{"title":"Ultrasound-Guided Thermal Ablation vs Surgery in T1N0M0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-analysis.","authors":"Yanwei Chen, Jianming Li, Shuangshuang Zhao, Zheng Zhang, Yun Cai, Huajiao Zhao, Xin Zhang, Baoding Chen","doi":"10.1016/j.acra.2025.02.048","DOIUrl":null,"url":null,"abstract":"<p><strong>Rationale and objectives: </strong>Ultrasound-guided thermal ablation (TA) offers a minimally invasive alternative to surgery for T1N0M0 papillary thyroid carcinoma (PTC), but its efficacy and safety remain controversial. This meta-analysis aimed to evaluate and compare the outcomes of TA and surgery in treating T1N0M0 PTC, encompassing both T1a and T1b stages.</p><p><strong>Materials and methods: </strong>We conducted a systematic review and meta-analysis including studies comparing TA and surgery for T1N0M0 PTC up to October 23, 2024. Standardized mean differences and odds ratios (OR) with 95% confidence intervals (CI) were calculated for primary and secondary outcomes.</p><p><strong>Results: </strong>Sixteen studies with a total of 5045 patients were analyzed. No significant differences were observed in recurrence (OR=1.464; 95% CI=0.881, 2.433; P=.141), lymph node metastasis (OR=0.817; 95% CI=0.492, 1.356; P=.434), transient hoarseness (OR=0.700; 95% CI=0.339, 1.445; P=.334), hematoma (OR=0.528; 95% CI=0.187, 1.492; P=.228), and infection (OR=0.368; 95% CI=0.060, 2.268; P=.281). Notably, TA significantly reduced permanent hoarseness, hypoparathyroidism, dysphagia, procedure time, hospitalization, cost, estimated blood loss, and surgical incision (all P<.05). The subgroup analyses demonstrated similar primary outcomes within each subgroup, including tumor stage (T1a/T1b), type of TA (microwave/radiofrequency), and follow-up time (short-term/long-term).</p><p><strong>Conclusion: </strong>Ultrasound-guided TA is a safe and effective alternative to surgery for both T1a and T1b stages of T1N0M0 PTC, offering comparable prognostic outcomes with fewer complications, lower costs, and faster recovery.</p>","PeriodicalId":50928,"journal":{"name":"Academic Radiology","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.acra.2025.02.048","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
Ultrasound-Guided Thermal Ablation vs Surgery in T1N0M0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-analysis.
Rationale and objectives: Ultrasound-guided thermal ablation (TA) offers a minimally invasive alternative to surgery for T1N0M0 papillary thyroid carcinoma (PTC), but its efficacy and safety remain controversial. This meta-analysis aimed to evaluate and compare the outcomes of TA and surgery in treating T1N0M0 PTC, encompassing both T1a and T1b stages.
Materials and methods: We conducted a systematic review and meta-analysis including studies comparing TA and surgery for T1N0M0 PTC up to October 23, 2024. Standardized mean differences and odds ratios (OR) with 95% confidence intervals (CI) were calculated for primary and secondary outcomes.
Results: Sixteen studies with a total of 5045 patients were analyzed. No significant differences were observed in recurrence (OR=1.464; 95% CI=0.881, 2.433; P=.141), lymph node metastasis (OR=0.817; 95% CI=0.492, 1.356; P=.434), transient hoarseness (OR=0.700; 95% CI=0.339, 1.445; P=.334), hematoma (OR=0.528; 95% CI=0.187, 1.492; P=.228), and infection (OR=0.368; 95% CI=0.060, 2.268; P=.281). Notably, TA significantly reduced permanent hoarseness, hypoparathyroidism, dysphagia, procedure time, hospitalization, cost, estimated blood loss, and surgical incision (all P<.05). The subgroup analyses demonstrated similar primary outcomes within each subgroup, including tumor stage (T1a/T1b), type of TA (microwave/radiofrequency), and follow-up time (short-term/long-term).
Conclusion: Ultrasound-guided TA is a safe and effective alternative to surgery for both T1a and T1b stages of T1N0M0 PTC, offering comparable prognostic outcomes with fewer complications, lower costs, and faster recovery.
期刊介绍：
Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.
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