Active surveillance of low-risk papillary thyroid carcinoma (part I): concept, epidemiology and current situation in the world

Abstract

In recent decades, the increasing identification of thyroid nodules has led to a dramatic increase in the diagnosis and incidence rate of thyroid cancer. However, their mortality has remained stable. The largest fraction of this increase is attributable to the growing use of diagnostic technologies, which has identified an increasing number of mostly small, low cli- nical risk papillary thyroid cancers (PTC). Most of these tumors will not generate morbidity or mortality despite being untreated. Clinical practice has evolved towards a less aggressive treatment of PTC's. Active surveillance (AS) has emerged as a new therapeutic alternative within the treatment algorithm, which aims to recognize a potential minority group of pa- tients in whom their thyroid papillary carcinoma will progress clinically, and therefore in whom surgical treatment will result in greater benefit than harm. In this review we aim to describe the epidemiology ofpapillary thyroid carcinoma, the concept of active surveillance in this area and the clinical results obtained by this therapeutic approach in the different experiences carried out in the world until now.