Claudio R Cernea1, Leandro Luongo Matos2,3,4, Cecília Eugênio2, Giovanna Mattos Ferreira5, Yasmin Sa Cerqueira5, Ana Kober N Leite3,4, Felipe A B Vanderlei6, Dorival de Carlucci6, Renato N Gotoda6, Flávio C Hojaij7, Vergilius J F Araújo-Filho6. 1. Department of Surgery, Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil. cerneamd@gmail.com. 2. Department of Head and Neck Surgery, Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil. 3. São Paulo State Cancer Institute (Instituto do Câncer do Estado de São Paulo - ICESP), São Paulo, Brazil. 4. Hospital Israelita Albert Einstein, School of Medicine, São Paulo, Brazil. 5. Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil. 6. Head and Neck Surgery of the Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil. 7. Department of Topographic Anatomy, Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil.
Abstract
PURPOSE OF THE REVIEW: There has been an increasing interest on active surveillance for papillary thyroid microcarcinomas (PTMC) in the literature. We will analyze the contributions of those authors who support this approach in most patients with low-risk tumors. RECENT FINDINGS: The development of molecular methods to effectively detect aggressive PTMC at the fine-needle aspiration biopsy will enable the sound indication of immediate surgery in those patients, assuring the other individuals with the far more frequent indolent PTMC will undergo active surveillance with less anxiety. Several studies compared the quality of life between patients with PTMC who underwent active surveillance with immediate total thyroidectomy. However, thyroid lobectomy is a quite acceptable intermediate alternative for most patients with PTMC, with less surgical morbidity. It is important to wait for worldwide validation, with reports from low- and middle-income areas, before recommending the routine adoption of active surveillance for patients with PTMC, due to difficult logistic obstacles in those environments.
PURPOSE OF THE REVIEW: There has been an increasing interest on active surveillance for papillary thyroid microcarcinomas (PTMC) in the literature. We will analyze the contributions of those authors who support this approach in most patients with low-risk tumors. RECENT FINDINGS: The development of molecular methods to effectively detect aggressive PTMC at the fine-needle aspiration biopsy will enable the sound indication of immediate surgery in those patients, assuring the other individuals with the far more frequent indolent PTMC will undergo active surveillance with less anxiety. Several studies compared the quality of life between patients with PTMC who underwent active surveillance with immediate total thyroidectomy. However, thyroid lobectomy is a quite acceptable intermediate alternative for most patients with PTMC, with less surgical morbidity. It is important to wait for worldwide validation, with reports from low- and middle-income areas, before recommending the routine adoption of active surveillance for patients with PTMC, due to difficult logistic obstacles in those environments.
Authors: R Michael Tuttle; James A Fagin; Gerald Minkowitz; Richard J Wong; Benjamin Roman; Snehal Patel; Brian Untch; Ian Ganly; Ashok R Shaha; Jatin P Shah; Mark Pace; Duan Li; Ariadne Bach; Oscar Lin; Adrian Whiting; Ronald Ghossein; Inigo Landa; Mona Sabra; Laura Boucai; Stephanie Fish; Luc G T Morris Journal: JAMA Otolaryngol Head Neck Surg Date: 2017-10-01 Impact factor: 6.223