(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.
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.