Ultrasound and gene-guided microwave ablation vs. surgery for low-risk papillary thyroid carcinoma: a prospective observational cohort study

Abstract

Objective: This prospective observational cohort real-world study evaluates and compares the efficacy and prognosis of ultrasound (US) and gene-based microwave ablation (MWA) and surgical treatment in patients with low-risk papillary thyroid carcinoma (PTC), emphasizing the influence of genetic mutations on low-risk patient selection.

Background: MWA, a minimally invasive technique, is increasingly recognized in the management of PTC. While traditional criteria for ablation focus on tumor size, number, and location, the impact of genetic mutations on treatment efficacy remains underexplored.

Methods: A total of 201 patients with low-risk PTC without metastasis were prospectively enrolled. All patients underwent US and next-generation sequencing to confirm low-risk status. Patients chose either ablation or surgery and were monitored until November 2024. Efficacy and complications were assessed using thyroid US and contrast-enhanced US.

Results: The median follow-up of this study is 12 months. There is no significant difference between the ablation group (3.0%) and the surgery group (1.0%) in disease free survival (P = 0.360). However, the surgery group exhibited a significantly higher complication rate, particularly for temporary hypoparathyroidism (P < 0.001). Ablation offers notable advantages, including shorter treatment duration, faster recovery, less intraoperative blood loss, and reduced costs (P < 0.001), while maintaining favorable safety and comparable efficiency.

Conclusions: For patients with low-risk genetic mutations, ablation provides comparable efficacy and disease free survival to surgery, with significant benefits in safety, recovery, and overall cost. Guided by US and next-generation sequencing, precise patient selection enhances the potential of ablation as a promising, minimally invasive alternative to surgery in the management of low-risk PTC.

Keywords

papillary thyroid carcinoma / next-generation sequencing / microwave ablation / surgical treatment

Acknowledgments

We appreciate the assistance and support provided by Joint Big Data Laboratory, Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University; UMedEVO Artificial Intelligence Technology (Guangzhou) Co., Ltd. and UMedREVO Artificial Intelligence Technology (Guangzhou) Co., Ltd. in this study.

Author contributions

Yunfang Yu (Conceptualization, Funding acquisition, Writing - review & editing), Yuxin Shen (Data curation, Formal analysis, Writing - original draft, Writing - review & editing), Yujie Tan (Writing - original draft, Writing - review & editing), Yisikandaer Yalikun (Data curation, Formal analysis, Writing - original draft, Writing - review & editing), Tian Tian (Formal analysis, Writing - original draft, Writing - review & editing), Qingqing Tang (Formal analysis, Writing - original draft, Writing - review & editing), Qiyun Ou (Conceptualization, Writing - original draft, Writing - review & editing), Yue Zhu (Conceptualization, Writing - original draft, Writing - review & editing), and Miaoyun Long (Conceptualization, Writing - original draft, Writing - review & editing).

Supplementary data

Supplementary data are available at PCMEDI Journal online.

Conflicts of interest

None declared.

Funding

This study was supported by the National Natural Science Foundation of China (Grant No. 82402294), the Guangzhou Science and Technology Project (Grant Nos. 2023A03J0722 and 2024A03J1194), the Scientific Research Launch Project of Sun Yat-Sen Memorial Hospital (Grant No. SYSYQH-II-2024–07), the Guangdong Science and Technology Department (Grant No. 2024B1212030002), and the Guangdong Yiyang Healthcare Charity Foundation (Grant No. 2023CSM003).

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