Ultrasound-Guided Thermal Ablation vs Surgery in T1N0M0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-analysis

Rationale and Objectives: Ultrasound-guided thermal ablation (TA) offers a minimally invasive alternative to surgery for T1N0M0 papillary thyroid carcinoma (PTC), but its efficacy and safety remain controversial. This meta-analysis aimed to evaluate and compare the outcomes of TA and surgery in treating T1N0M0 PTC, encompassing both T1a and T1b stages. Materials and Methods: We conducted a systematic review and meta-analysis including studies comparing TA and surgery for T1N0M0 PTC up to October 23, 2024. Standardized mean differences and odds ratios (OR) with 95% confidence intervals (CI) were calculated for primary and secondary outcomes. Results: Sixteen studies with a total of 5045 patients were analyzed. No significant differences were observed in recurrence (OR = 1.464; 95% CI = 0.881, 2.433; P = .141), lymph node metastasis (OR = 0.817; 95% CI = 0.492, 1.356; P = .434), transient hoarseness (OR = 0.700; 95% CI = 0.339, 1.445; P = .334), hematoma (OR = 0.528; 95% CI = 0.187, 1.492; P = .228), and infection (OR = 0.368; 95% CI = 0.060, 2.268; P = .281). Notably, TA significantly reduced permanent hoarseness, hypoparathyroidism, dysphagia, procedure time, hospitalization, cost, estimated blood loss, and surgical incision (all P < .05). The subgroup analyses demonstrated similar primary outcomes within each subgroup, including tumor stage (T1a/T1b), type of TA (microwave/radiofrequency), and follow-up time (short-term/long-term). Conclusion: Ultrasound-guided TA is a safe and effective alternative to surgery for both T1a and T1b stages of T1N0M0 PTC, offering comparable prognostic outcomes with fewer complications, lower costs, and faster recovery.