Radiofrequency and microwave versus surgery for the treatment of Less-than-1-cm papillary thyroid carcinoma: a systematic review and Meta-Analysis.

PURPOSE: To compare the clinical outcomes of radiofrequency ablation (RFA) and microwave ablation (MWA) with those of total or hemi-thyroidectomy in patients with less-than-1-cm papillary thyroid carcinoma. METHODS: A systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted up to June 30, 2025. Eligible studies were identified according to predefined PICO criteria, evaluating differences in local recurrence, lymph node metastasis, complications, treatment variables, and quality of life between RFA or MWA and surgery. PRISMA guidelines were followed, and study quality was assessed using QUADAS-2. RESULTS: Fifteen studies including 5,583 patients (24% male) were analyzed: seven studies (2,455 patients) compared MWA with surgery, and eight studies (3,128 patients) compared RFA with surgery. Mean follow-up was 42.4 ± 14.7 months (57.0 ± 16.5 months for RFA; 26.6 ± 12.6 months for MWA). No significant differences were found between image-guided thermal ablation (I-GTA) and surgery for local recurrence (OR 1.41, 95% CI 0.87–2.29; p = 0.983) or lymph node metastasis (OR 0.91, 95% CI 0.56–1.47; p = 0.909). I-GTA was associated with lower costs (–$646.91, 95% CI –$879.60 to –$414.22; p < 0.0001), shorter hospital stay (–5.19 days, 95% CI − 9.73 to − 0.66; p < 0.0001), reduced procedure time (–69.01 min, 95% CI − 78.16 to − 59.85; p < 0.001), and lower complication rates (OR 0.26, 95% CI 0.14–0.51; p = 0.0497). CONCLUSION: This meta-analysis, including the largest patient cohort and longest follow-up to date, confirms that I-GTA and surgery achieve comparable local control and nodal outcomes in less-than-1-cm papillary thyroid carcinoma, while I-GTA offers significant advantages in cost, recovery, and safety. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251077888.