Active surveillance of low-risk PMC of the thyroid proposed as first-line management
A 10-year study of more than 1,200 patients with low-risk papillary microcarcinoma (PMC) of the thyroid led researchers to conclude that close and continuous monitoring is an acceptable first-line approach to patient management instead of immediate surgery to remove the tumor. The article entitled "Insights into the Management of Papillary Microcarcinoma of the Thyroid" is part of a special section on Japanese Research led by Guest Editor Yoshiharu Murata, Nagoya University, Japan, in the January 2018 issue of Thyroid.
Coauthors Akira Miyauchi, Yasuhiro Ito, and Hitomi Oda, Kuma Hospital, Kobe, Japan, report that in only 8% of patients with PMC evaluated during the study period did the tumor increase in size by 3 mm or more, and only 3.8% of patients had a new metastasis. PMCs were least likely to grow in older patients (60 years of age or older). Furthermore, compared to a management approach of "active surveillance," patients who underwent immediate surgery had significantly higher risks of unfavorable events and more than 4 times the total cost of PMC treatment.
"The seminal observations by the groups from Kuma Hospital and the Cancer Institute Hospital in Tokyo from Japan indicate that the vast majority of papillary thyroid microcarcinomas have an indolent behavior and that active surveillance may be an alternative approach in many patients," says Peter A. Kopp, MD, Editor-in-Chief of Thyroid and Professor of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. "Similar prospective studies are now underway in other parts of the world. Ultimately, the goal is to avoid unnecessary treatment. The challenge that lies ahead of us is to identify the small group of patients with papillary thyroid microcarcinomas that require active intervention."