Efficacy and safety of thermal ablation in papillary thyroid carcinoma with sonographic tracheal adhesions: a preliminary analysis.

Background: Microwave ablation (MWA) has demonstrated promising efficacy in management of papillary thyroid carcinoma (PTC). Tracheal adhesions present a significant clinical challenge in these patients, necessitating systematic analysis of MWA outcomes to establish evidence-based protocols for this complex subgroup.

Purpose: To evaluate safety and efficacy of MWA for PTC with sonographically classified mild and moderate tracheal adhesions.

Methods: This retrospective study analyzed 103 pathologically confirmed PTC patients with mild and moderate tracheal adhesions treated by MWA between January 2018 and December 2024. Primary endpoints included technical success and complications; secondary endpoints comprised disease progression, volume reduction rate, and tumor disappearance. Risk factors for hoarseness were screened through logistic analyses and integrated into a predictive nomogram, evaluated using receiver operating characteristic (ROC) curve and calibration chart.

Results: Complete ablation was achieved in all patients. Complications were documented in 23.3% of cases, with 20.4% experiencing temporary hoarseness. Disease progression occurred in 1.9% of cases. Complete tumor disappearance was observed in 33.0% of cases, with 90.0% achieving ≥75% volume reduction rate at 2 years follow-up. Multivariable logistic analysis identified minimal tumor-trachea distance ≤3.9 mm (OR = 15.52, 95% CI: 3.93-61.36) and absence of anechoic areas (OR = 4.25, 95% CI: 1.15-15.68) following hydrodissection as significant predictors of hoarseness. The predictive nomogram demonstrated strong discrimination (the area under the ROC curve = .85).

Conclusions: Ultrasound-guided MWA demonstrates safety and efficacy for PTC with mild and moderate tracheal adhesions. The developed nomogram may facilitate clinical decision-making during treatment planning.