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Marked Decrease Over Time in Conversion Surgery After Active Surveillance of Low-Risk Papillary Thyroid

Takahiro Sasaki1, Akira Miyauchi2, Yasuhiro Ito2

  • 1Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan.

Thyroid : Official Journal of the American Thyroid Association
|July 16, 2020
PubMed
Summary

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Postoperative risk stratification using calcitonin doubling rate in medullary thyroid carcinoma with biochemical persistent disease.

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Dynamic Risk Assessment Using Unstimulated Serum Thyroglobulin Level and Thyroglobulin Doubling Rate after Total Thyroidectomy for Papillary Thyroid Carcinoma.

Thyroid : official journal of the American Thyroid Association·2025

Active surveillance for papillary microcarcinoma (PMC) is safe. Fewer patients converted to surgery in recent years, likely due to increased physician confidence and patient trust in active surveillance outcomes.

Area of Science:

  • Endocrinology
  • Oncology
  • Surgical Oncology

Background:

  • Active surveillance is a safe management strategy for low-risk papillary microcarcinoma (PMC) of the thyroid.
  • Some patients initially managed with active surveillance eventually undergo conversion surgery for various reasons.

Purpose of the Study:

  • To investigate the reasons for conversion surgery in patients with PMC undergoing active surveillance.
  • To determine if the reasons and rates of conversion surgery have changed over time.

Main Methods:

  • A cohort of 2288 patients with PMC on active surveillance was analyzed.
  • Patients were categorized by reasons for conversion surgery (disease progression, patient/physician preference, other diseases).
  • The cohort was divided into two groups based on the start of active surveillance (2005-2011 vs. 2011-2017) to assess temporal changes.
Keywords:
active surveillanceconversion surgerylymph node metastasispapillary thyroid microcarcinomatumor sizetumor volume-doubling rate

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Main Results:

  • Overall, 7.1% of patients underwent conversion surgery.
  • Patients starting active surveillance more recently (2011-2017) were significantly less likely to undergo conversion surgery compared to earlier patients (2005-2011).
  • Conversion surgery rates decreased across all major reasons (disease progression, patient preference, physician preference) in the later group.

Conclusions:

  • Active surveillance for PMC is associated with decreasing rates of conversion surgery over time.
  • Increased physician confidence and patient trust, supported by accumulating favorable outcomes data, likely contribute to the reduced conversion rates.
  • Active surveillance remains a viable and increasingly accepted management strategy for PMC.