[Current treatment strategies for papillary thyroid microcarcinoma]

Area of Science:

• Oncology
• Endocrinology
• Surgical Innovation

Background:

• Papillary thyroid microcarcinoma (PTMC) treatment is increasingly controversial.
• Active surveillance is gaining traction in Western countries, mirroring practices in Japan where over 50% of PTMCs are observed.
• The debate centers on active surveillance versus traditional surgical interventions like lobectomy or total thyroidectomy.

Purpose of the Study:

• To explore the evolving landscape of PTMC treatment, focusing on the active surveillance versus surgical intervention debate.
• To identify patient subgroups potentially suitable for active surveillance.
• To highlight the critical need for shared decision-making in PTMC management.

Main Methods:

• Review of current treatment trends and observational data for PTMC.
• Analysis of factors influencing the decision for active surveillance versus surgery.
• Estimation of tumor progression risks associated with active surveillance in different age groups.

Main Results:

• Unifocal PTMCs in older patients without extrathyroidal extension or lymph node metastasis are potential candidates for active surveillance.
• Estimated lifelong observation shows a tumor progression probability exceeding 60% for patients under 30 years old.
• The decision-making process requires a thorough evaluation of risks and benefits for each patient.

Conclusions:

• The choice between surgery and active surveillance for PTMC necessitates a comprehensive discussion of pros and cons.
• Patient age is a significant factor, with younger patients facing higher progression risks under surveillance.
• Personalized treatment planning and shared decision-making are paramount in managing PTMC.