Skip to main content
SpringerLink
Log in

Ablation techniques or active surveillance compared to surgical resection in patients with low-risk papillary thyroid cancer: a systematic review and meta-analysis

  • Meta- Analysis
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Background

The global prevalence of thyroid cancer is on the rise. About one-third of newly diagnosed thyroid cancer cases comprise low-risk papillary thyroid cancer (1.5 cm or more minor). While surgical removal remains the prevailing approach for managing low-risk papillary thyroid cancer (LPTC) in patients, other options such as active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) are also being considered as viable alternatives. This study evaluated and compared surgical thyroid resection (TSR) versus non-surgical (NS) methods for treating patients with LPTC.

Methods

The study encompassed an analysis of comparisons between surgical thyroid resection (TSR) and alternative approaches, including active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), or laser ablation (LA). The focus was on patients with biopsy-confirmed low-risk papillary thyroid cancer (LPTC) of less than 1.5 cm without preoperative indications of local or distant metastasis. The primary outcomes assessed were recurrence rates, disease-specific mortality, and quality of life (QoL). Data were collected from prominent databases, including Cochrane Database, Embase, MEDLINE, and Scopus, from inception to June 3rd, 2020. The CLARITY tool was utilized to evaluate bias risk. The analysis involved odds ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes, as well as mean differences (MD) and standardized mean differences (SMD) for continuous outcomes. The study is registered on PROSPERO under the identifier CRD42021235657.

Results

The study incorporated 13 retrospective cohort studies involving 4034 patients. Surgical thyroid resection (TSR), active surveillance (AS), and minimally invasive techniques like radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) were performed in varying proportions of cases. The analysis indicated that specific disease mortality rates were comparable among AS, MWA, and TSR groups. The risk of recurrence, evaluated over different follow-up periods, showed no significant differences when comparing AS, RFA, MWA, or LA against TSR. Patients undergoing AS demonstrated better physical health-related quality of life (QoL) than those undergoing TSR. However, no substantial differences were observed in the overall mental health domain of QoL when comparing AS or RFA with TSR. The risk of bias was moderate in nine studies and high in four.

Conclusion

Low-quality evidence indicates comparable recurrence and disease-specific mortality risks among patients with LPTC who underwent ablation techniques or active surveillance (AS) compared to surgery. Nevertheless, individuals who opted for AS exhibited enhanced physical quality of life (QoL). Subsequent investigations are warranted to validate these findings.

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
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. E. Olson, G. Wintheiser, K.M. Wolfe, J. Droessler, P.T. Silberstein, Epidemiology of thyroid cancer: a review of the national cancer database, 2000-2013. Cureus. 2019 Feb 24.

  2. H. Lim, S.S. Devesa, J.A. Sosa, D. Check, C.M. Kitahara, Trends in thyroid cancer incidence and mortality in the United States, 1974-2013. JAMA - J. Am. Med. Assoc. Am. Med. Assoc. 317, 1338–1348 (2017).

    Article  Google Scholar 

  3. V.D. Tarasova, R.M. Tuttle, Current management of low-risk differentiated thyroid cancer and papillary microcarcinoma. Clin. Oncol. 29(5), 290–297 (2017).

    Article  CAS  Google Scholar 

  4. B. Xu, N.M. Zhou, W.T. Cao, S.Y. Gu, Comparative study on operative trauma between microwave ablation and surgical treatment for papillary thyroid microcarcinoma. World J. Clin. Cases 6(15), 936–943 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  5. E. Lincango-Naranjo, P. Solis-Pazmino, O. El Kawkgi, J. Salazar-Vega, C. Garcia, T. Ledesma et al. Triggers of thyroid cancer diagnosis: a systematic review and meta-analysis. Endocr. Springe. 72, 644–659 (2021).

    Article  CAS  Google Scholar 

  6. E.P. Lincango Naranjo, J.P. Brito, Clinical THYROIDOLOGY ® 400 l is delayed papillary thyroid cancer surgery associated with higher mortality risk? 2021; Available from: www.liebertpub.com.

  7. W. Liu, W. Cao, Z. Dong, R. Cheng, Can active surveillance management be developed for patients with low-risk papillary thyroid microcarcinoma? A preliminary investigation in a Chinese population. Endocr. Pract. 2022 Feb

  8. R. Chou, T. Dana, M. Haymart, A.M. Leung, R.P. Tufano, J.A. Sosa et al. Active surveillance versus thyroid surgery for differentiated thyroid cancer: a systematic review. Thyroid. Mary Ann. Liebert Inc. 32, 351–367 (2022).

    CAS  Google Scholar 

  9. G. Orlando, G. Scerrino, A. Corigliano, I. Vitale, R. Tutino, S. Radellini et al. Papillary thyroid microcarcinoma: active surveillance against surgery. Considerations of an Italian working group from a systematic review. Vol. 12, Front. Oncol. Front. Media S.A.; 2022.

  10. B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov 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 26(1), 1–133 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  11. M. Tong, S. Li, Y. Li, Y. Li, Y. Feng, Y. Che, Efficacy and safety of radiofrequency, microwave and laser ablation for treating papillary thyroid microcarcinoma: a systematic review and meta-analysis. Int. J. Hyperth. 36(1), 1278–1286 (2019).

    Article  Google Scholar 

  12. J. Xiao, M. Zhang, Y. Zhang, L. Yan, Y. Lan, Y. Zhu et al. Efficacy and safety of ultrasonography-guided radiofrequency ablation for the treatment of T1bN0M0 papillary thyroid carcinoma: a retrospective study. Int. J. Hyperth. 37(1), 392–398 (2020).

    Article  Google Scholar 

  13. W.W. Yue, L. Qi, D.D. Wang, S.J. Yu, X.J. Wang, H.X. Xu et al. US-guided microwave ablation of low-risk papillary thyroid microcarcinoma: longer-term results of a prospective study. 2020; Available from: https://academic.oup.com/jcem/advance-article-abstract/doi/10.1210/clinem/dgaa128/5810812.

  14. U.C. Megwalu, Observation versus thyroidectomy for papillary thyroid microcarcinoma in the elderly. J. Laryngol. Otol. 131(2), 173–176 (2017).

    Article  CAS  PubMed  Google Scholar 

  15. S.H. Kong, J. Ryu, M.J. Kim, S.W. Cho, Y.S. Song, K.H. Yi et al. Longitudinal assessment of quality of life according to treatment options in low-risk papillary thyroid microcarcinoma patients: active surveillance or immediate surgery (interim analysis of MAeSTro). Thyroid 29(8), 1089–1096 (2019).

    Article  CAS  PubMed  Google Scholar 

  16. J. Li, Y. Liu, J. Liu, P. Yang, X. Hu, L. Qian, A comparative study of short-term efficacy and safety for thyroid micropapillary carcinoma patients after microwave ablation or surgery. Int. J. Hyperth. 36(1), 640–646 (2019).

    Article  Google Scholar 

  17. J.H. Kim, J.H. Baek, H.K. Lim, H.S. Ahn, S.M. Baek, Y.J. Choi et al. 2017 Thyroid radiofrequency ablation guideline: Korean society of thyroid radiology. Korean J. Radio. 19(4), 632–655 (2018).

    Article  Google Scholar 

  18. A. Liberati, D.G. Altman, J. Tetzlaff, C. Mulrow, P.C. Gøtzsche, J.P.A. Ioannidis et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Vol. 6, PLoS Med. (2009).

  19. S. Chen, Y. Mao, G. Chen, Economic effect between surgery and thermal ablation for patients with papillary thyroid microcarcinoma: a systemic review and meta-analysis. Endocr. Springe. 76, 9–17 (2022).

    Article  CAS  Google Scholar 

  20. L. Yan, Y. Lan, J. Xiao, L. Lin, B. Jiang, Y. Luo, Long-term outcomes of radiofrequency ablation for unifocal low-risk papillary thyroid microcarcinoma: a large cohort study of 414 patients. Eur. Radio. 31(2), 685–694 (2021).

    Article  CAS  Google Scholar 

  21. L.G. Rangel, J.H. Steck, E.M. Volpi, J.O. Russell, R.P. Tufano, Radiofrequency ablation of papillary thyroid microcarcinomas. AACE Clin. Case Rep. 8(2), 99–101 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  22. H.K. Lim, S.J. Cho, J.H. Baek, K.D. Lee, C.W. Son, J.M. Son et al. US-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma: Efficacy and safety in a large population. Korean J. Radio. 20(12), 1653–1661 (2019).

    Article  Google Scholar 

  23. S.J. Cho, S.M. Baek, D.G. Na, K.D. Lee, Y.K. Shong, J.H. Baek, Five-year follow-up results of thermal ablation for low-risk papillary thyroid microcarcinomas: systematic review and meta-analysis. Eur. Radio. 31(9), 6446–6456 (2021).

    Article  Google Scholar 

  24. S.P.J. van Dijk, H.I. Coerts, S.T.G. Gunput, E.F.S. van Velsen, M. Medici, A. Moelker et al. Assessment of radiofrequency ablation for papillary microcarcinoma of the thyroid. JAMA Otolaryngology–Head & Neck Surgery. (2022).

  25. T. Li, B. Lu, Y. Zhang, Y. Sun, Meta-analysis of the application effect of different modalities of thermal ablation and surgical treatment in papillary thyroid microcarcinoma. Dis Markers. (2022).

  26. H.J. Kim, S.J. Cho, J.H. Baek, Comparison of thermal ablation and surgery for low-risk papillary thyroid microcarcinoma: a systematic review and meta-analysis. Korean J. Radio. 22(10), 1730–1741 (2021).

    Article  Google Scholar 

  27. Tool to Assess Risk of Bias in Cohort Studies.

  28. E. Lincango, P. Solis, J. Salazar, C. Garcia, G. Jaramillo, T. Ledesma et al. PROSPERO International prospective register of systematic reviews Citation Efficacy and safety of minimally invasive local therapies for papillary thyroid micro-carcinoma patients: a systematic review and meta-analysis review question.

  29. J. Li, Y. Liu, J. Liu, L. Qian, Ultrasound-guided percutaneous microwave ablation versus surgery for papillary thyroid microcarcinoma. Int. J. Hyperth. 34(5), 653–659 (2018).

    Article  CAS  Google Scholar 

  30. M. Zhang, R.P. Tufano, J.O. Russell, Y. Zhang, Y. Zhang, Z. Qiao et al. Ultrasound-guided radiofrequency ablation versus surgery for low-risk papillary thyroid microcarcinoma: results of over 5 years’ follow-up. Thyroid 30(3), 408–417 (2020).

    Article  PubMed  Google Scholar 

  31. 19. GRADE approach _ Cochrane Training.

  32. NEUROLOGY2020144980 357..368 _ Enhanced Reader.

  33. 20. RStudio _ Open source & professional software for data science teams - RStudio.

  34. 21. GitHub_ Where the world builds software · GitHub.

  35. Y. Yoshida, K. Horiuchi, T. Okamoto, Patients’ view on the management of papillary thyroid microcarcinoma: active surveillance or surgery. Thyroid 30(5), 681–687 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  36. M.J. Jeon, Y.M. Lee, T.Y. Sung, M. Han, Y.W. Shin, W.G. Kim et al. Quality of life in patients with papillary thyroid microcarcinoma managed by active surveillance or lobectomy: a cross-sectional study. Thyroid 29(7), 956–962 (2019).

    Article  CAS  PubMed  Google Scholar 

  37. Q. Song, L. Yu-Kun, X. Tian, L. Ren, Y. Zhu, L. Yan et al. Comparative study on the efficacy and safety of radiofrequency ablation and thyroidectomy of low-risk papillary thyroid microcarcinoma of isthmus : a prospective study. Am. Thyroid Assoc. Annu. Meet. (2004) http://www.liebertpub.com.

  38. T. Sukarayothin, W.P. Kluijfhout, J. Gosnell, W. Shen, I. Suh, Q. Duh et al. Thyroid cancer thursday poster clinical risk of recurrence in papillary thyroid microcarcinoma depends on initial presentation thyroid cancer thursday poster clinical medullary thyroid carcinoma in men2a: ata moderate or high-risk ret mutations do not predict disease aggressiveness thyroid cancer thursday poster clinical a new surgical concept of in situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma [Internet]. Available from: www.liebertpub.com.

  39. A. Smulever, F. Pitoia, High rate incidence of post-surgical adverse events in patients with low-risk papillary thyroid cancer who did not accept active surveillance. Endocrine 69(3), 587–595 (2020).

    Article  CAS  PubMed  Google Scholar 

  40. H. Oda, A. Miyauchi, Y. Ito, K. Yoshioka, A. Nakayama, H. Sasai et al. Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery. Thyroid 26(1), 150–155 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  41. W. Zhou, X. Ni, S. Xu, L. Zhang, Y. Chen, W. Zhan, Ultrasound-guided laser ablation versus surgery for solitary papillary thyroid microcarcinoma: a retrospective study. Int. J. Hyperth. 36(1), 897–904 (2019)

    Article  Google Scholar 

  42. Y. Lan, Y. Luo, M. Zhang, Z. Jin, J. Xiao, L. Yan et al. Quality of life in papillary thyroid microcarcinoma patients undergoing radiofrequency ablation or surgery: a comparative study. Front Endocri. (Lausanne). 11, (2020).

  43. M.F. Bates, M.R. Lamas, R.W. Randle, K.L. Long, S.C. Pitt, D.F. Schneider et al. Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease? Surg. (U. S.) 163(1), 118–123 (2018).

    Google Scholar 

  44. I.C. Huang, J.L. Lee, P. Ketheeswaran, C.M. Jones, D.A. Revicki, A.W. Wu. Does personality affect health-related quality of life? A systematic review. PLoS One. 12(3), (2017).

  45. J.J. Stulberg, R. Huang, L. Kreutzer, K. Ban, B.J. Champagne, S.R. Steele et al. Association between surgeon technical skills and patient outcomes. JAMA Surg. 155(10), 960–968 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  46. G. Li, T.T. Sajobi, B.K. Menon, L. Korngut, M. Lowerison, M. James et al. Registry-based randomized controlled trials- what are the advantages, challenges, and areas for future research? J. Clin. Epidemiol. Elsevier USA 80, 16–24 (2016).

    Article  Google Scholar 

  47. C.P. Patel Chavez, E. Godinez Leiva, D. Bagautdinova, J. Hidalgo, S. Hartasanchez, D. Barb et al. Patient feedback receiving care using a shared decision making tool for thyroid nodule evaluation—an observational study. Endocrine. (2022).

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Author notes

  1. These authors contributed equally: Tannya Ledesma-Leon, Paola Solis-Pazmino, Eddy P. Lincango

Authors and Affiliations

  1. Universidad Central del Ecuador, Facultad de Ciencias Médicas, Quito, Ecuador

    Tannya Ledesma-Leon & Luis A. Figueroa

  2. CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador

    Tannya Ledesma-Leon, Paola Solis-Pazmino, Eddy P. Lincango, Luis A. Figueroa, Tatiana Rojas, Junior Torres-Román, Emilia Camacho, Benjamin Alvarado-Mafla & Oscar J. Ponce

  3. Surgery Group Los Angeles, Los Angeles, CA, USA

    Paola Solis-Pazmino, Joshua Ellenhorn, Yosef Nasseri & Jason Cohen

  4. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA

    Paola Solis-Pazmino, Eddy P. Lincango, Sebastian Vallejo, Oscar J. Ponce & Juan P. Brito

  5. Department of Surgery, Weill Cornell Medicine New York Presbyterian Brooklyn Methodist Hospital, New York, NY, USA

    Minerva Romero-Arenas

  6. Instituto de la Tiroides y Enfermedades de Cabeza y Cuello, Quito, Ecuador

    Cristhian Garcia

  7. Department of Surgery, Universidad de Antioquia. -Centro de Excelencia en Enfermedades de Cabeza y Cuello. CEXCA, Medellin, Colombia

    Alvaro Sanabria

  8. Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Sophie Dream

  9. Beth Israel Deaconess Medical Center Department of Surgery, 484273, Surgery, 185 Pilgrim Road, Palmer 605, Boston, MA, 02115, USA

    Benjamin C. James

  10. Harvard Medical School, Boston, MA, 02115, USA

    Benjamin C. James

  11. MultiCare Health System Tacoma General Hospital, Tacoma, WA, USA

    Arun Sharma

  12. Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, 55905, USA

    Juan P. Brito

Authors
  1. Tannya Ledesma-Leon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paola Solis-Pazmino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eddy P. Lincango
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luis A. Figueroa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joshua Ellenhorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yosef Nasseri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jason Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Minerva Romero-Arenas
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Cristhian Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alvaro Sanabria
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tatiana Rojas
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Junior Torres-Román
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Emilia Camacho
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Sebastian Vallejo
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Benjamin Alvarado-Mafla
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Sophie Dream
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Benjamin C. James
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Oscar J. Ponce
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Arun Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Juan P. Brito
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

T.L.-L., P.S.-P., E.P.L.N. and J.P.B.: drafting/revising the manuscript, including medical writing for content; significant role in data acquisition; study concept or design; analysis or interpretation of data. J.E., Y.N., J.C., M.R.-A., C.G., A.S., T.R., J.T.-R., E.C., S.V., and B.A.-M. contribute to data acquisition and manuscript revision. O.J.P. and L.A. Figueroa contribute to the study concept, analysis, and interpretation of data. S.D., M.D., B.C.J., and A.S. revised the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Juan P. Brito.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

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

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ledesma-Leon, T., Solis-Pazmino, P., Lincango, E.P. et al. Ablation techniques or active surveillance compared to surgical resection in patients with low-risk papillary thyroid cancer: a systematic review and meta-analysis. Endocrine 83, 330–341 (2024). https://doi.org/10.1007/s12020-023-03502-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-023-03502-8

Keywords

Search

Navigation