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Thermal ablation of lymph node metastases in papillary thyroid carcinoma: node size impacts outcomes
Wen-Jia Cai1, Zhen-Long Zhao1, Ying Wei1
1Department of Interventional Medicine, China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East St, Chao-yang District, Beijing, 100029, China.
Purpose:
To evaluate the efficacy and safety of thermal ablation (TA) for cervical lymph node metastases (LNMs) from papillary thyroid carcinoma (PTC) and to assess the impact of nodal size on treatment outcomes.
Methods:
This retrospective single center study analyzed 87 patients (177 LNMs, ≤ 5 nodes per patient) who underwent percutaneous TA from July 2018 to July 2024. Technical success, volume reduction rate (VRR), nodule disappearance, disease progression, and complications were assessed. Kaplan-Meier, Cox regression, and decision tree analyses were performed to identify prognostic factors and optimal cut-off values for nodal diameter.
Results:
TA achieved 100% technical success, with a mean VRR of 98.2 ± 8.1% and node disappearance rate in 94.3% of cases at a median follow-up of 34 months. Multivariable analysis identified LNM diameter (HR 2.02; 95% CI 1.15-3.56; P = 0.014) and location (lateral vs. central: HR 2.84; 95% CI 1.04-7.76; P = 0.042) as independent predictors of progression. Decision tree and Kaplan-Meier analyses indicated LNMs ≤ 2.4 cm as a practical threshold balancing efficacy and procedural burden. Major complications were rare (2.3%, transient recurrent laryngeal nerve injury), with no permanent morbidity.
Conclusion:
TA is a safe and effective minimally invasive treatment for selected patients with up to five LNMs from PTC. Smaller LNM diameter was associated with a lower risk of disease progression after TA, and the data-derived 2.4-cm cutoff may serve as a preliminary reference for patient selection.
