BACKGROUND
Thyroid cancer has been one of the fastest rising cancer over the last 10 years. Fortunately, the prognosis for thyroid cancer is excellent as there are very effective treatments. The initial treatment for thyroid cancer is usually surgery. Many of the thyroid cancers diagnosed are small cancers (<1 cm), known as papillary microcarcinoma. Because of the excellent prognosis, the approach to the management of papillary microcarcinoma has shifted to deferring surgery and monitoring with ultrasound, known as active surveillance. However, due to an increase in worry and anxiety associated with a cancer diagnosis, active surveillance is not a option for many patients.

One way of treating recurrent thyroid cancer without surgery is to use heat to try and destroy the involved nodule(s). The most common option is using radiowavebased heat (radiofrequency ablation, RFA). This is done by inserting a fine needle through the skin into the nodule(s). The tip of this needle then delivers heat to the nodule, burning the nodule from the inside out and, as a result, hopefully destroying any cancer cells inside the nodule. In this study, the researchers evaluate RFA as an option to treat papillary microcarcinoma as an alternative to surgery in patients that are not interested in active surveillance.

THE FULL ARTICLE TITLE
Yan L et al Five-year outcome between radiofrequency ablation vs surgery for unilateral multifocal papillary thyroid microcarcinoma. J Clin Endocrinol Metab 2023;108(12):3230-3238; doi: 10.1210/clinem/dgad360. PMID: 37318878.

SUMMARY OF THE STUDY
This is a study of adult patients with thyroid microcarcinoma diagnosed on biopsy treated at Chinese PLA General Hospital between 2014 and 2017, with a minimum follow-up of 60 months. Worth mentioning, that the Chinese guidelines recommended surgery as the standard treatment for papillary microcarcinoma. Thus, RFA was only used if patients declined or were not candidates for surgery. The goal was to analyze growth of the cancer, either as persistent or recurring cancer, or development of spread of the cancer to the lymph nodes. Other goals included treatment variables, including procedure time and cost, treatment complications, and the need for delayed surgery after RFA.

A total of 44 patients that received RFA were compared to 53 patients that underwent surgery (lobectomy group). These patients were followed for an average of 73 months. The rate of cancer progression was the same in both groups, and no patient in either group developed spread of the cancer outside the neck. The RFA group had shorter hospitalization times, shorter procedure time, and lower associated costs than the lobectomy group while the lobectomy group had a higher procedure- related complications. However, no group had permanent complications.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study showed that RFA of papillary microcarcinoma is comparable to lobectomy in terms of the low chances of cancer progression. RFA also had a lower procedure and hospitalization time, lower cost, and lower rates of treatment-related complications than lobectomy. This is a small study but suggests that RFA is safe and effective for treatment of papillary microcarcinoma. Larger studies are needed to confirm these findings.

— Joanna Miragaya, MD

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