Thyroid Nodule, Thyroid Neoplasms, Thyroid Cancer
Conditions
Brief summary
This is a pilot study to compare two ways of managing newly identified thyroid nodules that are likely to be cancerous based on ultrasound result and which under usual care would undergo immediate biopsy. The main goals of this pilot study are 1) compare anxiety at 6 months in each treatment arm using the validated instrument Anxiety-CA, 2) measure thyroid quality of life in each treatment arm Participants will be randomized to one of two groups: 1. immediate biopsy (usual care) 2. Active monitoring (serial ultrasound based monitoring and close clinical follow-up)
Interventions
PROCEDUREBiopsy
Local anesthetic is usually given and a small needle is used to take cells from the thyroid under ultrasound guidance through several 'passes' and placed into specialized media for pathology evaluation.
PROCEDUREActive Monitoring
Ultrasound and a check-up at 6 months. Depending on ultrasound results, either biopsy and further care (as for the treatment arm called 'biopsy'), or continue with active monitoring.
Sponsors
Dartmouth-Hitchcock Medical Center
American College of Radiology
Dartmouth College
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Participants must be ≥18 years of age. * Participants must be able and willing to provide informed consent or have a surrogate capable of providing same. * Participants must be absent of symptoms referable to the nodule: dysphagia or nodule physically visible and/or bothersome to patient. * Participants' thyroid nodule must have a TI-RADS rating of 4 or 5. * Participants thyroid nodule must be ≤2 cm in largest diameter. * Participants must be being considered for biopsy. * Participants with a prior history of papillary thyroid cancer are eligible.
Exclusion criteria
Patients who fall into one of the following categories will NOT be eligible for this study: * Adults who are unable to provide informed consent. * Patients for whom biopsy is not a consideration. * Patients with a prior history of thyroid cancer other than papillary thyroid cancer. * Patients with a history of radiation to the neck. * Patients who are athyroidal (thyroid gland has been removed or patient has only lingual thyroid tissue). * Patients who have ultrasound evidence of one or more of the following: * Airway invasion of the nodule. * Nodule adjacency to/invading the recurrent nerve. * Extra-thyroidal invasion by the nodule. * Patients who have metastasis to cervical lymph nodes (confirmed by needle biopsy if ultrasound suspicious), distant metastases, if identified) testing not required, not usual care) * Patients who have already had a biopsy of the nodule being considered for inclusion in the study. TRAIL Pilot Integrated QRI: Inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Anxiety at 6 months | 6 months after randomization | Rate of anxiety will be measured using Anxiety-CA instrument PROMIS-Anxiety Short form. Each question has five response options ranging in value from one to five. (1 = never experiencing a type of distressing emotion; 5 = always feeling that emotion). To find the total raw score for a short form with all questions answered, sum the values of the response to each question. For the adult PROMIS Anxiety 7a short form, a raw score of 10 converts to a T-score of 46.7 with a standard error (SE) of 2.6. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Representativeness of enrolled participants compared to eligible participants | 6 months after randomization. | Representativeness will be compared in terms of age in years (continuous), biological male or female (categorical), and race/ethnicity (categorical). |
| Study Procedure compliance | 6 months after randomization | Rate of completion of patient reported outcomes and number of participants who withdraw from study or are lost to follow-up. |
| Clinical outcomes: needle biopsy cytology results (if done), | 6 months after randomization. | A needle biopsy is a procedure to obtain samples of tissue or cells from thyroid nodule or lymph nodes to reveal whether a nodule is a benign tumor or cancer. Bethesda classification (ordinal) will be used. The Bethesda system identifies six diagnostic categories on thyroid nodule cytopathology. Each category is linked to a malignancy risk. Categories are as follows: Category I (Nondiagnostic), Category II (Benign), Category III (Atypical of undetermined significance), Category IV (Suspicious for follicular neoplasm), Category V (suspicious for malignancy), Category VI (Malignant). If Cytology results shows Bethesda V or VI, then histology (categorical) will be performed. |
| Clinical outcomes: pathology at surgery (if surgery performed), | 6 months after randomization. | Histologic examination (Categorical) will be performed to make diagnosis. Histology is a medical practice to review tissues under microscope to identify potential changes in a suspected tissue. The histological exam will help to diagnose if cancer is present or not and to find out the histologic type of the suspected tissue. The histologic types for thyroid cancer are as follows: Papillary, follicular, oncocytic, medullary, and anaplastic. |
| Clinical outcomes; Nodule size | Baseline and 6 months after randomization. | If patient is on active monitoring, then the nodule size will be followed with ultrasound exams. |
| Score on selected domains of the ThyPRO short form instrument | 3 and 6 months post randomization | The ThyPRO survey is a quality-of-life measure designed to evaluate how thyroid disease has affected the participant's life. Domains being used from this measure for the pilot study include symptoms (8 items), tiredness (2 items), and memory and concentration (3 items). Answer choices range from 1 (not at all) to 5 (very much) with higher scores indicating worse quality of life. |
Countries
United States
Contacts
CONTACTMichaela M Geffert, BS
PRINCIPAL_INVESTIGATORLouise Davies, MD, MS
Dartmouth-Hitchcock Medical Center
Outcome results
None listed