IMPLEMENTING LONG-TERM ACTIVE SURVEILLANCE FOR PATIENTS WITH T1B PAPILLARY THYROID CARCINOMA IN BULGARIA: AN EXTENDED MONITORING APPROACH

AUTHORS:
P. Pakataridis (Sofia, Bulgaria) , F. Chelmis (Sofia, Bulgaria) , I. Sorotou (Sofia, Bulgaria) , R. Pandev (Pleven, Bulgaria)
Background:
The occurrence of T1b papillary thyroid carcinomas (PTC) is common in healthy adults, and mostly exhibit minimal risk. To mitigate the risk of unnecessary surgical intervention among low-risk PTC patients, we propose the adoption of a follow-up protocol.
Methods:
Prospective surveillance conducted at a single center on an outpatient basis spanning from 2014 to 2023. Seventeen patients, aged between 22 and 52, opted for observation rather than immediate surgical intervention. Inclusion criteria: Patients exhibiting classical variant PTC with a diameter < 20mm based on FNA findings (BETHESDA Category V or VI, T1bNoMo=17), The patients declined the surgical treatment at the time of the cytological diagnosis. Twelve patients with PTC 11-15mm. Five patients with PTC 16-18mm. Follow-up protocol: evaluations every 6-12 months, TSH levels and neck ultrasounds. Follow-up period ranged from 17 to 116 months. Criteria for performing Surgery: increase in size, presence of suspicious lymph nodes, or the patient's preference.
Results:
2 out of 17 patients underwent surgery for size enlargement n=1), ultrasound suspected lymph nodes (n=0), patient request (n=1). Final histology revealed in 2 cases PTC. 15 patients were just followed-up without evidence of clinical progression. None of the patients showed distant metastases or died during observation. TNM patients' data: pT1bNoMo(n=2).
Conclusions:
Our encounter with low-risk PTC underscores active surveillance as a possible option for specific cases of T1b PTCs ≤15mm. Should active surveillance become unfeasible, surgeons can explore alternative methods such as RFA or surgical excision.