Abstract
Thyroid cancer is the most common endocrine malignancy, representing 2.9% of all new cancers in the United States. It has an excellent prognosis, with a five-year relative survival rate of 98.3%.Differentiated Thyroid Carcinomas (DTCs) are the most diagnosed thyroid tumors and are characterized by a slow growth rate and indolent course. For years, the only approach to treatment was thyroidectomy. Active surveillance (AS) has recently emerged as an alternative approach; it involves regular observation aimed at recognizing the minority of patients who will clinically progress and would likely benefit from rescue surgery. To better clarify the indications for active surveillance for low-risk thyroid cancers, we reviewed the current management of low-risk DTCs with a systematic search performed according to a PRISMA flowchart in electronic databases (PubMed, Web of Science, Scopus, and EMBASE) for studies published before May 2021. Fourteen publications were included for final analysis, with a total number of 4830 patients under AS. A total of 451/4830 (9.4%) patients experienced an increase in maximum diameter by >3 mm; 609/4830 (12.6%) patients underwent delayed surgery after AS; metastatic spread to cervical lymph nodes was present in 88/4213 (2.1%) patients; 4/3589 (0.1%) patients had metastatic disease outside of cervical lymph nodes. Finally, no subject had a documented mortality due to thyroid cancer during AS. Currently, the American Thyroid Association guidelines do not support AS as the first-line treatment in patients with PMC; however, they consider AS to be an effective alternative, particularly in patients with high surgical risk or poor life expectancy due to comorbid conditions. Thus, AS could be an alternative to immediate surgery for patients with very-low-risk tumors showing no cytologic evidence of aggressive disease, for high-risk surgical candidates, for those with concurrent comorbidities requiring urgent intervention, and for patients with a relatively short life expectancy.
Highlights
Thyroid cancer is the most common endocrine malignancy, representing 2.9% of all new cancers in the United States (US)
Considering the data in the literature and the available evidence, we reviewed the current management of low-risk Differentiated thyroid cancer (DTC), and papillary microcarcinomas (PMCs) in particular, to better clarify the indications for active surveillance for low-risk thyroid cancers
We identified a total of 2976 articles, of which 87 articles were selected for full text review
Summary
Thyroid cancer is the most common endocrine malignancy, representing 2.9% of all new cancers in the United States (US). It has an excellent prognosis, with a five-year relative survival rate of 98.3%, and has a higher frequency in females than males, with ratio of 3:1 [1]. In the last ten years, the incidence of DTC has dramatically increased. This tendency is mainly as a result of the diffusion of imaging systems, the use of ultrasound-guided Fine Needle Aspirations Cytology (FNAC), and improvements in histological evaluations [3,4]. In the last few years, active surveillance (AS) has been established as an alternative approach; it is aimed at identifying patients who would likely benefit from rescue surgery [6]
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