Endocrine Abstracts (2017) 49 S19.1 | DOI: 10.1530/endoabs.49.S19.1

Thyroid microcarcinoma: to treat or not to treat?

Paolo Vitti


In the last 20 years, the incidence of thyroid cancer (TC) has more than doubled. Since 50% of the increase is related to papillary microcarcinomas (mPTC, <1 cm), it appears that an increased detection, due to the wide use of neck ultrasound (US), is the major factor driving this dramatic rise. Autoptic and histological studies after thyroidectomy (TX) show that 10 to 30% of adults harbor an undiagnosed mPTC. The disease-specific mortality of patients treated by surgery for mPTC is <1% and loco-regional and distant recurrence rates are 2–6 and 1–2%, respectively. Furthermore, 2 Japanese prospective clinical trials demonstrated a good outcome in more than 1,300 patients with biopsy-proven mPTC who were not submitted to TX. Thus, since only a minority of mPTC progress to a clinically overt disease, it is critical to re-evaluate the current management strategy that indiscriminately recommends thyroid surgery that is, although infrequently, burdened by complications. We retrospectively evaluated clinical data of 293 consecutive patients with mPTC, surgically treated at our Department. After 6 years of follow-up no patient had evidence of structural disease. This prompted us to obtain the approval by the ethical committee to offer patients an active surveillance instead of immediate surgery, when they had an intrathyroid nodule with a Thy4 or a Thy5 cytology, less than 1.3 cm of diameter, with no evidence at US of extrathyroid extension and cervical lymphnodes suspicious for metastasis. Out of 163 patients who choose active surveillance, 97 (59.5%) did not satisfied the inclusion criteria and 66 (40.5%) were enrolled in the protocol. With a median follow-up of 12 months (6–28) only 3/66 (4.5%) were addressed to surgery for the appearance of neck metastatic lymphnodes or an enlargement of the nodule. 7/66 (10.6%) patients withdrew from the study. In conclusion, the results of prospective studies will provide more precise data to build up a patient tailored approach for the management of mPTC.

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