Active Surveillance for Patients With Papillary Thyroid Microcarcinoma: A Single Center's Experience in Korea.

Kwon, Hyemi; Oh, Hye-Seon; Kim, Mijin; Park, Suyeon; Jeon, Min Ji; Kim, Won Gu; Kim, Won Bae; Shong, Young Kee; Song, Dong Eun; Baek, Jung Hwan; Chung, Ki-Wook; Kim, Tae Yong

<bold>Context: </bold>Papillary thyroid microcarcinoma (PTMC) usually has an excellent prognosis.<bold>Objective: </bold>To evaluate the three-dimensional structures of PTMCs, using serial neck ultrasonography (US) in patients under active surveillance.<bold>Design and Setting: </bold>A retrospective cohort study.<bold>Participants: </bold>In total, 192 patients diagnosed with PTMC under active surveillance for >1 year were included in a median 30-month follow-up. Changes in tumor size were evaluated not only using the maximal tumor diameter but also the tumor volume.<bold>Results: </bold>The median age of patients was 51.3 years and 145 patients (76%) were female. The median initial maximal tumor diameter and tumor volume were 5.5 mm and 48.8 mm3, respectively. The tumor size increased in 27 patients (14%); 23 patients showed a tumor volume increase >50% without a maximal diameter increase of ≥3 mm. The other four patients had both an increasing tumor volume and increasing maximal tumor diameter ≥3 mm. One patient (0.5%) had newly appeared cervical lymph node (LN) metastasis at 3 years after the initial diagnosis. There were no significant risk factors associated with increased tumor size, such as age, sex, or Hashimoto thyroiditis. Twenty-four patients (13%) underwent delayed thyroid surgery at a median of 31.2 months and seven (29%) had cervical LN metastasis on pathologic examination.<bold>Conclusion: </bold>Some PTMCs could grow significantly after a relatively short period of active surveillance. We also found that the change in tumor volume was more sensitive to detect tumor progression than the change in the maximal tumor diameter.

SOUTH Korea; ANTHROPOMETRY; LONGITUDINAL method; LYMPH nodes; EVALUATION of medical care; NECK surgery; NEEDLE biopsy; THYROID gland tumors; THYROIDECTOMY; TUMOR classification; ULTRASONIC imaging; THREE-dimensional imaging; RETROSPECTIVE studies; DISEASE progression; PAPILLARY carcinoma

Journal of Clinical Endocrinology & Metabolism, 2017, pN.PAG

0021-972X

Academic Journal

10.1210/jc.2016-4026