Active Surveillance In Papillary Thyroid Microcarcinomas (PMCS): A 2 Years Follow Up (FU) At A Single Center

Objective: an active surveillance can be considered as an alternative to immediate surgery in PMC, however few studies are available at the present. After the approval of our Ethical Committee on November 2014 we started the “active surveillance” in PMC patients (5 yrs for enrollment period and 5 yrs for FU). Methods: the inclusion criteria were the presence of a single thyroid nod- ule <1.3 cm in the biggest diameter at neck ultrasound (nUS) with a Thy4 or Thy5 cytology on FNA, and no evidence of metastatic latero-cervical lym- phnodes at nUS. FNAB specimens were also collected for genetic analysis. Results: we enrolled 66 patients with thyroid nodules with the above men- tioned features. They were 15/66(23%) males and 51/66(77%) females with a mean age of 45 yrs(21-79). Cytology on FNA was Thy4 in 19/66(28,8%) and Thy5 in 47/66(71,2%) nodules. Patients were followed–up every six months with nUS and thyroid function tests. After a median FU of 24 months(6-28) only 3/66(4.5%) showed a clinical progression with the appearance of meta- static lymph nodes or an enlargement of the nodule (from 10 to 15 months after enrolment). In these 3 patients radioiodine ablation was also performed after surgical treatment, according to the histological features (2/3 pT3N1; 1/3 pT3). To date these patients are cured (no structural or biochemical persistent disease). During the first 12 months of FU 7/66(10.6%) patients withdrew the study for personal reasons and opted for surgery, genetic analysis are ongoing. Conclusions: an active surveillance appears to be a suitable and safe approach in patients with PMC. Less than 5% of PMC required to be surgi- cally treated during the first 2 years of observation and their delayed treatment did not impact on the final outcome. It’s worth to note that 10% of patients dropped out for personal reasons.