Clinical application of active surveillance in papillary thyroid microcarcinoma

Incidence of papillary thyroid carcinoma (PTC) has increased during last decades world-widely, especially in Korea. There are reasonable evidences which the increase of incidence may be due to real increase of incidence. However, there are more evidences that this increase is due to increase of ultrasonography screening. Furthermore, majority of increase are increase of small papillary thyroid microcarcinoma (PTMC) and mortality from thyroid carcinoma is relatively stable even though incidence increase. Thus, suspicion of over-diagnosis and over-treatment has been raised. Concept of active surveillance has been proposed from Japanese surgeons under this circumstance. Gradually, management guidelines of leading societies are accepting concept of active surveillance. However, there are unsolved problems to imply active surveillance concept in clinical situation. In this article, we will discuss concept, application and problems of active surveillance.