Abstract
The acceptance and results of active surveillance in patients with low-risk papillary
thyroid microcarcinomas (PTMC) are unknown in populations other than the Japanese
population. This was the objective of the present prospective study. We selected patients
≥20 years who had thyroid nodules ≤1.2 cm with intermediate or high suspicion for
malignancy on ultrasonography (US), not located near the recurrent laryngeal nerve
and without extrathyroidal invasion or apparent lymph node metastases, whose cytology
was suspicious (Bethesda V) or diagnostic (Bethesda VI) of papillary thyroid carcinoma.
Patients who opted for active surveillance were followed up by biannual US. Fifteen
patients (18.7%) readily opted for surgery and 12 (15%) for active surveillance. Fifty-three
patients (66.2%) delegated the decision or wished to know the doctor’s preference
before deciding. After the doctor had declared his/her preference for active surveillance,
50 patients decided to have this management and three to have surgery. Only 1/70 patients
exhibited tumor progression (growth associated with a suspicion of extrathyroidal
invasion) after 30 months of follow-up. Two patients decided to have surgery during
follow-up, although the indication was not defined by the study. A>50% reduction in
tumor volume was observed in three patients. The study shows that active surveillance
can be well accepted if doctors were convinced that it is the best option for patients
with low-risk PTMC. At least the short-term results reproduced those observed in other
populations, with tumor progression being uncommon.
Key words
active surveillance - thyroidectomy - microcarcinoma
