Efficacy and Safety of Thermal Ablation Techniques for the Treatment of Primary Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis

Abstract

Background: The increased incidence of primary papillary thyroid microcarcinoma (PTMC) has led to increased research in the field of nonsurgical therapeutic options for those who refuse surgery or are at high risk for surgery. The study aimed at comprehensively evaluating the efficacy and safety of thermal ablation techniques for the treatment of PTMC via a systematic review and meta-analysis. Methods: The Pubmed MEDLINE and EMBASE databases were searched for studies reporting the efficacy and safety of thermal ablations (radiofrequency-, laser-, and microwave-ablations [RFA, LA, and MWA]) until August 10, 2019. A review of 105 potential papers identified 11 eligible papers, including 715 patients. The pooled proportions of complete disappearance and recurrence, and the pooled estimates of mean volume reduction and its rate of the treated PTMC were assessed by using random-effects modeling. The pooled proportions of overall and major complications were calculated. Subgroup analysis was performed according to the treatment modality. Between-study heterogeneity was explored by using v 2 statistic for pooled estimates and inconsistency index I 2 . Quality of the studies was evaluated by using the Risk of Bias Assessment Tool for Nonrandomized Studies. Results: The pooled proportions of complete disappearance and recurrence of PTMC were 57.6% [95% confidence interval (CI): 35.4-79.8] and 0.4% [95% CI: 0-1.1], respectively. The pooled estimates of mean volume reduction and its rate were 73.5 mm 3 [52.4-94.6 mm 3 ] and 98.1% [95% CI: 96.7-99.5], respectively. The pooled proportions of overall and major complications were 3.2% [95% CI: 1.1-5.2] and 0.7% [95% CI: 0-1.5], respectively. Significant between-study heterogeneity was observed for complete disappearance ( p < 0.001, I 2 : 99%), mean volume reduction ( p < 0.001, I 2 : 93%), and its rate ( p < 0.001, I 2 : 86%). Subgroup analysis revealed heterogeneity of the complete disappearance proportion among the treatment modality (I 2 range: 95-100%). RFA showed the highest mean volume reduction rate (99.3%), followed by MWA (95.3%) and LA (88.6%) ( p < 0.001). Conclusions: All thermal ablation techniques were effective and safe for the treatment of PTMC. However, each treatment modality had significant heterogeneity with respect to complete disappearance of PTMC. Compared with RFA and MWA, LA was less effective in reducing the volume of PTMC.

Comparison of thermal ablation and routine surgery for the treatment of papillary thyroid microcarcinoma: a systematic review and Meta-analysis

“…In terms of safety, all the included studies [21][22][23][24][25][26][27] compared complication rate after the TA or RS and indicated that patients undergoing TA had a low complication rate with a pooled statistically significant difference (3.39% vs 12.94%, p < 0.001). The pooled proportion of complication was similar to a previous meta-analysis of single-arm tests (3.2% for TA) [40]. Voice change is the most common complication after TA and it may be caused by both thermal injury and hemorrhage or other factors such as inflammation, lidocaine injection, and fibrosis around the nerve [42,43].…”

“…In the new century, many original articles have explored the efficacy and safety of ablation for treating metastatic lymph nodes from PTMC [36][37][38][39]. Recently, two meta-analysis of single-arm tests also suggested that TA techniques have reasonable safety and efficacy profiles [40,41]. However, studies about the efficiency, safety, and economy of TA for PTMC are limited, and the effect directly compared with RS is worth assessing.…”

Contemporary Thyroid Nodule Evaluation and Management

“…( 114 , 115 ). Minimally invasive US-guided ablation techniques are also being proposed by some groups for nonsurgical treatment of small suspicious nodules ( 119 , 120 ).…”

Unexplained Hyperthyroglobulinemia in Differentiated Thyroid Cancer Patients as an Indication for Radioiodine Adjuvant Therapy: A Prospective Multicenter Study

“…With the exception of active surveillance and thermal ablation in patients with low-risk microscopic papillary thyroid cancer, the initial management of differentiated thyroid cancer (DTC) mainly relies on surgery followed by radioiodine ( 131 I) remnant ablation (RRA), radioiodine adjuvant therapy (RAT) of potential residual thyroid cancer, or radioiodine treatment (RT) of known disease, under thyroid-stimulating hormone (TSH) suppression (1)(2)(3).…”