PDF(Pubmed)
Abstract：
The indolent nature and favorable outcomes associated with papillary thyroid microcarcinoma have prompted numerous prospective studies on active surveillance (AS) and its adoption as an alternative to immediate surgery in managing low-risk thyroid cancer. This article reviews the current status of AS, as outlined in various international practice guidelines. AS is typically recommended for tumors that measure 1 cm or less in diameter and do not exhibit aggressive subtypes on cytology, extrathyroidal extension, lymph node metastasis, or distant metastasis. To determine the most appropriate candidates for AS, factors such as tumor size, location, multiplicity, and ultrasound findings are considered, along with patient characteristics like medical condition, age, and family history. Moreover, shared decision-making, which includes patient-reported outcomes such as quality of life and cost-effectiveness, is essential. During AS, patients undergo regular ultrasound examinations to monitor for signs of disease progression, including tumor growth, extrathyroidal extension, or lymph node metastasis. In conclusion, while AS is a feasible and reliable approach for managing lowrisk thyroid cancer, it requires careful patient selection, effective communication for shared decision-making, standardized follow-up protocols, and a clear definition of disease progression.
摘要：
与甲状腺乳头状微癌相关的惰性性质和良好的结局促使许多关于主动监测（AS）的前瞻性研究及其作为立即手术治疗低危甲状腺癌的替代方法。本文回顾了AS的现状，正如各种国际惯例准则所概述的那样。AS通常建议用于直径为1厘米或更小的肿瘤，并且在细胞学上没有表现出侵袭性亚型。甲状腺外延伸，淋巴结转移,或远处转移。为了确定最适合AS的候选人，肿瘤大小等因素，location,多重性,并考虑了超声检查结果，以及病人的特征，如医疗状况，年龄,和家族史。此外，共同决策，其中包括患者报告的结果，如生活质量和成本效益，是必不可少的。在AS期间，患者接受定期超声检查以监测疾病进展的迹象，包括肿瘤生长，甲状腺外延伸，或淋巴结转移。总之,虽然AS是管理低风险甲状腺癌的可行和可靠的方法，这需要仔细选择病人，有效沟通，共同决策，标准化的后续协议，和疾病进展的明确定义。
