Can Patients With Papillary Thyroid Cancer Be Actively Surveyed?

Background: Active surveillance (AS) is a defined strategy for low-risk papillary thyroid cancer (PTC) <1.5 cm, but outcomes data for larger tumors remain unknown. Objective: To evaluate the feasibility and safety of surveillance in patients with PTC primary tumor size of >1.5 cm. Design: Single-institution, retrospective cohort study. Methods: 783 patients were placed on AS at Memorial Sloan Kettering Cancer Center, of which 45 patients had PTC of >1.5 cm (range 1.6 to 2.9 cm) were identified. Serial ultrasound was performed at 6- to 12-month intervals. Outcomes included tumor volume change, maximal diameter change, new cervical lymph node metastasis, and transition to surgery. Results: Median follow-up time was 50 months, and 13% of patients demonstrated a >70% increase in tumor volume, and 11% developed newly identified cervical lymph node metastases. Of all patients, 20% transitioned to surgery, with 89% achieving an excellent response. No thyroid cancer-specific deat more...