 26 (38 percent) had nodules 2 cm or larger.

None of the patients developed new-incident occurrence of lymph node or distant metastasis, but one showed concern for progression to a dedifferentiated cancer on repeat core biopsy 17 years after initial start of nonoperative selection. Nearly one in five patients (21 percent) had an increase of >3 mm in maximum diameter, while one in four (25 percent) had a volume increase of ≥50 percent.

Thirteen patients had delayed or rescue surgery. After the procedure, none of them experienced any disease recurrence. Of note, age and initial nodule size did not predict nodule growth.

“These data expand consideration of active surveillance of PTC in select patients with intrathyroidal suspected malignancy >1 cm in diameter,” the researchers said. “Rescue surgery, if required at a later time point, appears effective.”

In this study, the researchers performed a retrospective review of consecutive patients undergoing nonoperative active surveillance of suspicious or malignant thyroid nodules over a 20-year period from 2001 to 2021. Those with an initial ultrasound‒fine-needle aspiration confirming either Bethesda 5 or 6 cytology or a “suspicious” Afirma molecular test were included.

The rate of adverse oncologic outcomes (ie, mortality and recurrence) and the cumulative incidence of size or volume growth served as the primary outcome measures.