The active surveillance management approach for patients with low risk papillary thyroid microcarcinomas: is China ready?

Due to exponential increases in incidences,low risk papillary thyroid microcarcinoma(PTMC)has become a clinical and social issue in recent years.An active surveillance(AS)management approach is an alternative to immediate surgery for patients with low risk PTMC.With decreased doubts about the safety and validity due to evidence from a large number of studies,the AS approach has become increasingly popular worldwide.However,Chinese thyroid surgeons still lag behind other countries in their knowledge of clinical practices and research related to AS.To promote the implementation of AS in China,thyroid surgeons should understand the implications,advantages,and disadvantages of management approaches for AS,and should also consider the willingness of Chinese patients,the impact on the medical billing system,and the enthusiasm of doctors.Thus,a management approach for AS based on the Chinese population should be developed to reduce the risk of disease progression and enhance patient adherence.Herein,we summarize the recent research achievements and deficiencies in AS approaches,and describe the initial experiences regarding AS in the Chinese population,in order to assist Chinese thyroid surgeons in preparing for AS management in the era of PTMC precision medicine.

2016 Chinese expert consensus and guidelines for the diagnosis and treatment of papillary thyroid microcarcinoma

The incidence of papillary thyroid carcinoma(PTC)has exponentially increased in recent years.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of the reported cases of PTC.The debates and crucial issues in PTMC management have received researchers'attention.To further improve the clinical management of PTMC in China,

2017 Chinese expert consensus on the clinical application ofserum marker for thyroid cancer

In recent years, the clinical incidence of thyroid cancer has been increasing year by year, and its risk assessment and clinical management methods have also been accordingly modified and constantly improved. There are great differences between the clinical diagnostic and therapeutic modes and disease management of thyroid cancer employed by various medical institutions in China, particularly with regard to the clinical application of serum marker of thyroid cancer. To this end, the China Anti-Cancer Association Thyroid Cancer Specialized Committee Chinese Association of Thyroid Oncology organized this compilation of ExpertConsensus on Clinical Application of Serum Marker of Thyroid Cancer to help and impel relevant clinical institutions and professionals to standardize clinical diagnosis, treatment, and long-term management of thyroid cancer, and to properly utilize the serum marker for scientific auxiliary clinical diagnosis and assessment of thyroid cancer before and after operation.

Estimating the risk of completion total thyroidectomy using real-world data to guide initial surgical decision-making for patients with clinical low-risk papillary thyroid carcinoma

Background:Continuing controversy exists in diferent guidelines’recommendations regarding whether total thyroidectomy(TT)or lobectomy is the optimal surgery for patients with low-risk papillary thyroid carcinoma(PTC).Diverse perceptions of the risk of completion TT after lobectomy are the main debate between guidelines and institutions.Methods:Patients who underwent thyroidectomy and prophylactic central lymph node dissection for≤4 cm PTC(January 2007 to December 2020)by high-volume surgeons were included.Patients with preoperatively known highrisk characteristics or suspicious bilateral multifocality were excluded.The pathological fndings were defned as the risk stratifcations of completion TT from low to high to evaluate which initial surgical procedure could allow more patients to meet the criteria of optimal surgical extent.Results:Of 4965 consecutive patients met lobectomy criteria as the initial operation.Aggressive histological subtypes were found in 2.5%of patients,T3b disease in 1.1%,T4 disease in 3.1%,LNs involved≤5 in 29.5%,LNs involved>5 in 3.1%,and incidental bilateral multifocality in 7.9%.According to our defned risk stratifcation system,TT and lobectomy would be considered the optimal initial procedure in 12.0%and 67.2%PTC patients with a tumor≤1 cm and 28.7%and 36.6%in the 1-4 cm groups in our real-world cohort,respectively.Conclusion:Lobectomy alone,as an initial procedure,could allow more low-risk PTC patients with a tumor either≤1 cm or 1-4 cm to achieve the optimal surgical extent.Moreover,surgeons should balance the high-risk characteristics and complication risks during surgery to re-evaluate surgical decision-making.

CACA guidelines for holistic integrative management of thyroid cancer

Purpose:In recent years,thyroid cancer is a common clinical problem.Since guidelines for the diagnosis and treatment of thyroid nodules and diferentiated thyroid cancer were revised in 2012,signifcant scientifc advances have occurred in the feld.The aim of this guidelines is to inform clinicians,researchers,patients and health policy makers on published evidence and expert consensus relating to the diagnosis and management of thyroid malignancy.Methods:In order to better promote the clinical management of thyroid cancer in China,Chinese Association of Thyroid Oncology(CATO)organized relevant experts to write these guidelines based on latest relevant literatures and clinical experience of multiple centers.The specifc clinical issues and topics addressed in these guidelines were based on published evidence,prior versions of the Chinese guidelines and expert consensus.Results and conclusion:The guidelines provide recommendations for the management of diferent types of thyroid carcinoma,including papillary,follicular,medullary,and anaplastic carcinomas.