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Ho-Ryun Won Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea

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Min Gyu Kim Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea

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Min Soo Kim Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea

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Jae Won Chang Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea

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Bon Seok Koo Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea

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as 1993, a management protocol using active surveillance (AS) was attempted for PTMC patients, mainly in Japan. The results of approximately 10 years of follow-up were reported ( 9 , 10 ), and based on those results, AS was accepted as an effective

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Sang-Hyeon Ju Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea

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Yong Bae Ji Department of Otolaryngology–Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea

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Minchul Song Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea

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Joung Youl Lim Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea

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Da Beom Heo Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea

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Min-Gyu Kim Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea

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Jae Won Chang Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea

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Ho-Ryun Won Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea

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Yea Eun Kang Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea

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Eu Jeong Ku Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea

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Mijin Kim Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea

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Eun Kyung Lee Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang-si, Republic of Korea

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June Young Choi Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea

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Hyeong Won Yu Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea

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Young Joo Park Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

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Jun-Ho Choe Division of Endocrine Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea

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Bon Seok Koo Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
Department of Otorhinolaryngology–Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea

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the MASTER study group †
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the MASTER study group

.6–4.8% between 2003 and 2019 ( 4 ). Consequently, given the resulting prevalence of low-risk papillary thyroid carcinoma (PTC) patients and the burden posed by the potential complications, active surveillance (AS) has received increased attention ( 6 , 7

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Andrew G Gianoukakis The Lundquist Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Torrance, California, USA

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Jennifer H Choe Department of Medicine, Duke University Medical Center/Duke Cancer Institute, Durham, North Carolina, USA

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Daniel W Bowles Division of Medical Oncology, University of Colorado, Aurora, Colorado, USA

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Marcia S Brose Department of Otorhinolaryngology: Head and Neck Surgery, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA

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Lori J Wirth Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA

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Taofeek Owonikoko Winship Cancer Institute of Emory University, Atlanta, Georgia, USA

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Svetlana Babajanyan Bayer HealthCare Pharmaceuticals, Whippany, New Jersey, USA

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Francis P Worden Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA

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for active surveillance. Real-world data suggest that delaying MKI therapy until rapid disease progression may result in a suboptimal clinical benefit ( 9 ). However, there is no consensus on when to initiate MKI therapy. To elucidate the optimal

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Carla Gambale Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

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Alessandro Prete Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

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Chiara Romei Department of Diagnostic Imaging, Unit of Radiology, Pisa University Hospital, Pisa, Italy

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Alessandro Celi Department of Surgery, Medicine, Molecular Biology and Critical Care, Respiratory Pathophysiology Unit, Pisa University Hospital, Pisa, Italy

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Rossella Elisei Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

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Antonio Matrone Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

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distant metastases were detected. Therefore, an active surveillance strategy was chosen. At the following evaluation (June 2020) CTN values increased (3254 ng/L) and 2 small (<1 cm) suspicious liver metastases were detected by abdomen magnetic resonance

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Ian D Hay Department of Medicine 1, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA

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Suneetha Kaggal Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA

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Geoffrey B Thompson Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA

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postoperative years, only 85/1318 (6%) of the BT-alone patients were being actively followed (remaining at risk), as were 89/541 (16%) of the BT+RRA patients, probably consistent with a greater intensity of postoperative tumor surveillance in those patients who

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Stéphane Bardet Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France

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Renaud Ciappuccini Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France

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Livia Lamartina Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Villejuif, France

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Sophie Leboulleux Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Villejuif, France

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low tumour burden, active surveillance was advised. In June 2017, CT and CEA levels were 1097 ng/L and 9.5 µg/L, respectively, and MRI detected new small pelvic bone lesions, so treatment with denosumab was initiated. The symptoms were slowly but

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Yasuhiro Ito Department of Surgery, Kuma Hospital, Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, Japan

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Akira Miyauchi Department of Surgery, Kuma Hospital, Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, Japan

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-to-lymphocyte ratio (NLR) is an inflammatory marker that reflects the imbalance between immune surveillance and tumor progression; an increased number of neutrophils and a decreased lymphocyte ratio are thought to reflect carcinoma progression and immunological

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Furio Pacini Section of Endocrinology, University of Siena, Siena, Italy

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Dagmar Fuhrer Department of Endocrinology, Diabetes and Metabolism, West German Cancer Centre (WTZ), University Hospital Essen, University Duisburg-Essen, Essen, Germany

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Rossella Elisei Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Daria Handkiewicz-Junak Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland

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Sophie Leboulleux Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, Cedex, France

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Markus Luster Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany

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Martin Schlumberger Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, Cedex, France

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Johannes W Smit Radboud University Medical Center, Nijmegen, Netherlands

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surgery (lobectomy rather than total thyroidectomy), changes in DTC nomenclature, for example, NIFTP and the concept of 'active surveillance' in (very) low-risk PTC ( 8 , 12 ). Indeed, despite the inevitable body radiation exposure, the risk of the

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Carla Gambale Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Alessandro Prete Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Lea Contartese Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Liborio Torregrossa Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University Hospital of Pisa, Pisa, Italy

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Francesca Bianchi Department of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy

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Eleonora Molinaro Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Gabriele Materazzi Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Endocrine Surgery, University Hospital of Pisa, Pisa, Italy

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Rossella Elisei Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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Antonio Matrone Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy

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an ER at last evaluation (19/40 (47%)), belonged to the BiR/InR group after the second 131 I treatment. Among them, 10 patients received other 131 I treatments, while nine patients became ER without other active treatments during the follow

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Jaume Capdevila Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), IOB Quiron-Teknon, Barcelona, Spain

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Desiree’ Deandreis Department of Medical Sciences, Nuclear Medicine Unit, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy

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Cosimo Durante Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

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Sophie Leboulleux Service of Endocrinology, Diabetology, University Hospital Geneve, Geneve, Switzerland

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Markus Luster Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany

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Romana Netea-Maier Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands

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Kate Newbold Royal Marsden Hospital, London, United Kingdom

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Susanne Singer Institute of Medical Biostatistics Epidemiology and Informatics (IMBEI), University Medical Center of Johannes Gutenberg University, Mainz, Germany

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Gerasimos P Sykiotis Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

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Beate Bartes Association “Vivre sans Thyroïde”, Léguevin, France

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Kate Farnell Butterfly Thyroid Cancer Trust, Rowlands Gill, Tyne & Wear, UK

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Laura Deborah Locati Medical Oncology Unit, IRCCS ICS Maugeri, Pavia, Italy
Department of Internal Medicine and Therapeutics, University of Pavia, Italy

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cytology, according to which patients are assigned to surveillance or surgery. Many patients who undergo surgery will receive post-surgical therapy with radioactive iodine (RAI) and thyroid-stimulating hormone (TSH) suppression, which can improve long

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