Choosing optimal microcarcinoma patients for active surveillance study (COMPASS) - effectiveness evaluation of a pre-operative clinical framework

ABSTRACT Objective Active surveillance (AS) is a management alternative for patients with low risk papillary thyroid microcarcinoma (PTMC). To decide the best candidates for AS, clinicians can use a framework to classify PTMC patients as ideal, appropriate or inappropriate. The aim of this study is to explore the correlation of the framework categories and surgical pathology. Methods This was a multicenter retrospective study between 2014 and 2016. Totally 1997 patients who underwent thyroid surgery for the first time due to suspected PTMC and confirmed as PTMC by postoperative pathology were included. Consistence of a modified preoperative risk stratification and the pathologic condition were evaluated using consistency ratio and Kappa test. Stratified analysis was also performed to test consistency in different age groups. Results Based on the decision-making framework, 558 (27.9%) patients could receive AS. While 810 (40.6%) patients did not require immediate surgery according to the actual postoperative pathology. The sensitivity, false positive rate, specificity, false negative rate and consistency rate were 82.39%, 56.91%, 43.09%, 17.61% and 66.45% respectively. The Kappa value was 0.268. Stratified analysis showed that the sensitivity was 87.7% among patients between ages 18 and 59. In over 60 years group, the specificity was up to 87.5% but the sensitivity was low. Conclusions The results of modified risk-stratified clinical decision-making framework do not have a high consistency with the postoperative results. However, the framework shows good effect in selecting patients for immediate surgery in the younger group and the ones for AS in the older group.