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Thermal ablation versus surgical resection for follicular thyroid neoplasm: a multicenter study
Zhenlong Zhao1, Boqiang Fan2, Junfeng He3
1Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China.
Summary
Thermal ablation (TA) and surgical resection (SR) show similar progression-free survival for follicular thyroid neoplasm (FTN). TA offers fewer complications and avoids hormone replacement therapy, making it a viable alternative for select FTN patients.
Area of Science:
- Endocrinology
- Oncology
- Minimally Invasive Surgery
Background:
- Follicular thyroid neoplasm (FTN) management often involves a choice between thermal ablation (TA) and surgical resection (SR).
- Understanding the comparative efficacy and safety profiles of these treatments is crucial for patient care.
- F-TIRADS scoring aids in risk stratification for thyroid nodules.
Purpose of the Study:
- To compare thermal ablation (TA) versus surgical resection (SR) for follicular thyroid neoplasm (FTN) with an F-TIRADS score below 12.
- To evaluate differences in progression-free survival rates (overall, 1-, 3-, and 5-year) and complication rates between TA and SR.
- To determine the feasibility of TA as an alternative treatment for selected FTN patients.
Main Methods:
- Retrospective analysis of 692 patients with FTN treated with TA or SR across 9 centers (January 2014 - June 2023).
- Primary outcomes included overall and time-specific progression-free survival rates and complication incidence.
- Patients were followed for a median of 23 months (TA group) and 25 months (SR group).
Main Results:
- No significant difference in overall, 1-, 3-, or 5-year progression-free survival rates between TA and SR (5-year: 98.6% vs. 99.4%, p > 0.05).
- TA was associated with shorter incision length, procedure duration, and hospitalization (all p < 0.001).
- Complications like permanent hoarseness (8.1%) and the need for lifelong hormone replacement therapy (64.4%) were exclusively observed in the SR group (p < 0.001).
Conclusions:
- Thermal ablation (TA) demonstrates comparable progression-free survival to surgical resection (SR) for FTN patients with F-TIRADS scores < 12.
- TA offers significant advantages, including reduced complications and elimination of the need for hormone replacement therapy.
- TA represents a feasible and potentially superior alternative treatment option for carefully selected patients with FTN.
