Management Of Sonographically Suspicious Thyroid Nodules 1 Cm Or Smaller And Candidacy For Active Surveillance: Experience Of A Tertiary Center In China

Objective: Our objective was to investigate the management of patients with asymptomatic suspicious thyroid nodules <= 1 cm.Methods: We retrospectively reviewed medical records of patients with sonographically suspicious thyroid nodules <= 1 cm and without distant metastases, suspicious lymph node metastasis (LNM), or extrathyroidal extension (ETE).Results: Of the 386 enrolled patients, 174 (45.1%) had immediate surgery (IS), while 212 (54.9%) underwent active surveillance (AS). In the IS group, 166 (95.4%) patients were confirmed as having papillary thyroid microcarcinoma. LNM and ETE were observed in 24.7% and 2.4% cases, respectively. In the AS group, nodule size increased by >= 3 mm in 11 (5.2%) patients and 39 (18.4%) had a >50% increase in nodule volume after a median follow-up of 12 months. Nodules with smaller volume at diagnosis were more likely to increase in volume later. Newly suspicious LNM was detected in 23 (10.8%) patients. Delayed surgery (DS) was performed in 101 patients, with 27 showing disease progression. ETE and LNM were detected in 3% and 36%, respectively, of patients with papillary thyroid microcarcinoma. Compared with IS, tumors in the DS group more frequently showed lateral LNM and capsular invasion (P <.05). No patient had recurrence or died of thyroid cancer during postoperative follow-up (median 26 [4-60] months).Conclusions: IS or DS of patients with asymptomatic suspicious thyroid nodules <= 1 cm was relatively high in China. The inertia of low-risk nodules and the effectiveness of DS for those that progressed make AS a feasible strategy. (C) 2021 AACE. Published by Elsevier Inc. All rights reserved.