Skip to main content
SpringerLink
Log in

Management of Papillary Thyroid Microcarcinoma: A Japanese Experience

  • Chapter
  • First Online:
Practical Management of Thyroid Cancer

Abstract

Active surveillance (AS) for low-risk (T1aN0M0) papillary microcarcinoma of the thyroid (PTMC) was initiated at Kuma Hospital (Kobe, Japan) in 1993 and is now being adopted worldwide. To date, favorable outcomes of patients under AS have been reported in Japan, Korea, the United States, and Italy etc. In this chapter, we describe the indications and implementation approach for AS, and compare the benefits of AS with immediate surgery. Important factors affecting PTMC progression, such as patient age, multiplicity, and thyroid stimulating hormone level, are also discussed. If appropriately implemented, AS is a safe management strategy for PTMC patients and more beneficial than immediate surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ito Y, Onoda N, Okamoto T. The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer. Endocr J. 2020;67:669–717.

    Article  PubMed  Google Scholar 

  2. Takebe K, Date M, Yamamoto Y. Mass screening for thyroid cancer with ultrasonography. Karkinos. 1994;7:309–17.

    Google Scholar 

  3. Ito Y, Miyauchi A. A therapeutic strategy for incidentally detected papillary microcarcinoma of the thyroid. Nat Clin Pract Endocrinol Metab. 2007;3:240–8.

    Article  PubMed  Google Scholar 

  4. Miyauchi A. Clinical trials of active surveillance of papillary microcarcinoma of the thyroid. World J Surg. 2016;40:516–22.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sugitani I, Ito Y, Takeuchi D, et al. Indications and strategy for active surveillance of adult low-risk papillary thyroid microcarcinoma: consensus statements from the Japan Association of Endocrine Surgery task force on management for papillary thyroid microcarcinoma. Thyroid. 2021;31:183–92.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Horiguchi K, Yoshida Y, Iwaku K, et al. Position paper from the Japan Thyroid Association task force on the management of low-risk papillary thyroid microcarcinoma (T1aN0M0) in adults. Endocr J. 2021;68:763–80.

    Article  PubMed  Google Scholar 

  8. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;595:2164–7.

    Article  Google Scholar 

  9. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg. 2014;140:317–22.

    Article  PubMed  Google Scholar 

  10. Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”—screening and overdiagnosis. N Engl J Med. 2014;371:1765–7.

    Article  PubMed  Google Scholar 

  11. Vaccarella S, Dal Maso L, Laversanne M, et al. The impact of diagnostic changes on the rise in thyroid cancer incidence: a population-based study in selected high-resource countries. Thyroid. 2015;25:1127–36.

    Article  PubMed  Google Scholar 

  12. Brito JP, Ito Y, Miyauchi A, Tuttle RM, et al. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid. 2016;26:144–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kasahara T, Miyauchi A, Ito Y, et al. Tumor volume kinetic analysis might explain excellent prognoses in young patients with papillary thyroid carcinoma. J Thyroid Res. 2020;2020:4652767. https://doi.org/10.1155/2020/4652767.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Ito Y, Miyauchi A, Oda H, et al. Revisiting low-risk thyroid papillary microcarcinomas resected without observation: was immediate surgery necessary? World J Surg. 2016;40:523–8.

    Article  PubMed  Google Scholar 

  15. Kawano S, Miyauchi A, Ito Y. Routine chest computed tomography at presentation does not identify distant metastasis in cT1aN0 papillary thyroid carcinoma. Thyroid. 2020;30:1620–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Choi JB, Lee WK, Lee SG, et al. Long-term oncologic outcomes of papillary thyroid microcarcinoma according to the presence of clinically apparent lymph node metastasis: a large retrospective analysis of 5348 patients. Cancer Manage Res. 2018;10:2883–91.

    Article  Google Scholar 

  17. Reinke R, Mathiesen JS, Larsen SR, et al. Incidental and non-incidental papillary thyroid microcarcinoma in Denmark 1996–2015: a national study on incidence, outcome and thoughts on active surveillance. Cancer Epidemiol. 2019;60:46–50.

    Article  PubMed  Google Scholar 

  18. Ito Y, Miyauchi A, Kudo T, et al. Trends in the implementation of active surveillance for low-risk papillary thyroid microcarcinomas at Kuma Hospital: gradual increase and heterogeneity in the acceptance of this new management option. Thyroid. 2018;28:488–95.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ito Y, Uruno T, Nakano K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003;13:381–7.

    Article  PubMed  Google Scholar 

  20. Ito Y, Miyauchi A, Inoue H, et al. An observation trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2010;34:28–35.

    Article  PubMed  Google Scholar 

  21. Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014;24:27–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ito Y, Miyauchi A, Fujishima M, et al. Thyroid-stimulating hormone, age, and tumor size are risk factors for progression during active surveillance of low-risk papillary thyroid microcarcinoma in adults. World J Surg. 2023;47:392–401.

    Article  PubMed  Google Scholar 

  23. Sugitani I, Toda K, Yamada K, et al. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg. 2010;34:1222–31.

    Article  PubMed  Google Scholar 

  24. Fukuoka O, Sugitani I, Ebina A, et al. Natural history of asymptomatic papillary thyroid microcarcinoma: time-dependent changes in calcification and vascularity during active surveillance. World J Surg. 2016;40:529–37.

    Article  PubMed  Google Scholar 

  25. Nagaoka R, Ebina A, Toda K, et al. Multifocality and progression of papillary thyroid microcarcinoma during active surveillance. World J Surg. 2021;45:2769–76.

    Article  PubMed  Google Scholar 

  26. Tuttle RM, Fagin JA, Minkowitz G, et al. Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance. JAMA Otolaryngol Head Neck Surg. 2017;143:1015–20.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Oh HS, Ha J, Kim HI, et al. Active surveillance of low-risk papillary thyroid microcarcinoma: a multi-center cohort study in Korea. Thyroid. 2018;28:1587–94.

    Article  PubMed  Google Scholar 

  28. Sanabria A. Experience with active surveillance of thyroid low-risk carcinoma in a developing country. Thyroid. 2020;7:985–91.

    Article  Google Scholar 

  29. Molinaro E, Campopiano MC, Pieruzzi L, et al. Active surveillance in papillary thyroid microcarcinomas is feasible and safe: experience at a single Italian center. J Elin Endocrinol Metab. 2020;105:e172–80.

    Article  Google Scholar 

  30. Tuttle RM, Fagin J, Minkowitz G, et al. Active surveillance of papillary thyroid cancer: frequency and time course of the six most common tumor volume kinetic patterns. Thyroid. 2022;32:1337–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Lee EK, Moon JH, Hwangbo Y, et al. Progression of low-risk papillary thyroid microcarcinoma during active surveillance: Interim analysis of a multicenter prospective cohort study of active surveillance on papillary thyroid microcarcinoma in Korea. Thyroid. 2022;32:1328–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Miyauchi A, Kudo T, Ito Y, et al. Natural history of papillary thyroid microcarcinoma: kinetic analyses on tumor volume during active surveillance and before presentation. Surgery. 2019;165:25–30.

    Article  PubMed  Google Scholar 

  33. Ito Y, Miyauchi A, Kudo T, et al. Kinetic analysis of growth activity in enlarging papillary thyroid microcarcinomas. Thyroid. 2019;29:1765–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Campopiano MD, Matrone A, Rago T, et al. Assessing mPTC progression during active surveillance: volume or diameter increase? J Clin Med. 2021;10:4068.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Miyauchi A, Kudo T, Ito Y, et al. Estimation of the lifetime probability of disease progression of papillary microcarcinoma of the thyroid during active surveillance. Surgery. 2018;163:48–52.

    Article  PubMed  Google Scholar 

  36. Sasaki T, Miyauchi A, Fujishima M, et al. Comparison or postoperative unfavorable events in patients with low-risk papillary thyroid carcinoma: immediate surgery versus conversion surgery following active surveillance. Thyroid. 2022;33(2):186–91. https://doi.org/10.1089/thy.2022.0444.

    Article  CAS  PubMed  Google Scholar 

  37. Fujishima M, Miyauchi A, Ito Y, et al. Active surveillance is an excellent management technique for identifying patients with progressive low-risk papillary thyroid microcarcinoma requiring surgical treatment. Endocr J. 2023;70:411–8. https://doi.org/10.1507/endocrj.EJ22-0559.

    Article  PubMed  Google Scholar 

  38. Sugitani I, Fujimoto Y, Yamada K. Association between serum thyrotropin concentration and growth of asymptomatic papillary thyroid microcarcinoma. World J Surg. 2014;38:673–8.

    Article  PubMed  Google Scholar 

  39. Kim HI, Jang HW, Ahn HS, Ahn S, Park SY, Oh YL, Hahn SY, Shin JH, Kim J-H, Kim JS, Chung JH, Kim TH, Kim SW. High serum TSH level is associated with progression of papillary thyroid microcarcinoma during active surveillance. J Clin Endocrinol Metab. 2018;103:446–51.

    Article  PubMed  Google Scholar 

  40. Ito Y, Miyauchi A, Kudo T, et al. Effects of pregnancy on papillary microcarcinomas of the thyroid re-evaluated in the entire patient series at Kuma Hospital. Thyroid. 2016;26:156–60.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Hirokawa M, Kudo T, Ota H, et al. Pathological characteristics of low-risk papillary thyroid microcarcinoma with progression during active surveillance. Endocr J. 2016;63:805–10.

    Article  CAS  PubMed  Google Scholar 

  42. Xing M, Liu R, Liu X, Murugan AK, Zhu G, Zeiger MA, Pai S, Bishop J. BRAF V600E and TERT promoter mutations cooperatively identify the most aggressive papillary thyroid cancer with highest recurrence. J Clin Oncol. 2014;32:2718–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Yabuta T, Matsuse M, Hirokawa M, et al. TERT promoter mutations were not found in papillary thyroid microcarcinomas that showed disease progression on active surveillance. Thyroid. 2017;27:1206–7.

    Article  PubMed  Google Scholar 

  44. De Biase D, Gandolfi G, Ragazzi M, et al. TERT promoter mutations in papillary thyroid microcarcinoma. Thyroid. 2015;25:1013–9.

    Article  PubMed  Google Scholar 

  45. Lee J, Ha EJ, Roh J, et al. Presence of TERT ± BRAF V600E mutation is not a risk factor for the clinical management of patients with papillary thyroid microcarcinoma. Surgery. 2021;170:743–7.

    Article  PubMed  Google Scholar 

  46. Miyauchi A, Kudo T, Kihara M, et al. Spontaneous deceleration and acceleration of growth rate in medullary thyroid carcinomas suggested by changes in calcitonin doubling times over long-term surveillance. World J Surg. 2019;43:504–12.

    Article  PubMed  Google Scholar 

  47. Ito Y, Fukushima M, Kihara M, et al. Investigation of the prognosis of patients with papillary thyroid carcinoma by tumor size. Endocr J. 2012;59:457–64.

    Article  PubMed  Google Scholar 

  48. Oda H, Miyauchi A, Ito Y, et al. Incidence of unfavorable events in the management of low-risk papillary microcarcinoma of the thyroid by active surveillance versus immediate surgery. Thyroid. 2016;26:150–5.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Lin JF, Jonker PKC, Cunich M, et al. Surgery alone for papillary thyroid microcarcinoma is less costly and more effective than long term active surveillance. Surgery. 2020;167:110–6.

    Article  PubMed  Google Scholar 

  50. Kim K, Choi JY, Kim SJ, et al. Active surveillance versus surgery for low-risk papillary thyroid microcarcinoma patients in South Korea: a cost-minimization analysis from the MAeSTro study. Thyroid. 2022;32:648–56.

    Article  CAS  PubMed  Google Scholar 

  51. Lang BH-H, Wong CKH. A cost-effectiveness comparison between early surgery and non-surgical approach for incidental papillary thyroid microcarcinoma. Eur J Endocrinol. 2015;173:367–75.

    Article  CAS  PubMed  Google Scholar 

  52. Oda H, Miyauchi A, Ito Y, et al. Comparison of the costs of active surveillance and immediate surgery in the management of low-risk papillary microcarcinoma of the thyroid. Endocr J. 2017;64:59–64.

    Article  PubMed  Google Scholar 

  53. Yoshida Y, Horiuchi K, Okamoto T. Patients’ view on the management of papillary thyroid microcarcinoma: active surveillance or surgery. Thyroid. 2020;30:681–7.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Jeon MJ, Lee Y-M, Sung T-Y, et al. Quality of life in patients with papillary thyroid microcarcinoma managed by active surveillance or lobectomy: a cross-sectional study. Thyroid. 2019;29:956–62.

    Article  CAS  PubMed  Google Scholar 

  55. Moon JH, Ryu CH, Cho SW, et al. Effect of initial treatment choice on 2-year quality of life in patients with low-risk papillary thyroid microcarcinoma. J Clin Endocrinol Metab. 2021;106:724–35.

    Article  PubMed  Google Scholar 

  56. Nakamura T, Miyauchi A, Ito Y, et al. Quality of life in patients with low-risk papillary thyroid microcarcinoma: active surveillance versus immediate surgery. Endocr Pract. 2020;26:1451–7.

    Article  PubMed  Google Scholar 

  57. Kazusaka H, Sugitani I, Toda K, et al. Patient-reported outcomes in patients with low-risk papillary thyroid carcinoma: cross-sectional study to compare active surveillance and immediate surgery. World J Surg. 2022;47(5):1190–8. https://doi.org/10.1007/s00268-022-06786-5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Kuma Hospital, Kobe, Japan

    Yasuhiro Ito, Akira Miyauchi & Makoto Fujishima

Authors
  1. Yasuhiro Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akira Miyauchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Makoto Fujishima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yasuhiro Ito .

Editor information

Editors and Affiliations

  1. Consultant Clinical Oncologist (Hon), Northern Centre for Cancer Care, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    Ujjal K. Mallick

  2. St. George’s Healthcare NHS Trust and The Royal Marsden NHS Trust, London, UK

    Clive Harmer

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ito, Y., Miyauchi, A., Fujishima, M. (2023). Management of Papillary Thyroid Microcarcinoma: A Japanese Experience. In: Mallick, U.K., Harmer, C. (eds) Practical Management of Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-031-38605-3_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-38605-3_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-38604-6

  • Online ISBN: 978-3-031-38605-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation