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23-11-2023 | Metastasis | Original Article

Undercover active surveillance of small highly suspicious thyroid nodules without fine needle aspiration

Authors: Chae A Kim, Jungmin Yoo, Hye-Seon Oh, Min Ji Jeon, Sae Rom Chung, Jung Hwan Baek, Won Bae Kim, Young Kee Shong, Won Gu Kim

Published in: Endocrine | Issue 2/2024

Abstract

Purpose

Active surveillance (AS) is an alternative treatment approach for small, low-risk papillary thyroid microcarcinoma (PTMC). This study aimed to assess the clinical outcomes of small, highly suspicious nodules lacking initial cytological confirmation.

Methods

This study included 112 patients with highly suspicious nodules measuring ≤ 10 mm who underwent serial ultrasound at Asan Medical Center, Korea, between 2010 and 2023.

Results

The median participant age was 51.9 years, and 74.1% were female. The median maximal tumor diameter and tumor volume (TV) were 4.5 (interquartile range [IQR] 3.7–5.2, range 2.2–9.3) mm and 25.2 (IQR 13.1–49.2) mm³, respectively. During a median follow-up period of 4.8 years, four (3.6%) patients showed a ≥ 3 mm increase in maximal diameter, and two (1.8%) developed new lymph node (LN) metastasis. Disease progression was associated with a TV doubling time (TVDT) of < 5 years and a ≥ 75% increase in TV (p = 0.017 and p < 0.005, respectively). Furthermore, 34.8% of patients underwent fine needle aspiration (FNA), primarily at their own request, yielding 46.2%, 5.1%, 41.0%, and 12.8 % malignant, benign, indeterminate, and non-diagnostic results, respectively. Of 18 patients with PTMC, 8 (44.4%) underwent surgery and 10 continued AS, with no LN metastasis during AS and no postoperative recurrence.

Conclusion

Small, highly suspicious nodules had a low disease progression rate during AS without FNA. Disease progression was associated with a TVDT of < 5 years and a ≥ 75% increase in TV. FNA can be performed more conservatively than it currently is in patients with highly suspicious nodules measuring ≤ 10 mm.

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Title: Undercover active surveillance of small highly suspicious thyroid nodules without fine needle aspiration
Authors: Chae A Kim
Jungmin Yoo
Hye-Seon Oh
Min Ji Jeon
Sae Rom Chung
Jung Hwan Baek
Won Bae Kim
Young Kee Shong
Won Gu Kim
Publication date: 23-11-2023
Publisher: Springer US
Keywords: Metastasis
Aspiration
Published in: Endocrine / Issue 2/2024
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-023-03601-6

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