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Assessing mPTC Progression during Active Surveillance: Volume or Diameter Increase?

Maria Cristina Campopiano¹, Antonio Matrone¹, Teresa Rago¹

¹Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy.

Journal of Clinical Medicine

|September 28, 2021

Summary

Active surveillance for micropapillary thyroid carcinoma (mPTC) needs refined progression criteria. A 50% volume increase is overly sensitive, suggesting growth rate assessment for better patient management.

Keywords:

active surveillance differentiated thyroid cancer management observation papillary thyroid microcarcinoma tailored treatment for thyroid cancer

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Area of Science:

Endocrinology
Oncology
Surgical Oncology

Background:

Active surveillance (AS) is a viable alternative to immediate surgery for micropapillary thyroid carcinoma (mPTC).
Defining clinical progression during AS for mPTC remains controversial, impacting treatment decisions.

Purpose of the Study:

To evaluate tumor size changes using both diameter and volume measurements in mPTC patients undergoing AS.
To determine if a ≥50% volume increase accurately reflects mPTC progression during AS.

Main Methods:

Retrospective analysis of 109 mPTC patients on an AS protocol.
Assessment of tumor size changes via diameter and volume measurements over a mean follow-up of 31 months.
Calculation of tumor growth rates (mm³/month).

Main Results:

17.4% of mPTC (19/109) showed a ≥50% volume increase, but only 15.7% (3/19) met diameter-based progression criteria.
Mean growth rate in stable cases was 0.37 mm³/month.
Higher growth rates were observed in mPTC with ≥50% volume increase and those developing metastases.

Conclusions:

A ≥50% volume increase is a sensitive but potentially overly sensitive marker for mPTC progression during AS, possibly leading to unnecessary surgeries.
Tumor growth rate assessment can differentiate between high and low-growing mPTC, aiding in tailored surveillance strategies.