Papillary Thyroid Microcarcinoma: Active Surveillance Against Surgery. Considerations of an Italian Working Group From a Systematic Review

Abstract

IntroductionActive surveillance is considered a viable option for papillary thyroid microcarcinoma. Since the last decade of the 20th century, this method has spread from Japan to other countries, but has not yet been fully accepted and validated by the major Western Scientific Societies. In 2016, a systematic review on the results of active surveillance was published, based on two articles that showed encouraging results. Other reviews published subsequently, were mainly based on articles from the Far East. The aim of this review is to assess the most recent results published from 2017 to 2020 on this subject.Materials and MethodsA systematic literature search was performed on MEDLINE via PUBMED, Web of Science, and Scopus according to PRISMA criteria. The MESH terms “papillary thyroid microcarcinoma” and “active surveillance” were adopted. Tumor progression, secondary localizations, and quality of life were the main benchmarks.ResultsNine studies met the inclusion criteria. The increase in volume ranged from 2.7% and 23.2%; the occurrence of lymph node metastases from 1.3% to 29%; QoL was improved in both articles that addressed this topic. The level of evidence is considered low due to the retrospective and uncontrolled nature of most of the studies included in the review.ConclusionThe evidence from the literature currently available on AS falls into two strands: a robust data set from the Japanese experience, and an initial experience from Western countries, whose data are still limited but which show a lack of substantial alerts against this practice. Further data is useful to validate the spread of Active Surveillance.

The high degree of similarity in histopathological and clinical characteristics between radiogenic and sporadic papillary thyroid microcarcinomas in young patients

“…Avoiding overtreatment of patients with MPTCs became a challenging clinical problem in the field of endocrine oncology. Prospects of changing treatment strategies from total thyroidectomy to organ-preserving surgery or even active surveillance instead of surgery are widely debated in the medical and scientific communities (12)(13)(14)(15)(16)(17)(18)(19)(20).…”

First Application of the Orbeye™ 4K 3D Exoscope in Recurrent Papillary Thyroid Cancer Surgery

“…In most cases, it has a favourable impact on the patient’s quality of life and costs. Although the evidence refers mostly to Eastern populations, a limited but encouraging experience has been provided by Western countries [ 14 ].…”

Analysis of Therapeutic Effect and Influencing Factors of Ultrasound‐Guided Radiofrequency Ablation in the Treatment of Papillary Thyroid Microcarcinoma

“…Thyroid cancer represents a malignancy with an ever‐increasing incidence all over the world, such that approximately one third of new thyroid cancer cases are papillary thyroid microcarcinoma (PTMC) 1 . PTMC is a thyroid cancer measuring at most 1 cm in diameter 2 . Additionally, PTMC is detected in 35.6% of autopsy specimens as a latent carcinoma, whereas 11% of PTMC are associated with local invasion, lymph node, and distant metastasis 3 …”