Microwave ablation may offer comparable progression-free survival rates and fewer complications in patients with papillary thyroid carcinoma compared with surgical resection, according to a recent study published by Zhao et al in Radiology.
Background
Papillary thyroid carcinoma—the most common type of thyroid cancer—often presents with multifocality, in which two or more papillae are found within the thyroid gland. The occurrence of multifocality within papillary thyroid carcinoma cases is notably frequent, at a rate ranging from approximately 23.5% to 60%.
Although multifocal papillary thyroid carcinoma is often treated with surgical resection, the procedure can result in scarring, necessitate the lifelong use of hormone replacement and lead to subsequent complications such as permanent hoarseness or impaired thyroid function, and worsen the patient’s quality of life. Microwave ablation, a minimally invasive procedure that uses heat to destroy tumors, is currently under preliminary investigation as a treatment for papillary thyroid carcinoma and could be a viable alternative to surgery in some patients.
“This study marks the first multicenter comparative analysis between microwave ablation and surgical resection for multifocal papillary thyroid [carcinoma],” emphasized senior study author Ming-An Yu, MD, Director of Interventional Medicine at China-Japan Friendship Hospital in Beijing, China. “These findings challenge traditional treatment paradigms and open new avenues for less invasive management strategies,” he added.
Study Methods and Results
In the recent study, investigators recruited 775 patients with ultrasound-detected multifocal stage I papillary thyroid carcinoma who were treated with either microwave ablation or surgical resection across 10 cancer centers between May 2015 and December 2021. The investigators performed propensity score matching to reduce bias and create comparable groups of patients who underwent microwave ablation (n = 229) or surgical resection (n = 453) and could be assessed on the basis of treatment efficacy.
After a median follow-up of 20 months in the microwave ablation group and 26 months in the surgical resection group, the investigators found that microwave ablation was associated with similar 5-year progression-free survival rates (77.2% vs 83.1%), fewer complications, and a greater potential for preserving thyroid function compared with surgical resection. Further, the patients who underwent microwave ablation experienced less blood loss, shorter incision lengths, and shorter procedure and hospitalization durations. In the surgical resection group, 2.2% vs 0.0% and 4.0% vs 0.0% of patients experienced permanent hoarseness and hypoparathyroidism, respectively, compared with the patients in the microwave ablation group.
The investigators noted that microwave ablation does not routinely include preventive lymph node ablation, whereas in surgical resection, preventive lymph node removal is a common practice. However, the results provided evidence that even without lymph node ablation, microwave ablation yielded comparable survival rates to surgical resection.
Conclusions
“Our study has shown that microwave ablation offers a promising treatment option for multifocal papillary thyroid [carcinoma]. Additionally, microwave ablation is associated with fewer complications and can preserve thyroid function, thereby enhancing patients’ quality of life. This represents a significant advancement in the field of interventional thyroid cancer treatment,” Dr. Yu concluded.
Disclosure For full disclosures of the study authors, visit pubs.rsna.org.
