Radiofrequency and microwave ablation as promising minimally invasive treatment options for papillary thyroid micro-carcinoma: a systematic review.

Abstract

Introduction: Ultrasound-guided thermal ablation has progressively emerged in the treatment of benign thyroid nodules. More recently, thermal ablation has also been proposed as a promising treatment alternative for papillary thyroid microcarcinoma (PTMC). This systematic review evaluates the efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of PTMC.

Methods: The PubMed and Cochrane databases were searched for relevant studies up to December 2023 following PRISMA guidelines. Volume reduction rate (VRR), complete disappearance rate (CDR), and associated complications following RFA and MWA were analysed.

Findings: A total of 33 articles were included. Follow-up time ranged from 11 to 130 months. The efficacy of both MWA and RFA on PTMC was remarkable, with VRR reaching up to 99% at 12-month follow-up in the vast majority of patients, while CDR exceeded 80% in most studies. Following ablation, temporary complications at relatively low rates were reported including regional discomfort, voice change and haematoma, except for only one case with permanent recurrent laryngeal nerve injury.

Conclusions: Ultrasound-guided thermal ablation of PTMC is a promising therapeutic approach for patients who are ineligible for, or refuse, surgery. Current research suggests that RFA and MWA provide favourable, low-cost outcomes, but larger multicentre, randomised studies are required to confirm the feasibility and safety of this new treatment modality.