Safety and Efficacy of Thermal Ablation for Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma: A Systematic Review of Available Evidence.

Abstract

Background/objectives: Cervical lymph node metastasis and nodal recurrence remain clinically significant problems in papillary thyroid carcinoma (PTC). Thermal ablation techniques, including laser ablation (LA), radiofrequency ablation (RFA), and microwave ablation (MWA), have increasingly been investigated as minimally invasive alternatives to repeat surgery, when the latter is rejected by patients or is associated with high morbidity and technical challenges. The aim of this systematic review was to analyze the available evidence on efficacy and safety of LA, RFA, and MWA for cervical lymph node metastasis from PTC.

Methods: A literature search was conducted in PubMed, Embase, and Cochrane Library, and extracted outcomes included technical success, volume reduction rate (VRR), complete disappearance rate (CDR), serum thyroglobulin (Tg) response, local recurrence, and complications. Twenty-nine (N = 29) studies were included, eight on LA (n = 8), eleven on RFA (n = 11), and ten on MWA (n = 10).

Results: Across the included studies, all three modalities showed high technical success, progressive reduction in nodal volume, and meaningful local disease control. Safety outcomes were generally favorable across all three approaches, with most complications being mild, transient, and resolving in limited time periods.

Conclusions: Thermal ablation appears to be an effective and safe treatment option for selected patients with cervical lymph node metastasis from PTC, especially when repeat surgery is undesirable or high risk.