Korean Journal of Radiology

  • 제25권8호
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  • Pages.749-755
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  • 2024
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Ultrasound Imaging in Active Surveillance of Small, Low-Risk Papillary Thyroid Cancer

  • Sangeet Ghai (Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women's College Hospital, University of Toronto) ;
  • David P Goldstein (Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto) ;
  • Anna M Sawka (Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto)
  • 투고 : 2024.02.08
  • 심사 : 2024.05.11
  • 발행 : 2024.08.01
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초록

The recent surge in the incidence of small papillary thyroid cancers (PTCs) has been linked to the widespread use of ultrasonography, thereby prompting concerns regarding overdiagnosis. Active surveillance (AS) has emerged as a less invasive alternative management strategy for low-risk PTCs, especially for PTCs measuring ≤1 cm in maximal diameter. Recent studies report low disease progression rates of low-risk PTCs ≤1 cm under AS. Ongoing research is currently exploring the feasibility of AS for larger PTCs (<20 mm). AS protocols include meticulous ultrasound assessment, emphasis on standardized techniques, and a multidisciplinary approach; they involve monitoring the nodules for size, growth, potential extrathyroidal extension, proximity to the trachea and recurrent laryngeal nerve, and potential cervical nodal metastases. The criteria for progression, often defined as an increase in the maximum diameter of the PTC, warrant a review of precision and ongoing examinations. Challenges exist regarding the reliability of volume measurements for defining PTC disease progression. Although ultrasonography plays a pivotal role, challenges in assessing progression and minor extrathyroidal extension underscore the importance of a multidisciplinary approach in disease management. This comprehensive overview highlights the evolving landscape of AS for PTCs, emphasizing the need for standardized protocols, meticulous assessments, and ongoing research to inform decision-making.

키워드

과제정보

The authors have received the following grant funding to support research on active surveillance or surgery for management of small, low risk papillary thyroid cancer: Ontario Academic Health Sciences Centres Alternate Funding Plan Innovation Grant (Ontario Ministry of Health), the Canadian Cancer Society (Lotte and John Hecht Memorial Foundation Innovation Grant, #703948 and the Innovation to Impact Grant, #706302), as well as the Canadian Institutes of Health Research (Project Grant, #PJT-162314). Anna M Sawka is supported, in part, by a Scientific Merit award from the University of Toronto Department of Medicine.

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