Skip to main content
SpringerLink
Log in

Thermal Ablation for the Management of Papillary Thyroid Microcarcinoma in the Era of Active Surveillance and Hemithyroidectomy

  • Interventional Oncology (DC Madoff, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Thermal ablation presents a therapeutic option other than active surveillance and immediate surgery for patients with low-risk papillary thyroid microcarcinomas (PTMC). Here, we have reviewed the current oncologic outcome of thermal ablation in PTMC cases and compared it with active surveillance and surgery.

Recent Findings

Thermal ablation in PTMC cases revealed no tumor progression for pooled 5-year follow-up data. This oncologic outcome of thermal ablation was comparable to that of immediate surgery with less morbidity. Additionally, no patient who underwent thermal ablation received delayed surgery during the follow-up period due to anxiety. However, active surveillance has indicated that a substantial proportion (range, 8–32%) of patients underwent surgery mainly due to anxiety.

Summary

In a subset of PTMC patients who are high-risk surgical candidates or who refuse surgery, especially those who have failed or are reluctant to pursue active surveillance, thermal ablation can be a good option.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295(18):2164–7.

    Article  CAS  PubMed  Google Scholar 

  2. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg. 2014;140(4):317–22.

    Article  PubMed  Google Scholar 

  3. Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”–screening and overdiagnosis. N Engl J Med. 2014;371(19):1765–7.

    Article  PubMed  Google Scholar 

  4. Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med. 2016;375(7):614–7.

    Article  PubMed  Google Scholar 

  5. Ito Y, Uruno T, Nakano K, Takamura Y, Miya A, Kobayashi K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid: Off J Am Thyroid Assoc. 2003;13(4):381–7.

    Article  Google Scholar 

  6. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid: Off J Am Thyroid Assoc. 2016;26(1):1–133.

    Article  Google Scholar 

  7. Cho SJ, Suh CH, Baek JH, Chung SR, Choi YJ, Chung KW, et al. Active surveillance for small papillary thyroid cancer: a systematic review and meta-analysis. Thyroid: Off J Am Thyroid Assoc. 2019;29(10):1399–408. This meta-analysis evaluates the oncologic outcome and the reason for delayed surgery of low-risk PTMC under active surveillance.

    Article  Google Scholar 

  8. Sugitani I, Toda K, Yamada K, Yamamoto N, Ikenaga M, Fujimoto Y. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg. 2010;34(6):1222–31.

    Article  PubMed  Google Scholar 

  9. Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2009;34(1):28.

    Article  Google Scholar 

  10. Jeon MJ, Lee YM, Sung TY, Han M, Shin YW, Kim WG, et al. Quality of life in patients with papillary thyroid microcarcinoma managed by active surveillance or lobectomy: a cross-sectional study. Thyroid: Off J Am Thyroid Assoc. 2019;29(7):956–62.

    Article  CAS  Google Scholar 

  11. Davies L, Roman BR, Fukushima M, Ito Y, Miyauchi A. Patient experience of thyroid cancer active surveillance in Japan. JAMA Otolaryngol Head Neck Surg. 2019;145(4):363–70.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid: Off J Am Thyroid Assoc. 2014;24(1):27–34.

    Article  CAS  Google Scholar 

  13. Kwon H, Oh HS, Kim M, Park S, Jeon MJ, Kim WG, et al. Active surveillance for patients with papillary thyroid microcarcinoma: a single center’s experience in Korea. J Clin Endocrinol Metab. 2017;102(6):1917–25.

    Article  PubMed  Google Scholar 

  14. Jensen CB, Saucke MC, Pitt SC. Active surveillance for thyroid cancer: a qualitative study of barriers and facilitators to implementation. BMC Cancer. 2021;21(1):471.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Li J, Liu Y, Liu J, Yang P, Hu X, Qian L. A comparative study of short-term efficacy and safety for thyroid micropapillary carcinoma patients after microwave ablation or surgery. Int J Hyperthermia: Off J Eur Soc Hyperthermic Oncol N Am Hyperthermia Group. 2019;36(1):640–6.

    Google Scholar 

  16. Cho SJ, Baek JH, Chung SR, Choi YJ, Lee JH. Long-term results of thermal ablation of benign thyroid nodules: a systematic review and meta-analysis. Endocrinol Metab. 2020;35(2):339–50.

    Article  Google Scholar 

  17. Bernardi S, Giudici F, Cesareo R, Antonelli G, Cavallaro M, Deandrea M, et al. Five-year results of radiofrequency and laser ablation of benign thyroid nodules: a multicenter study from the Italian minimally invasive treatments of the thyroid group. Thyroid: Off J Am Thyroid Assoc. 2020;30(12):1759–70.

    Article  CAS  Google Scholar 

  18. Chung S, Baek J, Choi YJ, Lee JH. Longer-term outcomes of radiofrequency ablation for locally recurrent papillary thyroid cancer. Eur Radiol. 2019;29:4897–903.

  19. Kim J-H, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, et al. 2017 Thyroid radiofrequency ablation guideline: Korean society of thyroid radiology. Korean J Radiol. 2018;19(4):632–55.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Garberoglio R, Aliberti C, Appetecchia M, Attard M, Boccuzzi G, Boraso F, et al. Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement. J Ultrasound. 2015;18(4):423–30.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mauri G, Hegedüs L, Bandula S, Cazzato RL, Czarniecka A, Dudeck O, et al. European thyroid association and cardiovascular and interventional radiological society of Europe 2021 clinical practice guideline for the use of minimally invasive treatments in malignant thyroid lesions. Eur Thyroid J. 2021;10(3):185–97.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Cho SJ, Baek SM, Na DG, Lee KD, Shong YK, Baek JH. Five-year follow-up results of thermal ablation for low-risk papillary thyroid microcarcinomas: systematic review and meta-analysis. Eur Radiol. 2021;31(9):6446–6456. This meta-analysis evaluates the 5-year follow-up oncologic outcome and safety of thermal abation for low-risk PTMC.

  23. Zhang M, Tufano RP, Russell JO, Zhang Y, Zhang Y, Qiao Z, et al. Ultrasound-guided radiofrequency ablation versus surgery for low-risk papillary thyroid microcarcinoma: results of over 5 years’ follow-up. Thyroid: Off J Am Thyroid Assoc. 2020;30(3):408–17. This study demonstrated the 5-year comparable data for patients who underwent RFA and surgery for PTMC.

    Article  Google Scholar 

  24. Teng D-K, Li W-H, Du J-R, Wang H, Yang D-Y, Wu X-L. Effects of microwave ablation on papillary thyroid microcarcinoma: a five-year follow-up report. Thyroid: Off J Am Thyroid Assoc. 2020;30(12):1752–8. This study demonstrated the first 5-year follow-up data for patients who underwent microwave ablation for PTMC.

    Article  CAS  Google Scholar 

  25. Cho SJ, Baek SM, Lim HK, Lee KD, Son JM, Baek JH. Long-term follow-up results of ultrasound-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma: more than 5-year follow-up for 84 tumors. Thyroid. 2020;30(12):1745–51. This study demonstrated the first 5-year follow-up data for patients who underwent RFA for PTMC.

  26. Xu B, Zhou NM, Cao WT, Gu SY. Comparative study on operative trauma between microwave ablation and surgical treatment for papillary thyroid microcarcinoma. World J Clin Cases. 2018;6(15):936–43.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Zhou W, Ni X, Xu S, Zhang L, Chen Y, Zhan W. Ultrasound-guided laser ablation versus surgery for solitary papillary thyroid microcarcinoma: a retrospective study. Int J Hyperthermia: Off J Eur Soc Hyperthermic Oncol N Am Hyperthermia Group. 2019;36(1):897–904.

    Google Scholar 

  28. Kim HJ, Cho SJ, Baek JH. Comparison of thermal ablation and surgery for low-risk papillary thyroid microcarcinoma: a systematic review and meta-analysis. Korean J Radiol. 2021;22:1730–41. This meta-analysis compares the oncologic outcome and safety of thermal abation and surgery for low-risk PTMC.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mauri G, Gennaro N, Lee MK, Baek JH. Laser and radiofrequency ablations for benign and malignant thyroid tumors. Int J Hyperthermia. 2019;36(2):13–20. This study is a comprehensive review of thermal ablation for benign and malignant thyroid nodules.

  30. Ma B, Wei W, Xu W, Wang Y, Guan H, Fan J, et al. Surgical confirmation of incomplete treatment for primary papillary thyroid carcinoma by percutaneous thermal ablation: a retrospective case review and literature review. Thyroid: Off J Am Thyroid Assoc. 2018;28(9):1134–42.

    Article  Google Scholar 

  31. Ha EJ, Baek JH, Lee JH. Ultrasonography-based thyroidal and perithyroidal anatomy and its clinical significance. Korean J Radiol. 2015;16(4):749–66.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Shin JE, Baek JH, Lee JH. Radiofrequency and ethanol ablation for the treatment of recurrent thyroid cancers: current status and challenges. Curr Opin Oncol. 2013;25(1):14–9.

    Article  CAS  PubMed  Google Scholar 

  33. Baek JH, Lee JH, Sung JY, Bae JI, Kim KT, Sim J, et al. Complications encountered in the treatment of benign thyroid nodules with US-guided radiofrequency ablation: a multicenter study. Radiology. 2012;262(1):335–42.

    Article  PubMed  Google Scholar 

  34. Laeseke PF, Sampson LA, Brace CL, Winter TC 3rd, Fine JP, Lee FT Jr. Unintended thermal injuries from radiofrequency ablation: protection with 5% dextrose in water. AJR Am J Roentgenol. 2006;186(5 Suppl):S249–54.

    Article  PubMed  Google Scholar 

  35. Chung SR, Suh CH, Baek JH, Park HS, Choi YJ, Lee JH. Safety of radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: a systematic review and meta-analysis. Int J Hyperthermia. 2017;33(8):920–30.

  36. Jung SL, Baek JH, Lee JH, Shong YK, Sung JY, Kim KS, et al. Efficacy and safety of radiofrequency ablation for benign thyroid nodules: a prospective multicenter study. Korean J Radiol. 2018;19(1):167–74.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Wang JF, Wu T, Hu KP, Xu W, Zheng BW, Tong G, et al. Complications following radiofrequency ablation of benign thyroid nodules: a systematic review. Chin Med J. 2017;130(11):1361–70.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kim C, Lee JH, Choi YJ, Kim WB, Sung TY, Baek JH. Complications encountered in ultrasonography-guided radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers. Eur Radiol. 2017;27(8):3128–37.

    Article  PubMed  Google Scholar 

  39. Chung SR, Baek JH, Choi YJ, Lee JH. Management strategy for nerve damage during radiofrequency ablation of thyroid nodules. Int J Hyperthermia. 2019;36(1):204–10. In this study, the effect of cold dextrose solution injection on nerve damage occurred during thermal ablation was studied, and management methods were presented when nerve damage occurred during thermal ablation.

  40. Lee MK, Baek JH, Chung SR, Choi YJ, Lee Y-M, Kim TY, et al. Effectiveness of injecting cold 5% dextrose into patients with nerve damage symptoms during thyroid radiofrequency ablation. Endocrinol Metab (Seoul). 2020;35(2):407–15.

    Article  CAS  Google Scholar 

  41. Hughes DT, White ML, Miller BS, Gauger PG, Burney RE, Doherty GM. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery. 2010;148(6):1100–6 (discussion 006-7).

    Article  PubMed  Google Scholar 

  42. Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope. 2009;119(6):1135–9.

    Article  PubMed  Google Scholar 

  43. Viola D, Materazzi G, Valerio L, Molinaro E, Agate L, Faviana P, et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab. 2015;100(4):1316–24.

    Article  CAS  PubMed  Google Scholar 

  44. Suh CH, Baek JH, Choi YJ, Lee JH. Performance of CT in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid cancer: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2017;38(1):154–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Kim H, Ryu W, Woo SU, Son G, Lee E, Lee J, et al. Primary papillary thyroid carcinoma previously treated incompletely with radiofrequency ablation. J Cancer Res Ther. 2010;6:310–2.

    Article  PubMed  Google Scholar 

  46. Ji L, Wu Q, Gu J, Deng X, Zhou W, Fan X, et al. Ultrasound-guided percutaneous laser ablation for papillary thyroid microcarcinoma: a retrospective analysis of 37 patients. Cancer Imaging. 2019;19(1):16.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Kim JH, Baek JH, Sung JY, Min HS, Kim KW, Hah JH, et al. Radiofrequency ablation of low-risk small papillary thyroidcarcinoma: preliminary results for patients ineligible for surgery. Int J Hyperthermia. 2017;33(2):212–9.

  48. Li J, Liu Y, Liu J, Qian L. Ultrasound-guided percutaneous microwave ablation versus surgery for papillary thyroid microcarcinoma. Int J Hyperthermia: Off J Eur Soc Hyperthermic Oncol N Am Hyperthermia Group. 2018;34(5):653–9.

    Article  CAS  Google Scholar 

  49. Lim HK, Cho SJ, Baek JH, Lee KD, Son CW, Son JM, et al. US-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma: efficacy and safety in a large population. Korean J Radiol. 2019;20(12):1653–61.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Teng DK, Li HQ, Sui GQ, Lin YQ, Luo Q, Fu P, et al. Preliminary report of microwave ablation for the primary papillary thyroid microcarcinoma: a large-cohort of 185 patients feasibility study. Endocrine. 2019;64(1):109–17.

    Article  CAS  PubMed  Google Scholar 

  51. Wu R, Luo Y, Tang J, Yang M, Li J, Zhang Y, et al. Ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma: a retrospective analysis of 198 patients. Int J Hyperthermia. 2020;37(1):168–74.

  52. Yue WW, Qi L, Wang DD, Yu SJ, Wang XJ, Xu HX, et al. US-guided microwave ablation of low-risk papillary thyroid microcarcinoma: longer-term results of a prospective study. J Clin Endocrinol Metab. 2020;105(6):dgaa128.

    Article  PubMed  Google Scholar 

  53. Zhang L, Zhou W, Zhan W, Peng Y, Jiang S, Xu S. Percutaneous laser ablation of unifocal papillary thyroid microcarcinoma: utility of conventional ultrasound and contrast-enhanced ultrasound in assessing local therapeutic response. World J Surg. 2018;42(8):2476–84.

    Article  PubMed  Google Scholar 

  54. Zhou W, Jiang S, Zhan W, Zhou J, Xu S, Zhang L. Ultrasound-guided percutaneous laser ablation of unifocal T1N0M0 papillary thyroid microcarcinoma: preliminary results. Eur Radiol. 2017;27(7):2934–40.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Sae Rom Chung, Jung Hwan Baek, Young Jun Choi & Jeong Hyun Lee

  2. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 05505, Korea

    Jung Hwan Baek

Authors
  1. Sae Rom Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jung Hwan Baek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Young Jun Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeong Hyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jung Hwan Baek.

Ethics declarations

Conflict of Interest

Sae Rom Chung declares that he has no conflict of interest. Jung Hwan Baek has received compensation for service as a consultant from STARmed and RF Medical Co., Ltd. Young Jun Choi declares that he has no conflict of interest. Jeong Hyun Lee declares that he has no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical collection on Interventional Oncology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chung, S.R., Baek, J.H., Choi, Y.J. et al. Thermal Ablation for the Management of Papillary Thyroid Microcarcinoma in the Era of Active Surveillance and Hemithyroidectomy. Curr Oncol Rep 24, 1045–1052 (2022). https://doi.org/10.1007/s11912-022-01268-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-022-01268-2

Keywords

Search

Navigation