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Related Experiment Video

Updated: Jan 31, 2026

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Active Surveillance for Papillary Thyroid Microcarcinoma: Challenges and Prospects.

Shuai Xue1, Peisong Wang1, Zachary A Hurst2

  • 1Thyroid Surgery Department, The First Hospital of Jilin University, Changchun, China.

Frontiers in Endocrinology
|January 9, 2019
PubMed
Summary

Active surveillance for low-risk papillary thyroid microcarcinoma (PTMC) is feasible. Advances in imaging and biomarkers improve the selection of candidates, enhancing safety and effectiveness for this thyroid cancer management strategy.

Keywords:
active surveillancebiomarkerimagingpapillary thyroid microcarcinomarecurrence

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Area of Science:

  • Endocrinology
  • Oncology
  • Diagnostic Imaging

Background:

  • Active surveillance (AS) is an alternative to immediate surgery for low-risk papillary thyroid microcarcinoma (PTMC).
  • Historically, AS for PTMC faced controversy due to limited evidence and concerns regarding diagnostic accuracy.
  • Key challenges included ultrasound's limitations in detecting extrathyroidal extension (ETE) and lymph node metastasis (LNM).

Purpose of the Study:

  • To review current imaging modalities and biomarkers for selecting patients for AS in PTMC.
  • To address controversies surrounding AS in PTMC management.
  • To enhance the safety and effectiveness of AS for PTMC.

Main Methods:

  • Literature review summarizing publications on AS for PTMC.
  • Evaluation of diagnostic performance of ultrasound (US) and computed tomography (CT) for ETE and LNM.
  • Assessment of recent advances in imaging sensitivity/specificity and diagnostic biomarkers.

Main Results:

  • Ultrasound alone has limited accuracy for diagnosing gross ETE and LNM in PTMC; CT-US combination offers improved diagnostic performance.
  • Low-risk PTMC patients on AS showed a slightly higher LNM rate than immediate surgery patients, but overall rates remained low.
  • Improved imaging and biomarkers enhance differentiation between indolent and aggressive PTMCs, increasing confidence in AS candidate selection.

Conclusions:

  • Current advancements in imaging and biomarkers show promise for safer and more effective AS candidate selection in PTMC.
  • Further research is crucial to address challenges and promote AS adoption for PTMC.
  • AS is a viable option for carefully selected low-risk PTMC patients.