[Surgery of papillary thyroid microcarcinoma].

BACKGROUND: Different countries are currently reporting a substantial increase in the incidence rates of papillary thyroid microcarcinoma (PTMC).

OBJECTIVE: Presentation of diagnosis and surgical therapy of PTMC and discussion of a more conservative approach, such as active surveillance.

MATERIAL AND METHODS: Overview of the current guidelines from different countries and analysis of recent publications reporting the results of active surveillance of PTMC from Japan, Korea and the USA.

RESULTS: The majority of international guidelines for PTMC recommends thyroid lobectomy as the gold standard. Active surveillance as an alternative procedure is described in the Japanese guidelines (JSTS/JAES). Present surveillance studies including more than 1700 patients report a tumor growth in 8-14% of the cases during a median follow-up of up to 75 months. Tumor growth and lymph node metastases are detected most frequently in younger patients (below 40-50 years).

CONCLUSION: Active surveillance might serve as an alternative treatment option for older patients with PTMC. Since the median follow-up periods are currently not long enough, it seems difficult to draw definite conclusions of this procedure right now.