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Type: Outro documento
Title: Thyroid nodules <= 1 cm and papillary thyroid microcarcinomas: Brazilian experts opinion
Author: Rosario, Pedro Weslley
Ward, Laura Sterian
Graf, Hans
Vaisman, Fernando
Mourao, Gabriela Franco
Vaisman, Mario
Abstract: The indolent evolution of low-risk papillary thyroid microcarcinoma (mPTC) in adult patients and the consequences of thyroidectomy require a revision of the management traditionally recommended. Aiming to spare patients unnecessary procedures and therapies and to optimize the health system in Brazil, we suggest some measures. Fine-needle aspiration of nodules <= 1 cm without extrathyroidal extension on ultrasonography should be performed only in nodules classified as "very suspicious" (i.e., high suspicion according to ATA, high risk according to AACE,TI-RADS 5) and in selected cases [age <40 years, nodule adjacent to the trachea or recurrent laryngeal nerve (RLN), multiple suspicious nodules, presence of hypercalcitoninemia or suspicious lymph nodes]. Active surveillance (AS) rather than immediate surgery should be considered in adult patients with low-risk mPTC. Lobectomy is the best option in patients with unifocal low-risk mPTC who are not candidates for AS because of age, proximity of the tumor to the trachea or RLN, or because they opted for surgery. The same applies to patients who started AS but had a subsequent surgical indication not due to a suspicion of tumor extension beyond the gland or multicentricity. Molecular tests are not necessary to choose between AS and surgery or, in the latter case, between lobectomy and total thyroidectomy.The presence of RAS or other RAS-like mutations or BRAFV600E or other BRAF V600E-like mutations should not modify the management cited above; however, the rare cases of mPTC exhibiting high-risk mutations, like in the TERT promoter or p53, are not candidates for AS
Subject: Carcinoma papilar
Country: Brasil
Editor: Sociedade Brasileira de Endocrinologia e Metabologia
Rights: Aberto
Identifier DOI: 10.20945/2359-3997000000166
Date Issue: 2019
Appears in Collections:FCM - Artigos e Outros Documentos

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