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Evolving management considerations in active surveillance for micropapillary thyroid carcinoma

Ho, Allen S.a,b; Chen, Irenea,c; Melany, Michellea,c; Sacks, Wendy L.a,d

Current Opinion in Endocrinology, Diabetes and Obesity: October 2018 - Volume 25 - Issue 5 - p 353–359
doi: 10.1097/MED.0000000000000438
THYROID: Edited by Lewis E. Braverman and Angela M. Leung

Purpose of review To summarize developments on active surveillance for micropapillary thyroid cancers, with a focus on strategies for optimal risk stratification and caveats that currently limit adoption.

Recent findings Observational trials encompassing thousands of active surveillance patients worldwide have increasingly demonstrated the viability of active surveillance for small, low-risk thyroid cancers. Collectively, these data have established that with proper patient selection and strict monitoring, more than 85% of such cases remain indolent no meaningful clinical growth over at least 10 years. Moreover, to date no cases of symptomatic progression or distant metastasis have been reported, and that delayed treatment when needed has not led to unresectable disease or higher risk of complications. Deeper investigation to better predict clinical progression is necessary to improve patient selection, given concerns regarding patient anxiety, age eligibility, and underestimation of true disease extent.

Summary Compelling data from ongoing trials support active surveillance as a first-line management option for micropapillary thyroid carcinomas. Proper risk stratification and strict monitoring protocols will be necessary to sustain the excellent results achieved to date. Broad adoption of active surveillance will require further education, collaboration, and equipoise between physicians and patients to optimize such individualized treatment plans.

aSamuel Oschin Comprehensive Cancer Institute

bDepartment of Surgery, Division of Otolaryngology-Head and Neck Surgery

cDepartment of Radiology

dDepartment of Medicine, Division of Endocrinology, Cedars-Sinai Medical Center, Los Angeles, California, USA

Correspondence to Allen S. Ho, MD, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third St., Suite 590W, Los Angeles, CA 90048, USA. Tel: +1 310 423 1220; fax: +1 310 423-1230; e-mail: allen.ho@cshs.org

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