A Systematic Review of Primary Active Surveillance for Low Risk Papillary Thyroid Cancer

      Active Surveillance (AS) is close follow-up of neoplasms, with pre-determined intervention triggers, for disease progression. We systematically reviewed the published English language literature on patients with papillary thyroid cancer (PTC) under primary AS (in lieu of surgery). A librarian information specialist searched 7 electronic databases (1980 until May 2015) and a handsearch of relevant journals and cross-references was conducted. Two reviewers independently screened the citations from the electronic search and reviewed relevant full-text papers. There was consensus on included papers. Two reviewers independently abstracted the included papers and the results were summarized. We screened 1,715 unique electronic citations and reviewed 32 full-text papers. We included 2 studies, including patients with PTC microcarcinoma (primary 10mm or less in maximal diameter), confined to the thyroid. Neither study reported on a comparative surgical arm. AS included clinical examination and cross-sectional imaging, once or twice a year. Surgical triggers included incident enlargement of the primary tumor or metastases. Respective studies included 1235 and 322 patients, followed for a mean of 5 and 6 years. The rates rate of thyroidectomy in patients under AS in these studies was 15.5% (191/1235) and 8.7% (28/322). The incidence of primary tumor enlargement 3 or more mm in maximal diameter was 4.6% (58/1235) and 5.0% (16/322). The incidence of nodal metastases was 1.5% (19/1235) and 0.9% (3/322). No distant metastatic disease occurred. No PTC-related deaths were reported, in the largest study, reporting this outcome. In conclusion, AS of PTC microcarcinoma appears safe but more long-term controlled studies are needed.
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