Active surveillance or surgical resection? A survey of treatment strategies for low-risk papillary thyroid microcarcinoma in adults.

OBJECTIVE

The purpose of this study was to investigate the clinical status of active monitoring [active surveillance (AS)] or surgical resection for adult low-risk papillary thyroid microcarcinoma (cT1aN0M0 PTMC) in the military and some local medical institutions in southern China.

METHODS

A questionnaire survey was conducted on the actual treatment mode of adult PTMC patients in the member institutions of the Southern Theater Command General Surgery Specialty Alliance. The respondents mainly included surgeons engaged in the surgical treatment of thyroid diseases.

RESULTS

A total of 36 medical institutions received replies, and the average annual volume of thyroid surgery in these institutions exceeded 100 cases. For suspicious nodules detected via ultrasound, routine fine-needle aspiration cytology (FNAC) for all suspicious nodules was recommended by six institutions (16.7%); nine (25.0%) performed FNAC only for nodules larger than 10 mm. After diagnosis, AS was recommended by six institutions (16.7%), immediate surgery was recommended by six institutions (16.7%), and 13 institutions (36.1%) left the treatment decision to the patient. For the AS protocol, 22 institutions recommended initial monitoring every 3 months, and 11 recommended every 6 months. When obvious clinical symptoms, new lymph node metastasis, or extrathyroidal invasion appeared, these institutions tended to convert from AS to surgery. During the continuous 3-month period selected by each institution from 2024 to 2025, among 474 PTMC patients, 228 (48.1%) underwent immediate surgery as initial treatment, 175 (36.9%) chose initial AS, and 63 (13.3%) received radiofrequency/microwave ablation. Of the 175 patients initially managed with AS, 49 (28.0% of the AS group) subsequently underwent surgery. Correlation analysis showed that the number of patients undergoing surgery was significantly higher in general surgery departments and in institutions with a larger number of thyroid surgeons (p < 0.05). At the same time, the number of patients receiving AS was significantly higher in tertiary hospitals (p < 0.05).

CONCLUSION

Within our specialized alliance member institutions, more than one-third of low-risk PTMC patients have adopted AS as their management strategy. However, significant variability exists across medical institutions regarding the indications and implementation protocols for AS. To facilitate the broader and more standardized application of AS, it is essential to strengthen educational efforts directed at both clinicians and patients and to develop more refined, population-specific clinical guidelines or expert consensus for the management of low-risk PTMC in the Chinese population.