👉Asymptomatic, small thyroid nodules (usually equal or less than 1 cm maximal diameter, 1 cm3, or 1 mL volume) confined to the thyroid and surrounded by normal thyroid parenchyma can be followed with active surveillance, with or
without cytologic confirmation, in patients who value
their normal thyroid function and who desire avoidance of thyroid surgery.
👉Patients who demonstrate tumors larger than 1.5 cm to 2.0 cm; tumors in subcapsular locations adjacent to important structures, such as the trachea and recurrent laryngeal nerve; or tumors with
documented growth rate doubling times of less than 2 years are generally considered inappropriate for observation and would be considered to have actionable disease.
👉If the tumor growth rate is unknown at the time of nodule detection, then this can be established with serial ultrasound evaluations done approximately every 6 months for 1 to 2 years.
👉The frequency of ultrasound evaluations
and long-term follow-up depends on the tumor size,
location, and established growth rate.
👉With the use of this paradigm, active surveillance continues until there is a 3-mm increase in tumor diameter (which corresponds to a 100% increase in tumor volume), identification of metastatic disease, direct invasion into surrounding structures of the thyroid, or a decision to discontinue active surveillance based on patient preference.
👉This risk-stratified, minimalistic management approach to very low-risk thyroid cancers has been shown to be safe and effective over 5 to 10 years of follow-up in studies from Japan, Korea, and the United States.
👉In the first 10 years of active surveillance follow-
up, only 2% to 8% of papillary microcarcinomas
increase equal or greater than 3 mm in maximum diameter, 12% to 14% demonstrate an increase in tumor volume of greater than 50% (the smallest change in nodule volume that can be reproducibly measured), and novel lymph node metastases
are detected in 2% to 4%.
👉The likelihood of disease progression is higher in younger patients than in older patients.
👉Importantly, at the time of disease progression, deferred surgical intervention is quite effective with excellent outcomes and no disease-specific
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