Image-Guided Thermal Ablation as an Alternative to Surgery for Papillary Thyroid Microcarcinoma: Preliminary Results of an Italian Experience

Abstract

PurposeTo report the results of our preliminary experience in treating patients with papillary thyroid microcarcinoma (PTMC) with image-guided thermal ablation, in particular estimating the feasibility, safety and short-term efficacyMaterials and MethodsFrom 2018 patients with cytologically proven PTMC < 10 mm were discussed in a multidisciplinary team and evaluated for feasibility of image-guided thermal ablation. In case of technical feasibility, the three possible alternatives (i.e., image-guided thermal ablation, surgery, and active surveillance) were discussed with patients. Patients who agreed to be treated with image guided thermal ablation underwent radiofrequency (RFA) or laser ablation under local anesthesia and conscious sedation. Treatment feasibility, technical success, technique efficacy, change in thyroid function tests, side effects, minor and major complications, patients satisfaction and pain/discomfort perception during and after treatment, and disease recurrence during follow-up were recorded.ResultsA total of 13 patients were evaluated, and 11/13 (84.6%) patients (9 female, 2 male, mean age 49.3 ± 8.7 years) resulted suitable for image-guided thermal ablation. All 11 patients agreed to be treated with image-guided thermal ablation. In addition, 3/11 (27.3%) were treated with laser ablation and 8/11 (72.7%) with RFA. All procedures were completed as preoperatively planned (technical success 100%). Technique efficacy was achieved in all 11/11 (100%) cases. Ablated volume significantly reduced from 0.87 ± 0.67 ml at first follow-up to 0.17 ± 0.36 at last follow-up (p = 0.003). No change in thyroid function tests occurred. No minor or major complications occurred. All patients graded 10 the satisfaction for the treatment, and mean pain after the procedure was reported as 1.4 ± 1.7, and mean pain after the procedure as 1.2 ± 1.1 At a median follow-up of 10.2 months (range 1.5–12 months), no local recurrence or distant metastases were found.ConclusionsImage guided thermal ablations appear to be feasible and safe in the treatment of PTMC. These techniques hold the potential to offer patients a minimally invasive curative alternative to surgical resection or active surveillance. These techniques appear to be largely preferred by patients.

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

“…The growing incidental detection of papillary thyroid microcarcinomas (PTMCs) is paralleled by the progressive increase in surgical thyroid procedures [5]. Due to the frequently indolent nature of PTMC and the cost and risk of surgery, active surveillance (AS) and ultrasound (US)-guided minimally invasive treatments (MITs) are proposed as alternative management options to thyroidectomy for selected incidental PTMC [4,[6][7][8].…”

“…Papillary Thyroid Microcarcinoma Due to the frequent indolent nature of PTMC, and the cost and risk of surgery, AS and MIT are considered as alternative management options to thyroidectomy for incidental PTMC [8,55,56]. Since the first feasibility study using laser for nonsurgical management of PTMC [57], US-guided treatments with laser, RFA, and MWA have been documented by several centers [40,44,[50][51][52][53][54].…”

“…Up to 5 EA sessions were needed for complete ablation and, despite reporting no major complications, local pain and side effects may occur frequently. The major limitations of EA are the uneven and unpredictable area of ablation and risk of ethanol seeping into neck tissues [8]. A retrospective study comparing the outcomes of 42 patients with recurrence of DTC, treated either with EA or RFA, found no recurrences in the RFA group (61 months follow-up), while 5 of 21 (23%) metastases had local progression at 4-11 months after EA [74].…”

Ultrasound-guided thermal ablation for papillary thyroid microcarcinoma: a multicenter retrospective study

“…Some ablation guidelines and consensus statements indicate that thermal ablation can be used in benign and selected malignant thyroid nodules [6][7][8][9][10]. For instance, microwave ablation (MWA), radiofrequency ablation (RFA), or laser ablation were introduced to treat low-risk T1a papillary thyroid carcinoma [11,12], and even T1b [13]. However, most of these studies were single-center studies with relatively small number of patients, and the results were sometimes inconsistent [14].…”

Analysis and evaluation of the efficacy of ultrasound-guided microwave ablation for papillary thyroid microcarcinoma

“…In recent years, MWA has been widely applied to benign thyroid nodules [13][14][15][16][17][18][19], but only a few studies have reported its use for PTMC. Although favorable results have been obtained [5,[20][21][22][23][24], there is no international consensus on its long-term clinical value. The present study aimed to analyze and evaluate the efficacy of USguided MWA for unifocal PTMC with a diameter of 0.6 cm.…”