Table 1A Risk-Stratified Approach to Decision-Making for Probable or Proven Papillary Microcarcinoma
Candidate for observation |
Ideal |
Appropriate |
Inappropriate |
Tumor characteristics |
Solitary thyroid nodule Well-defined margins Surrounded by at least 2 mm of normal thyroid parenchyma No evidence of extrathyroidal extension Previous US documenting stability cN0 cM0 |
Multifocal PTMCs Subcapsular locations not adjacent to RLN without evidence of extrathyroidal extension Ill-defined margins Background US findings that will make follow-up difficult FDG-avid PTMCs |
Evidence of aggressive cytology on FNA Subcapsular locations adjacent to RLN Evidence of extrathyroidal extension Clinical evidence of invasion of RLN or trachea N1 disease at initial evaluation or identified during follow-up M1 disease Documented increase in size of 3 mm or more in a confirmed PTC |
Patient characteristics |
Older patients (at least 60 years) Willing to accept an active surveillance approach Understanding that surgical intervention may be necessary in the future Expected to be compliant with FU plans Supportive significant others Life-threatening comorbidities |
Middle-aged patients (18–59 years) Strong family history of PTC Childbearing potential |
Young patients (less than 18 years) Unlikely to be compliant with FU plans Not willing to accept an observation approach |
Medical team characteristics |
Experienced multidisciplinary management team High-quality neck US
Prospective data collection Tracking/reminder program to ensure proper FU |
Experienced endocrinologist or thyroid surgeon Neck US routinely available |
Reliable neck US not available Little experience with thyroid cancer management |