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Papillary microcarcinoma growth uncommon in pregnant women
Pregnancy and delivery do not affect the progression of tumor growth in Japanese women with low-risk papillary microcarcinoma of the thyroid, according to research in Thyroid.
Yasuhiro Ito, MD, PhD, of the department of surgery at Kuma Hospital in Japan, and colleagues analyzed data from 50 women with low-risk papillary microcarcinoma who experienced 51 pregnancies and deliveries and participated in an active papillary microcarcinoma surveillance program between 1993 and 2013 at Kuma Hospital (mean age at delivery, 33 years). Within the cohort, 29 women were positive for thyroid antibodies; six of those patients had Graves’ disease. All women underwent ultrasound 1 year or less before pregnancy to investigate tumor size; 48 patients underwent ultrasound within 1 year after delivery; two patients underwent ultrasound 22 and 26 months, respectively, after delivery; and 32 patients underwent ultrasound at least once during pregnancy. Researchers considered a papillary microcarcinoma to have enlarged when the tumor size grew by at least 3 mm; a single sonographer re-evaluated the changes in size of patients’ tumors before and after pregnancy to minimize observer variation.
Researchers found that four of the women experienced an increase in tumor size (8%), with one patient experiencing a decrease in tumor size. The remaining 46 patients had tumors that remained unchanged in size. No patients experienced novel lymph node metastases during pregnancy.
Of the four patients with tumor growth, two underwent surgery after delivery due to size enlargement during pregnancy, and two continued the active surveillance (one tumor remained stable; the other decreased in size).
Six more patients underwent surgery after delivery for reasons other than disease progression due to pregnancy and delivery. Among those, two opted out of active surveillance, two were identified with a nodal metastasis during active surveillance after delivery, one had Graves’ disease and one showed enlargement of nodules of the contralateral lobe.
“Despite the fact that long-term surveillance should be performed and further studies with larger series of pregnant patients are needed to draw more reliable conclusions, it can currently be concluded that [papillary microcarcinoma] growth during pregnancy is not a common event, suggesting that a possible future pregnancy does not preclude patients with [papillary microcarcinomas] from undergoing active surveillance, although watchful observation during the pregnancy is recommended,” the researchers wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
Callout: “A possible future pregnancy does not preclude patients with [PAPILLARY MICROCARCINOMAS] from undergoing active surveillance, although watchful observation during the pregnancy is recommended.”