Active Surveillance of Low-Risk Papillary Microcarcinoma of the Thyroid in Indian Scenario: Are we Ready for it? A Narrative Review

Papillary microcarcinoma (PMC) is defined as papillary thyroid carcinoma(PTC) measuring≤1cm, irrespective of the presence or absence of the high‑risk features. PMCs without any high‑risk features referred to as the low‑risk PMCs are generally indolent, and most of them remain latent without progression or with very slow progression. Active surveillance(AS)(observation without immediate surgery) could identify the small minority of PMCs that progress and rescue surgery for these PMCs should be effective resulting in no influence on the patients’ prognosis than performing immediate surgery which might result in more harm than good due to associated morbidity. Hence, with proper patient selection, organization, and patient counseling, AS has the potential to be a long‑term management strategy for patients with PMC. The recent update of the American Thyroid Association guidelines(2015) incorporated AS as an option within the management protocol of PTC, making it a considerable rather than an experimental treatment option. The cost for immediate surgery is higher than the medical costs of AS for 10years in most scenarios. Developing countries like India may have certain limitations such as lack of understanding, financial constraints, and lack of adequate radiology services, hence we propose additional recommendations along with standard surveillance strategy.