The active surveillance management approach for patients with low risk papillary thyroid microcarcinomas: is China ready?

Abstract

Due to exponential increases in incidences, low risk papillary thyroid microcarcinoma (PTMC) has become a clinical and social issue in recent years. An active surveillance (AS) management approach is an alternative to immediate surgery for patients with low risk PTMC. With decreased doubts about the safety and validity due to evidence from a large number of studies, the AS approach has become increasingly popular worldwide. However, Chinese thyroid surgeons still lag behind other countries in their knowledge of clinical practices and research related to AS. To promote the implementation of AS in China, thyroid surgeons should understand the implications, advantages, and disadvantages of management approaches for AS, and should also consider the willingness of Chinese patients, the impact on the medical billing system, and the enthusiasm of doctors. Thus, a management approach for AS based on the Chinese population should be developed to reduce the risk of disease progression and enhance patient adherence. Herein, we summarize the recent research achievements and deficiencies in AS approaches, and describe the initial experiences regarding AS in the Chinese population, in order to assist Chinese thyroid surgeons in preparing for AS management in the era of PTMC precision medicine.

Keywords: Papillary thyroid carcinoma; active surveillance; microcarcinoma; observation.

Figure 1

Anatomical position diagram of the thyroid. (A) Anterior view. (B) Posterior view. LRLN, left recurrent laryngeal nerve; RRLN, right recurrent laryngeal nerve.

Figure 2

Axial plane diagram of the thyroid. (A) The different levels of risk for the presence and absence of a normal rim between tumor and adjacent tissues. (a) The strap muscles are infiltrated when tumors located on the ventral side progress and penetrate into the thyroid capsule. (b) Tumors located on the dorsal side with a normal rim between the tumor and the course of RLN. (c) Tumors located on the dorsal side without a normal rim between the tumor and the course of the RLN. RLN, recurrent laryngeal nerve. (B) Different angles between the tumor surface and tracheal cartilage. (a) Acute angle; (b) Nearly right angle; (c) Obtuse angle.