Active Surveillance for Low-Risk Thyroid Cancers: A Review of Current Practice Guidelines

Abstract

The indolent nature and favorable outcomes associated with papillary thyroid microcarcinoma have prompted numerous prospective studies on active surveillance (AS) and its adoption as an alternative to immediate surgery in managing low-risk thyroid cancer. This article reviews the current status of AS, as outlined in various international practice guidelines. AS is typically recommended for tumors that measure 1 cm or less in diameter and do not exhibit aggressive subtypes on cytology, extrathyroidal extension, lymph node metastasis, or distant metastasis. To determine the most appropriate candidates for AS, factors such as tumor size, location, multiplicity, and ultrasound findings are considered, along with patient characteristics like medical condition, age, and family history. Moreover, shared decision-making, which includes patient-reported outcomes such as quality of life and cost-effectiveness, is essential. During AS, patients undergo regular ultrasound examinations to monitor for signs of disease progression, including tumor growth, extrathyroidal extension, or lymph node metastasis. In conclusion, while AS is a feasible and reliable approach for managing lowrisk thyroid cancer, it requires careful patient selection, effective communication for shared decision-making, standardized follow-up protocols, and a clear definition of disease progression.

Advances in clinical research on ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma

“…It offers an alternative to invasive procedures by accommodating patient preferences and minimizing exposure to surgical risks. This strategy aligns with the latest guidelines which suggest careful patient selection to avoid overtreatment, particularly in cases characterized by low-risk prognostic factors ( 23 ).…”

“…This conservative approach entails periodic monitoring through ultrasound and other diagnostic tools, without immediate surgical or ablative interventions ( 22 ). Supported by longitudinal studies that indicate a high stability rate of these microcarcinomas over time, active surveillance prioritizes patient safety and quality of life ( 23 ). It offers an alternative to invasive procedures by accommodating patient preferences and minimizing exposure to surgical risks.…”

Association between exercise habits and incident type 2 diabetes mellitus in patients with thyroid cancer: nationwide population-based study

“…Fourth, we could not include patients with thyroid cancer without thyroidectomy because we defined thyroid cancer patients who have a thyroid cancer code of ICD-10 within 1 year of thyroidectomy. However, since almost all patients with thyroid cancer in Korea receive thyroidectomy for the treatment of thyroid cancer, it is believed that there are very few patients who did not undergo thyroidectomy but active surveillance [ 32 ]. Fifth, we could not evaluate effects on incident T2DM between regular exercisers and unregular exercisers because patients who did not regular exercise included not only those who did unregular exercise but also those who did not exercise at all.…”