Table 2.

A Risk-Stratified Approach to Decision-Making in Probable or Proven Papillary Microcarcinoma

Candidates for observation	Tumor/neck US characteristics	Patient characteristics	Medical team characteristics
Ideal	Solitary thyroid nodule	Older patients (>60 years)	Experienced multidisciplinary management team
	Well-defined margins	Willing to accept an active surveillance approach
	Surrounded by ≥2 mm normal thyroid parenchyma	Understands that a surgical intervention may be necessary in the future	High-quality neck ultrasonography
	No evidence of extrathyroidal extension	Expected to be compliant with follow-up plans	Prospective data collection
	Previous US documenting stability	Supportive significant others (including other members of their healthcare team)	Tracking/reminder program to ensure proper follow-up
	cN0
	cM0	Life-threatening comorbidities
Appropriate	Multifocal papillary microcarcinomas	Middle-aged patients (18–59 years)	Experienced endocrinologist or thyroid surgeon
	Subcapsular locations not adjacent to RLN without evidence of extrathyroidal extension	Strong family history of papillary thyroid cancer
	Ill-defined margins	Child bearing potential	Neck ultrasonography routinely available
	Background ultrasonographic findings that will make follow-up difficult (thyroiditis, nonspecific lymphadenopathy, multiple other benign-appearing thyroid nodules)
	FDG-avid papillary microcarcinomas
Inappropriate	Evidence of aggressive cytology on FNA (rare)	Young patients (<18 years)	Reliable neck ultrasonography not available
	Subcapsular locations adjacent to RLN	Unlikely to be compliant with follow-up plans
	Evidence of extrathyroidal extension	Not willing to accept an observation approach	Little experience with thyroid cancer management
	Clinical evidence of invasion of RLN or trachea (rare)
	N1 disease at initial evaluation or identified during follow-up
	M1 disease (rare)
	Documented increase in size of ≥3 mm in a confirmed papillary thyroid cancer tumor

Adapted from Brito et al. [57], with permission from Mary Ann Libert, Inc.

US, ultrasonography; RLN, recurrent laryngeal nerve; FDG, fluorodeoxyglucose; FNA, fine-needle aspiration.