Active Surveillance of Papillary Thyroid Cancer: Tumor Volume Kinetics with Dr. Morris

We are honored to have Dr. Luc Morris present "Active Surveillance of Papillary Thyroid Cancer Frequency and Time Course of 6 Most Common Tumor Volume Kinetic Patterns." Dr. Eyal Robenshtok joins as the featured expert discussant.

0:00 Webinar

0:37 Dr. Morris presents

Incidence of Thyroid Cancer
The incidence of thyroid cancer, primarily driven by a three-fold increase in papillary thyroid cancer, has risen significantly. However, this increase in diagnoses has not been accompanied by a corresponding rise in mortality rates, which have remained relatively low. Interestingly, while the number of thyroid cancer diagnoses has surged, the actual number of thyroid cancer cases and associated deaths has remained stable. This phenomenon suggests that the apparent rise in thyroid cancer is not an epidemic of the disease itself but rather an increase in the rate of diagnosis, including the identification of previously undiagnosed cases.

Gender Disparities in Diagnosis
The incidence of thyroid cancer is three times higher in women than in men. Despite the similar prevalence of thyroid cancer in autopsy studies for both sexes, women are diagnosed three times more frequently than men. For every detected case of papillary thyroid carcinoma (PTC), there are an estimated 1,000 undiagnosed cases, referred to as occult PTC.

Overdiagnosis in Thyroid Cancer
Overdiagnosis in cancer refers to the identification of cancers that would not progress to cause symptoms or death. In South Korea, thyroid cancer treatments have reported a 2% incidence of recurrent laryngeal nerve injury and an 11% incidence of permanent hypoparathyroidism.

Active Surveillance Origins & Guidelines
Active surveillance of small PTCs originated in Japan, where data demonstrated that the majority of small PTCs do not grow significantly under close observation. In 2015, the American Thyroid Association (ATA) guidelines recommended that active surveillance could be considered an alternative to immediate surgery for low-risk PTC.

Criteria for Surgical Intervention
Reasons for opting for surgical intervention include tumor growth greater than 3mm, significant radiographic changes, or patient preference. Under active surveillance, the cumulative incidence of PTC growth over ten years shows a 20-25% increase in diameter by 3 mm and a 72% increase in volume. The risk of lymph node metastasis during active surveillance is approximately 3.3%, compared to 5% following total thyroidectomy.

Kinetic Patterns of PTC Growth
The kinetic patterns of growth indicate that the majority of papillary thyroid carcinoma (PTC) cases remain indolent, with 84% showing no significant growth at 5 years and 83% at 10 years.

Anxiety Levels in Patients
Surgery does not alleviate anxiety in thyroid cancer patients. Those who undergo immediate surgery experience higher levels of , which tend to increase over time. In contrast, patients who opt for active surveillance exhibit lower levels of anxiety, which decrease over time.

28:35 Dr. Robenshtok presents

Prevalence of Occult PTC
Occult papillary thyroid carcinoma (PTC) is present in approximately 5-10% of the general population. Decisions regarding lobectomy or active surveillance should ideally be made before a fine-needle aspiration (FNA) biopsy. In practice, patients with small suspicious nodules on ultrasound may rush to undergo biopsies; however, an FNA for nodules smaller than 1 cm is equivalent to active surveillance.

Requirements for Active Surveillance
Active surveillance requires an ideal patient, an ideal location, and a dedicated team of physicians. Follow-up involves a flexible ultrasound schedule based on observed changes, with growth monitored alongside periods of quiescence. The incidence of new lymph node metastasis over 10 years is approximately 3.3% and is not related to the tumor's kinetic pattern.

Quality of Life & Clinical Challenges
Patients who choose active surveillance generally experience a positive quality of life. For clinicians, active surveillance can be more labor-intensive, and there is no evidence of successful malpractice litigation associated with this approach in cancer treatment. Currently, no tool can definitively predict whether a lesion will grow or remain stable, highlighting the need for improved predictive tools in the future.

49:04 Discussion with Q&A

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