Active surveillance in low risk papillary thyroid carcinoma

Area of Science:

• Endocrinology
• Oncology
• Public Health

Background:

• Thyroid cancer incidence has surged globally, yet mortality remains stable.
• This rise is largely due to detecting intrathyroidal papillary microcarcinomas, which are slow-growing and indolent.
• Many diagnoses may represent overdiagnosis, as these tumors rarely cause death if untreated.

Purpose of the Study:

• To review the epidemiology, clinical course, prognostic factors, and mortality of papillary thyroid microcarcinomas.
• To summarize active surveillance (AS) strategies based on published evidence.
• To analyze patient selection criteria, risk factors, and limitations for AS implementation.

Main Methods:

• Systematic review of published evidence on papillary thyroid microcarcinomas and active surveillance.
• Analysis of epidemiological data, clinical evolution, and prognostic indicators.
• Evaluation of criteria for patient selection in active surveillance protocols.

Main Results:

• Papillary microcarcinomas are frequently overdiagnosed, with low mortality rates.
• Active surveillance (AS) is an emerging alternative to surgery, identifying patients needing intervention.
• Psychosocial factors significantly influence the clinical adoption of AS.

Conclusions:

• Active surveillance is a viable option for managing papillary microcarcinomas, reducing overtreatment.
• Careful patient selection based on risk factors is crucial for successful AS.
• Addressing psychosocial barriers is essential for broader AS implementation in clinical practice.