Kim Chae A, Yoo Jungmin, Oh Hye-Seon, Jeon Min Ji, Chung Sae Rom, Baek Jung Hwan, Kim Won Bae, Shong Young Kee, Kim Won Gu
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Endocrine. 2024 May;84(2):615-624. doi: 10.1007/s12020-023-03601-6. Epub 2023 Nov 23.
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.
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.
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) mm, 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.
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.
主动监测（AS）是小的、低风险甲状腺微小乳头状癌（PTMC）的一种替代治疗方法。本研究旨在评估缺乏初始细胞学确诊的小的、高度可疑结节的临床结局。
本研究纳入了2010年至2023年期间在韩国峨山医学中心对112例最大直径≤10mm的高度可疑结节患者进行了系列超声检查。
参与者的中位年龄为51.9岁，74.1%为女性。肿瘤最大直径和肿瘤体积（TV）的中位数分别为4.5（四分位间距[IQR]3.7 - 5.2，范围2.2 - 9.3）mm和25.2（IQR 13.1 - 49.2）mm。在中位随访期4.8年期间，4例（3.6%）患者的最大直径增加≥3mm，2例（1.8%）出现新的淋巴结（LN）转移。疾病进展与TV倍增时间（TVDT）<5年以及TV增加≥75%相关（分别为p = 0.017和p < 0.005）。此外，34.8%的患者接受了细针穿刺抽吸（FNA），主要是出于自身要求，结果显示恶性、良性、不确定和非诊断性的比例分别为46.2%、5.1%、41.0%和12.8%。在18例PTMC患者中，8例（44.4%）接受了手术，10例继续进行AS，AS期间无LN转移且术后无复发。
小的、高度可疑结节在未进行FNA的AS期间疾病进展率较低。疾病进展与TVDT<5年以及TV增加≥75%相关。对于最大直径≤10mm的高度可疑结节患者，FNA的实施可以比目前更为保守。
