North American Society for Interventional Thyroidology Statement on Directed Ablative Therapy for the Management of Cervical Recurrence of Papillary Thyroid Cancer.

This consensus statement from the North American Society for Interventional Thyroidology (NASIT) provides a framework for the safe and effective implementation of directed ablative therapy (DAT) as a therapeutic option for managing cervical regional nodal recurrence of differentiated thyroid cancer, specifically papillary thyroid cancer (PTC). A multidisciplinary task force comprising endocrine surgeons, endocrinologists, interventional radiologists, otolaryngologists-head and neck surgeons, and diagnostic radiologists conducted virtual meetings to review available evidence on DAT modalities, including radiofrequency ablation, microwave ablation, laser ablation, percutaneous ethanol injection, and cryoablation. Recommendations were grounded in available scientific evidence and expert consensus. The evidence base comprises approximately 36 original studies with substantial overlap across nine meta-analyses, predominantly from Asia and Europe, with limited North American representation. The statement addresses 3 main topics: patient case selection, technical considerations for DAT modalities, and outcomes in terms of effectiveness and safety. DAT is recommended for patients who refuse surgery, are at high surgical risk, exhibit RAI-refractoriness, or have small-volume nodal disease where the risk-benefit balance of RAI is unfavorable. For curative intent, DAT may be considered for recurrent papillary thyroid cancer with a limited number (≤3) of small-volume (≤2 cm) nodes without high-risk molecular features. No included study systematically stratified outcomes by PTC histological subtype; applicability to higher-risk subtypes should be approached with caution. A preprocedural checklist and structured follow-up are essential to ensure safety and effectiveness.