Active Surveillance as First-Line Management of Papillary Microcarcinoma

Annu Rev Med. 2019 Jan 27:70:369-379. doi: 10.1146/annurev-med-051517-125510. Epub 2018 Sep 19.


Papillary thyroid microcarcinoma (PMC) is defined as papillary thyroid carcinoma ≤10 mm. Active surveillance of PMC without high-risk features, such as clinical node metastasis, distant metastasis, and clinical evidence of significant extrathyroid extension, was initiated in two Japanese hospitals in the mid-1990s. This strategy was incorporated into guidelines in Japan in 2010 and in the United States in 2015. In studies conducted by the two hospitals, most PMCs grew very slowly or did not grow, and none of the patients during active surveillance showed distant metastasis or died of thyroid carcinoma. Furthermore, none of the patients who underwent surgery after progression signs were detected showed significant recurrence. Therefore, we conclude that active surveillance should be the first line in management of low-risk PMC, because it is safer and less costly than immediate surgery. Active surveillance helps in avoiding adverse events of surgery and is an economical strategy.

Keywords: active surveillance; guidelines; immediate surgery; medical cost; papillary thyroid microcarcinoma; unfavorable events.

Publication types

  • Review

MeSH terms

  • Carcinoma, Papillary / pathology
  • Carcinoma, Papillary / therapy*
  • Disease Management
  • Disease Progression*
  • Female
  • Follow-Up Studies
  • Humans
  • Japan
  • Male
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging
  • Patient Selection
  • Risk Assessment
  • Survival Rate
  • Thyroid Neoplasms / pathology*
  • Thyroid Neoplasms / therapy*
  • Thyroidectomy / methods
  • Watchful Waiting / methods*

Supplementary concepts

  • Papillary Thyroid Microcarcinoma