Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid

Abstract

IMPORTANCE Papillary microcarcinomas of the thyroid (mPTCs) account for an increasing proportion of thyroid cancers in past decades. The use of radiofrequency ablation (RFA) has been investigated as an alternative to surgery. The effectiveness and safety of RFA has yet to be determined. OBJECTIVE To evaluate the effectiveness and safety of RFA for low-risk mPTC. DATA SOURCES Embase, MEDLINE via Ovid, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and the top 100 references of Google Scholar were searched from inception to May 28, 2021. STUDY SELECTION Articles reporting on adult patients with mPTC treated with RFA were included. Studies that involved patients with pre-ablation lymph node or distant metastases, recurrence of disease, or extrathyroidal extension were excluded. Final article selection was conducted by multiple reviewers based on consensus. The proportion of eligible articles was 1%.DATA EXTRACTION AND SYNTHESIS This meta-analysis was conducted in accordance with the MOOSE guidelines. Random and fixed-effect models were applied to obtain pooled proportions and 95% CIs. MAIN OUTCOMES AND MEASURESThe primary outcome was the complete disappearance rate of mPTC. Secondary outcomes were tumor progression and complications. RESULTSFifteen studies were included in this meta-analysis. A total of 1770 patients (1379 women [77.9%]; mean [SD] age, 45.4 [11.4] years; age range, 42.5-66.0 years) with 1822 tumors were treated with RFA; 49 tumors underwent 1 additional RFA session and 1 tumor underwent 2 additional RFA sessions. Mean (SD) follow-up time was 33.0 (11.4) months (range, 6-131 months). The pooled complete disappearance rate at the end of follow-up was 79% (95% CI, 65%-94%). The overall tumor progression rate was 1.5% (n = 26 patients), local residual mPTC in the ablation area was found in 7 tumors (0.4%), new mPTC in the thyroid was found in 15 patients (0.9%), and 4 patients (0.2%) developed lymph node metastases during follow-up. No distant metastases were detected. Three major complications occurred (2 voice changes lasting >2 months and 1 cardiac arrhythmia). Minor complications were described in 45 patients. CONCLUSIONS AND RELEVANCEThe findings of this systematic review and meta-analysis suggest that RFA is a safe and efficient method to treat selected low-risk mPTCs. Radiofrequency ablation could be envisioned as step-up treatment after local tumor growth under active surveillance for an mPTC or initial treatment in patients with mPTCs with anxiety about active surveillance.

Radiofrequency Ablation of Indeterminate Thyroid Nodules: The First North American Comparative Analysis

“…With that, RFA has seen tremendous success with volume reduction rates as high as 70–90% with minimal reports of complication [ 15 , 16 , 17 ]. Internationally, RFA has demonstrated success in the treatment of papillary thyroid microcarcinomas and recurrent thyroid cancers [ 12 ]. Few studies have investigated the efficacy and safety of indeterminate nodule RFA in the United States.…”

“…International literature, however, suggests RFA to be promising beyond its typical treatment of benign nodules. For example, a meta-analysis of 1822 papillary thyroid microcarcinomas found a 79% tumor disappearance rate using RFA [ 12 ].…”

Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid

“…For these issues, we suggest that the authors elaborate in more detail to avoid misleading findings. In Reply We thank Drs Yang and Xu at Peking Union Medical Hospital for their interest in our article, 1 and for taking the time to express their concerns. We have provided our response herein and are willing to discuss further questions.…”

Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid—Reply

“…To the Editor We read the recent article by van Dijk et al 1 with great interest. The authors did a meta-analysis to evaluate the effectiveness and safety of radiofrequency ablation (RFA) in a large number of patients with low-risk papillary microcarcinoma of the thyroid (mPTC).…”