The Efficacy and Safety of Ultrasound-Guided Microwave Ablation Versus Surgery for Solitary T1N0M0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis.

OBJECTIVE

This meta-analysis aimed to assess and compare the results of microwave ablation (MWA) and surgical intervention for the management of solitary T1N0M0 papillary thyroid carcinoma (PTC), including T1A- and T1B-staged tumors.

METHODS

A search was conducted using PubMed, Embase, Cochrane Library, Web of Science, and Scopus. The variables included in the study were oncological outcomes, complications, surgery-related indicators, and tumor volume.

RESULTS

The findings from the meta-analysis indicated that, in comparison to surgical intervention, MWA treatment for isolated T1N0M0 PTC did not show significant differences in local tumor progression (P = .91), new-onset tumors (P = .88), lymph node metastasis (P = .19), technical success rate (P = 1.00), local recurrence (P = .50), transient hyperthyroidism (P = .60), permanent hyperthyroidism (P = .18), permanent hypoparathyroidism (P = .07), transient hoarseness (P = .29), hematoma (P = .12), infection (P = .27), and airway obstruction (P = .14). In contrast, MWA significantly reduced the overall complication rate, hypothyroidism, transient hypoparathyroidism, permanent hoarseness, dysphagia, and laryngeal edema. MWA also shortened the operation time, bleeding volume, and hospital stay, lowered the treatment cost, reduced the size of the incision, reduced the tumor volume, and improved quality of life (all P < .05). Subgroup analysis based on tumor stages showed similar trends in the outcome indicators within the T1A/T1B subgroup. However, in the new-onset tumors, the risk of new tumors increased in the T1B subgroup (P = .03).

CONCLUSION

Ultrasound-guided MWA may be a potential treatment option for highly selected patients with isolated T1N0M0 PTC. It shows advantages in short-term outcomes, but its long-term oncological safety still needs to be confirmed by longer and higher-quality studies. However, in the T1B subgroup, preoperative ultrasound or computed tomography (CT) examinations are required to screen for suspicious lymph nodes. If any suspicious metastasis is found, surgical treatment should be given priority.