Active Surveillance of Larger Malignant Thyroid Nodules Explained with Dr. Bikas скачать в хорошем качестве

Active Surveillance of Larger Malignant Thyroid Nodules Explained with Dr. Bikas

We are honored to have Dr. Thanos Bikas present "Non-operative, Active Surveillance of Larger Malignant & Suspicious Thyroid Nodules." Dr. Samantha Newman joins as the featured expert discussant. 0:00 Webinar 2:36 Dr. Bikas presents The prevalence of thyroid nodules rises, especially among women. Despite an increase in aggressive thyroid cancers, most cases are non-aggressive, with 95% confined to the thyroid and regional lymph nodes. The necessity of total thyroidectomy is questioned, as lobectomy offers comparable disease-free survival for intermediate-risk patients. This study assesses the impact of active surveillance on large thyroid nodules. 12:26 Results The study follows 69 patients with suspicious or malignant thyroid nodules for 55 months. Patients had Bethesda 5 (33%), Bethesda 6 (21%), or “suspicious” Afirma results (46%). 81% were managed with active surveillance, while 19% underwent delayed surgery. Mean nodule size was 2.1 cm, with 38% having nodules over 2 cm. No new lymph node or distant metastasis was observed. Nodule growth occurred in 21% of patients, with 50% volume growth in 25% of cases. Surgery patients had larger nodules. 20:53 Discussion This study includes both suspicious and malignant cases. Active surveillance is unsuitable for patients with clinical lymph node metastasis, aggressive subtypes, or tumors invading the RLN or trachea. Ideal candidates have a solitary intrathyroidal nodule (1-1.5 cm) with stability, no metastasis, and are typically older. Regular ultrasound monitoring is crucial, with surgery recommended if significant growth occurs. Active surveillance may lower anxiety and costs, though more research is needed. 30:14 Conclusions No adverse oncologic outcomes were reported with active surveillance or delayed surgery. The findings support a more permissive strategy for thyroid cancer management, suggesting an expanded patient pool for active surveillance and the integration of genomics and metabolomics. 31:50 Dr. Newman presents Well-differentiated PTC often shows microscopic lymph node metastases. Most thyroid cancers remain subclinical. The challenge lies in deciding who to observe, managing low-volume recurrences, and considering patients hesitant about surgery. Neck ultrasounds may not always detect progression, especially in RAS mutant tumors, which are prone to hematogenous spread. 45:46 Discussion with Q&A ** Check out our other programs! ** The THANC Guide https://thancguide.org/ TIRO: Thyroid Int'l Recommendations Online https://tiro.expert/ ** Follow us on Twitter! ** @thancfoundation - https://shorturl.at/puwS0 THANC on FB - https://shorturl.at/svNY4