Papillary Thyroid Microcarcinoma: Active Surveillance Against Surgery. Considerations of an Italian Working Group From a Systematic Review

Introduction Active surveillance is considered a viable option for papillary thyroid microcarcinoma. Since the last decade of the 20th century, this method has spread from Japan to other countries, but has not yet been fully accepted and validated by the major Western Scientific Societies. In 2016, a systematic review on the results of active surveillance was published, based on two articles that showed encouraging results. Other reviews published subsequently, were mainly based on articles from the Far East. The aim of this review is to assess the most recent results published from 2017 to 2020 on this subject. Materials and Methods A systematic literature search was performed on MEDLINE via PUBMED, Web of Science, and Scopus according to PRISMA criteria. The MESH terms papillary thyroid microcarcinoma and active surveillance were adopted. Tumor progression, secondary localizations, and quality of life were the main benchmarks. Results Nine studies met the inclusion criteria. The increase in volume ranged from 2.7% and 23.2%; the occurrence of lymph node metastases from 1.3% to 29%; QoL was improved in both articles that addressed this topic. The level of evidence is considered low due to the retrospective and uncontrolled nature of most of the studies included in the review. Conclusion The evidence from the literature currently available on AS falls into two strands: a robust data set from the Japanese experience, and an initial experience from Western countries, whose data are still limited but which show a lack of substantial alerts against this practice. Further data is useful to validate the spread of Active Surveillance.

Automated summary

This review examines the most recent findings on active surveillance (AS) for papillary thyroid microcarcinoma published from 2017 to 2020. The study includes nine articles and finds that tumor volume increased by 2.7% to 23.2%, lymph node metastases occurred in 1.3% to 29% of cases, and quality of life was improved in the articles that addressed this topic. However, the evidence is considered low due to the retrospective and uncontrolled nature of most of the studies.