Percutaneous ablation of low-risk papillary thyroid cancer

Abstract

Minimalistic management options such as active surveillance and thyroid lobectomy are increasingly being accepted as reasonable management options for properly selected patient with low-risk papillary thyroid cancer. Leveraging technologies developed for the treatment of benign thyroid nodules, ultrasound guided percutaneous thermal ablation is now being evaluated as a potential additional minimalistic management option for small, intrathyroidal, low-risk papillary thyroid cancer. Published retrospective data on more than 5,000 low risk papillary thyroid cancer patients treated with thermal ablation indicate that with appropriate training and proper patient selection these technologies can be safely and effectively applied to papillary microcarcinomas. When compared to immediate surgery, thermal ablation appears to have lower complication rates with similar short-term rates of recurrence. Proper patient selection is facilitated by use of a clinical framework which integrates imaging characteristics, patient characteristics, and medical team characteristics to classify a patient as ideal, appropriate, or inappropriate for minimalistic management options (active surveillance, thyroid lobectomy, or thermal ablation). While retrospective in nature and lacking randomized prospective clinical trial data, currently available data does support the proposition that thermal ablation technologies reliably destroy papillary thyroid microcarcinoma lesions and are associated with clinically acceptable oncologic outcomes when done by experienced teams in properly selected patients.

Tumor growth manifested in two-fifths of low-risk papillary thyroid microcarcinoma patients during active surveillance: data from a tertiary center in China

“…Currently, thyroid lobectomy, AS, and UGTA are recognized as the three methods for treating PTMC. Dr. Tuttle RM and his colleagues have introduced a new definition, referring to it as the minimalistic management option ( 22 ). They suggest establishing a clinical framework that integrates three characteristics of imaging, patient, and medical team characteristics to classify a patient as ideal, appropriate, or inappropriate candidates for these three treatments.…”

Comprehensive Review of the Imaging Recommendations for Diagnosis, Staging, and Management of Thyroid Carcinoma

“…Percutaneous thermal (radiofrequency, laser, microwave, and high-frequency ultrasound) or chemical (ethanol) ablation may be performed for papillary microcarcinoma in patients unwilling to have active surveillance, refusing surgery, or at high-risk for surgery [109,110]. In addition, recurrent thyroid carcinoma patients with a high surgical risk who are unwilling to have repeat surgery may also be managed using percutaneous ablation techniques [111].…”

“…For postoperative surveillance, neck US should be performed after 6 months and then at 6-to 12-month intervals for ATA pediatric intermediate-and high-risk patients and annually for ATA pediatric low-risk patients [112]. A posttreatment WBS with/without SPECT/CT is recommended for all children 4-7 days after 131 I therapy [109].…”

Brazilian Consensus on the Application of Thermal Ablation for Treatment of Thyroid Nodules: A Task Force Statement by the Brazilian Society of Interventional Radiology and Endovascular Surgery (SOBRICE), Brazilian Society of Head and Neck Surgery (SBCCP), and Brazilian Society of Endocrinology and Metabolism (SBEM)

“…( 121 ) on RFA ablation of benign and malignant thyroid nodules found results similar to those of the meta-analysis. Table 1 provides the current recommendations for the appropriate selection of patients for percutaneous thermal ablation in low-risk PTMC ( 116 , 122 , 123 ).…”