Oral Presentation ESA-SRB-APEG-NZSE 2022

A Clinical Decision Making Support Tool for Active Surveillance of Low Risk Papillary Thyroid Cancers (#167)

Eleanor White 1 2 , Bridget Abbott 1 3 , Geoffrey Schembri 1 3 4 , Roderick Clifton-Bligh 1 2 4 , Matti Gild 1 2 4
  1. Royal North Shore Hospital, St Leonards, NSW, Australia
  2. Endocrinology, Royal North Shore Hospital, St Leonards, NSW
  3. Nuclear Medicine , Royal North Shore Hospital, St Leonards, NSW, Australia
  4. University of Sydney, Sydney, NSW, Australia

Active surveillance (AS) is an alternative to surgery in select patients with very low risk papillary thyroid cancer (PTC). Many clinicians feel ill-equipped in selecting appropriate patients.  Our aims were: (1) develop a web-based decision support tool to assist clinicians in identifying patients appropriate for AS; and (2) evaluate the prevalence of patients suitable for AS in a tertiary centre.

A web based clinical support tool was developed utilising evidence based characteristics for AS suitability. A retrospective database was interrogated for patients who underwent hemithyroidectomy between 2012 - 2021 with final histopathology demonstrating PTC.

Between 2012 - 2021, 763 patients underwent hemithyroidectomy with final histopathology PTC. 316 patients were excluded (incomplete data, histopathology other than PTC, incidental PTC or hyperparathyroidism). We applied the tool to the remaining 447 patients. 352/447 (79%) were unsuitable due to the thyroid nodule ≥2cm. 95/447 (21%) were potentially suitable for AS. We restricted our final analysis to the cohort with pre-operative FNA demonstrating a Bethesda V or VI result 60/95 (63%).

51/60 patients were female and 9/60 male, age range between 19 – 77, median age 36.5 years. 10 patients had completion hemithyroidectomy, 4/10 demonstrating malignancy in contralateral lobe. All 4/10 had I-131 and 4/10 patients without malignancy in contralateral lobe had 1-131. No patients had evidence of disease recurrence. 

Subgroup analysis of 22 patients were analysed to ascertain if AS features were easily identifiable on pre-operative ultrasound. Overall, 18/22 (82%) patients would have been suitable utilising this tool, without incorporating 2mm to capsule. 4/22 were excluded due to presence of extrathyroidal extension on ultrasound.

Clinical support tools are an accessible way of empowering clinicians to decide suitability for active surveillance. In a cohort of patients who had hemithyroidectomy for PTC, 60/447 patients (13%) may have been suitable for AS. Further validation studies are required.