title: Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance?
abstract: The incidence of differentiated thyroid cancer is increasing greatly in high-income countries. Roughly 50% of this increase is attributable to the identification of intrathyroidal papillary thyroid microcarcinomas. Since mortality associated with these tumours remains low and stable, the increasing diagnosis has led to concerns about overdiagnosis and overtreatment. Management of papillary thyroid microcarcinomas should take into account the reported absence of mortality when diagnosed in the absence of lymph node metastases and distant metastases, as shown even in recent studies promoting active surveillance; a low recurrence rate of 1-5%; and the risk of permanent complications from surgery that cannot be decreased to less than 1-3%, even in high-volume tertiary care centres with experienced surgeons. On the basis of these data, active surveillance with curative intent, in which active treatment is delayed until the cancer shows signs of significant progression to avoid side-effects of treatment, should be considered in properly selected patients.
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France. Electronic address: sophie.leboulleux@gustaveroussy.fr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Leboulleux
authors.affiliation: Endocrinology Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Tuttle
authors.affiliation: Section of Endocrinology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
authors.forename: Furio
authors.initials: F
authors.lastname: Pacini
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Schlumberger
mesh_terms: D002291:Carcinoma, Papillary; D006801:Humans; D000069342:Medical Overuse; D013964:Thyroid Neoplasms; D057832:Watchful Waiting