Thyroid monitoring proves beneficial and applicable for older individuals

In a recent study published in JAMA Surgery, researchers from Toronto General Hospital in Ontario, Canada, have highlighted the potential benefits of active surveillance for managing small, low-risk papillary thyroid cancers in older patients.

The study, led by Dr. Anna Sawka, focused on a cohort of 200 patients, with an average age of 52 years. The researchers found that more than three-fourths of patients who opted for active surveillance via ultrasound and blood work continued this approach in the absence of disease progression or other indications for surgery at long-term follow-up.

The study's authors made a concerted effort to inform patients of their options, emphasizing the importance of high-quality ultrasound imaging in safely monitoring these cancers over time. However, ultrasound imaging limitations prevented accurate tumor measurement in 2.6% of cases under active surveillance.

The study reported no thyroid cancer-related deaths or any distant metastatic disease. The overall crossover rate from surveillance to definitive treatment reached 23.9% (n = 37). Disease progression was the reason for crossover in 56.8% of cases, patient preference in 40.5%, and ultrasound imaging limitations in 2.6%.

The five-year age-stratified cumulative overall crossover incidence was 41.5% in patients younger than 45 years, 20.9% in those aged 45 to 64 years, and 5.1% in patients aged 65 years and older (p < .001). This suggests that older patients may continue active imaging and pathology surveillance more often than younger patients.

Dr. Sawka noted that all patients in the study had thyroid cytopathology obtained by fine needle aspiration biopsy prior to enrollment, and the cytology was required to be either positive or suspicious for papillary thyroid carcinoma for inclusion in the study.

The study's authors are continuing to follow the patient cohort as part of a larger, multicenter Canadian study to gather longer-term outcomes in a broader population base. The full study can be found online.

The study's findings suggest that active surveillance may be a first-line management option for small, low-risk papillary thyroid tumors, particularly for older patients. However, it underscores the importance of precision imaging in supporting non-surgical management pathways for low-risk thyroid malignancies. During active surveillance, ultrasound exams, blood work, and clinical assessment are conducted every six months for two years, followed by a yearly assessment if the findings are stable. Ultrasound-guided biopsies are only performed if clinically indicated.

In conclusion, the study provides valuable insights into the long-term outcomes of active surveillance for small, low-risk papillary thyroid cancers, especially in older patients. It underscores the importance of informed patient choice, high-quality imaging, and regular monitoring in managing these cancers non-surgically.