ObjectiveTo explore the value of active surveillance (AS) with ultrasound for papillary thyroid microcarcinoma (PTMC) tumor growth.MethodsA retrospective collection of 196 patients who underwent ultrasound-guided fine-needle aspiration biopsy at West China Hospital of Sichuan University from January 2014 to December 2018 were pathologically diagnosed as PTMC, and no cervical lymph node metastasis was found on ultrasound, and AS was performed. According to the change of the maximum diameter of the nodule, the patients were divided into the maximum diameter increase group, the maximum diameter stable group and the maximum diameter reduction group. According to the nodule volume change, the patients were divided into the volume increase group, the volume stable group and the volume reduction group. The differences in the patients’ gender, age, with Hashimoto’s thyroiditis, follow-up time, tumor size, boundary, shape, echo, aspect ratio, calcifications, multifocality, bilateral involvement, other nodule, surrounding tissues and cervical lymph nodes among the different groups were analyzed in order to clarify the related factors of tumor growth.ResultsOne hundred and ninety-six patients had ultrasound AS time ranging from 6 to 79 months with the median (quartile) time were 16.0 (10.0, 30.0) months. One hundred and seventeen patients (59.7%) were in AS for 6 to 63 months with the median (quartile) time were 13.0. (8.0, 22.0), surgical treatments were performed after termination of AS. Forty-five patients (23.0%) continued to perform AS, 34 patients (17.3%) did not continue to perform AS in West China Hospital of Sichuan University. There was no significant reduction in the maximum diameter and volume of the nodules in all cases. Among them, 9 cases (4.6%) had an increase in the maximum diameter of the nodules, and 187 cases (95.4%) had a stable maximum diameter. Forty cases (20.4%) had an increase in the volume of the nodules, and 156 cases (79.6%) had a stable volume of the nodules. Comparison of the maximum diameter change of nodules between the two groups, there was a significant difference in the age of patients (P<0.05). Comparison of the maximum volume change between the two groups, there were significant differences in age, follow-up time and initial nodule volume (P<0.05). Logistic regression analysis showed that younger age was an independent risk factor for PTMC nodule growth [OR＝0.638, 95%CI (0.601, 0.675), P＝0.015].ConclusionsYounger age is a risk factor for PTMC tumor growth. We should adopt a more active monitoring program for younger patients. The increase of PTMC tumor volume can be more easily monitored than the increase of its maximum diameter, so it can be used as an indicator to predict nodule growth at an earlier stage in AS.
ObjectiveTo summarize the research progress in the treatment of papillary thyroid microcarcinoma (PTMC) , and provide rationalized treatment strategies for patients with PTMC. MethodsRetrieved and reviewed relevant literatures about the treatment of PTMC in recent years both at home and abroad. ResultsLow-risk and high-risk PTMC differ markedly in biological characteristics and prognosis and should be treated differently. For high-risk PTMC, surgery is the primary treatment, supplemented by endocrine and radioiodine therapy. Various options are available for low-risk PTMC, including surgery, active surveillance, and ablative therapy. Surgery is the preferred option with clear efficacy and diversified surgical options. However, there are surgical risks and postoperative complications. Active surveillance avoids surgical and/or postoperative complications. Thermal ablation is minimally invasive with a low impact on thyroid function. Still, both active surveillance and thermal ablation lack the results of large samples with long-term follow-up to validate effectiveness and safety. ConclusionsStratified management should be applied to PTMC. High-risk PTMC should be treated surgically. All three treatment options of low-risk PTMC have advantages and disadvantages, which should be considered in conjunction with the patients’ wishes. After careful assessments and fully informed communications with patients, doctors and patients work together to develop a rationalized and individualized PTMC treatment strategy.
ObjectiveTo summarize the latest research progress in active surveillance of low-risk papillary thyroid microcarcinoma at home and abroad, and provide some reference for future clinical work. MethodRetrieved and reviewed relevant literatures about prospective studies on active surveillance of papillary thyroid microcarcinoma.ResultsIn recent years, the incidence of papillary thyroid microcarcinoma had increased sharply, but most of the biological activities were inert, tumor-specific mortality was very low, and only a few had progressed. For patients with papillary thyroid microcarcinoma, surgery was a safe and effective treatment method, but due to changes in the epidemiological characteristics of the disease, people were reconsidering whether there was overtreatment in patients without high-risk characteristics. Expert consensus and guidelines no matter at home or abroad mentioned that active monitoring can be considered as an alternative to surgery. For suitable patients, active monitoring might be a better choice.ConclusionsActive surveillance for low-risk papillary thyroid microcarcinoma is basically considered to be a safe and feasible treatment option, but large numbers of clinical trials are still needed to provide evidence for the conversion of conventional clinical treatment models. In the future, by more accurately assessing the tumor progression of patients with low-risk papillary thyroid microcarcinoma, active surveillance is promising to alternate surgical treatments.
Organ preservation after neoadjuvant therapy for esophageal cancer has gained significant attention. While the CROSS trial established neoadjuvant chemoradiotherapy (nCRT) followed by surgery as standard care, approximately 30% of patients achieve pathological complete response (pCR), prompting exploration of active surveillance (AS). The landmark SANO phase Ⅲ trial (2025) demonstrated non-inferior 2-year overall survival (74% AS vs. 71% surgery), with 31% of patients avoiding surgery. Multimodal assessment (endoscopic deep biopsy+endoscopic ultrasound+PET-CT) reduced residual disease misdiagnosis to 10%. The Asian-led NEEDS trial is evaluating definitive chemoradiotherapy with salvage surgery. Although immunotherapy boosts pCR rates to 40%-55%, challenges persist, including 8%-12% false-negative cCR assessments, limited long-term data, and East-West histological disparities. The 2024 NCCN guidelines conditionally recommend AS (Category 2B, prioritized for squamous cell carcinoma), emphasizing centralized implementation. Future directions involve circulating tumor DNA and radiomics for risk stratification to advance precise organ-preserving strategies.
The evidence base, technical specifications and clinical implementation conditions of organ preservation strategies after neoadjuvant therapy for esophageal cancer were systematically reviewed, to provide an integrated framework for precise clinical decision-making. Based on the SANO randomized controlled trial and a series of diagnostic accuracy studies, the evolution of active surveillance (AS), the performance of multimodal evaluation techniques, and the outcomes of salvage treatment after recurrence were summarized. The SANO trial demonstrated that patients with rigorously selected clinical complete response (cCR) who received AS had a 2-year overall survival rate of 74%, which was non-inferior to the immediate surgery group (71%; absolute difference 0%, 95%CI –7% to 7%). Thirty-one percent of patients successfully avoided esophagectomy by the end of follow-up. However, the 2-year disease-free survival rate was significantly lower in the AS group than that in the surgery group (74% vs. 92%). The locoregional recurrence rate was 48%, the 30-day mortality rate after salvage esophagectomy following definitive chemoradiotherapy reached 11%, which was 3.7-fold higher than that of elective surgery (RR=3.67, 95%CI 2.89-4.66); whereas in the SANO study, the 30-day mortality rate of salvage surgery after neoadjuvant chemoradiotherapy with active surveillance for recurrence was 4%, showing no significant difference compared with the 5% observed in the immediate surgery group. The false-negative rate of cCR assessment was 13.5%-19.2%, with a negative predictive value of only 68.7%, indicating that approximately one in three patients judged as cCR actually had residual disease. Current evidence with immature long-term survival data does not support AS as a routine recommendation. This strategy should be strictly limited to high-volume esophageal cancer centers, patients with esophageal squamous cell carcinoma, highly consistent multimodal evaluations, and fully informed and highly compliant patients. Future studies are needed to optimize risk stratification using biomarkers such as circulating tumor DNA, and to balance quality-of-life benefits and oncological safety through adaptive therapeutic strategies.