The role of active surveillance in low-risk papillary thyroid carcinoma

Incidence of thyroid carcinoma has increased by 2- to 3-fold in many countries in the last years, reaching an epidemic 15-fold increase in Korea (1-3). The vast majority is represented by newly diagnosed thyroid papillary microcarcinoma [<10 mm, micropapillary thyroid carcinoma (mPTC)], which has probably risen because of earlier and more accurate screening programs (1-4). The natural history of mPTC is anyway quite indolent and only a small proportion of pMTCs show a progression requiring surgery (4,5). In a recent study by Ito et al., mPTC progression has been demonstrated to be inversely related to patient’s age (4). Data showed evolution of mPTC during a 10-year follow-up within the younger population (<40 years) of patients observed when compared to the older one (>60 years), regarding size enlargement (P=0.0014), lymph nodes metastases appearance (P<0.0001) and progression to clinical disease (P<0.0001) (4).