(HealthDay News) — Active surveillance may be a viable management strategy for most diagnosed thyroid cancers, according to a study published in JAMA Oncology.

Allen S. Ho, MD, from Cedars-Sinai Medical Center in Los Angeles, and colleagues evaluated 222 patients with 20-mm or smaller Bethesda 5 to 6 thyroid nodules.

Patients either underwent active surveillance (112 patients) or immediate surgery (110 patients). For patients who experienced size growth greater than 5 mm or more than 100% volume growth, delayed surgery was recommended. The mean follow-up was 37.1 months.

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Among the patients who chose active surveillance, 90.1% continued to be managed with active surveillance throughout follow-up, 41.0% had their tumors shrink, and none developed regional or distant metastases.

Size growth of greater than 5 mm occurred in 3.6% of active surveillance cases, with a cumulative incidence of 1.2% at 2 years and 10.8% at 5 years. Volumetric growth greater than 100% occurred in 7.1% of cases, with a cumulative incidence of 2.2% at 2 years and 13.7% at 5 years.

Of the patients who chose immediate surgery, 19.1% had equivocal-risk features identified on final pathology.

In both cohorts, disease-specific survival and overall survival rates were 100%.

Patients undergoing immediate surgery showed significantly higher baseline anxiety levels than active surveillance patients. This difference persisted at 4-year follow-up even after intervention.

“A more permissive active surveillance strategy encompassing most diagnosed thyroid cancers appears viable,” the authors wrote.

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