Enhancing patient selection for thyroid thermal ablation: insights from a multidisciplinary team approach

Thermal ablation (TA) is increasingly used to treat benign thyroid nodules; however, a residual risk of occult malignancy persists despite two benign cytology results. We aimed to: (1) evaluate the proportion of non-benign histological results among patients excluded from TA during multidisciplinary team meetings (MDTMs); (2) identify clinical and ultrasonographic features suggestive of malignancy and (3) assess non-benign outcomes among patients treated with TA who subsequently underwent surgery.

We conducted a retrospective single-center cohort study in a tertiary referral hospital between January 2019 and December 2023. Patients referred for TA with two benign cytology results but excluded after MDTM review were analyzed. Patients treated with TA who later underwent surgery were also reviewed. The primary endpoint was the proportion of non-benign histological results among surgically treated patients excluded from TA after MDTM review.

Among 573 patients discussed at MDTM, 131 (23%) were deemed ineligible for TA. Of these, 61 (47%) underwent surgery. Non-benign histology was identified in 6 of 61 operated patients (10%), corresponding to 4.6% of all excluded patients. Among 219 patients treated with TA, three (1.4%) required surgery during follow-up. Histology revealed one benign lesion, one noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), and one tumor of uncertain malignant potential.

Systematic MDTM evaluation in an expert center identified non-benign nodules among patients excluded from TA, while non-benign outcomes after TA were rare. These findings should be interpreted cautiously given the retrospective design and limited number of events.