Active surveillance for PTMC warranted for the UK population?

Area of Science:

• Endocrinology
• Oncology
• Surgical Pathology

Background:

• Global increase in thyroid cancer incidence driven by detection of subclinical papillary thyroid microcarcinomas (PTMC).
• International recommendations favor active surveillance for low-risk PTMC.
• UK's distinct approach prioritizes avoiding incidental detection of thyroid nodules.

Purpose of the Study:

• To determine the proportion of UK thyroid cancer patients eligible for active surveillance.
• To assess the applicability of active surveillance strategies within the UK healthcare system.

Main Methods:

• Retrospective review of a local thyroid cancer database (NHS Lothian, 2009-2020).
• Identification of patients with PTMC (<1 cm).
• Analysis of PTMC detection methods and pre-operative identification for active surveillance candidacy.

Main Results:

• 185 PTMC cases identified (28.4%) from 651 differentiated thyroid cancers.
• Majority of PTMC (81.6%) were incidental findings post-surgery or associated with nodal disease.
• Only 3.7% of all thyroid cancer patients were identified pre-operatively and suitable for active surveillance.

Conclusions:

• Less than 4% of UK thyroid cancer patients are appropriate candidates for active surveillance.
• Focus should remain on minimizing the detection of low-risk PTMC rather than developing surveillance programs for this minority.
• UK's current diagnostic approach limits the practical application of active surveillance for PTMC.