Management of sonographically suspicious thyroid nodules 1 cm or smaller and candidacy for active surveillance: Experience of a tertiary center in China.

OBJECTIVE 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%) performed immediate surgery (IS), while 212 (54.9%) underwent active surveillance (AS). In IS group, 166 (95.4%) patients were confirmed as having papillary thyroid microcarcinoma (PTMC). LNM and ETE were observed in 24.7% and 2.4% cases, respectively. In 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 are more likely to increase in volume later. Newly suspicious LNM was detected in 23 (10.8%) patients. Delayed surgery (DS) were performed in 101 patients, with 27 showing disease progression. ETE and LNM were detected in 3%, 36% respectively, of patients with PTMC. Compared with IS, tumors in DS group more frequently showed lateral LNM and capsular invasion (P < 0.05). No patient had recurrence or died of thyroid cancer during postoperative follow-up [median 26 (4-60) months]. CONCLUSION 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 progressed make AS to be a feasible strategy.