The evolution of image-guided ablations for thyroid disorders: a historical review

Over the past four decades, the management of thyroid nodules and selected thyroid malignancies has progressively shifted from surgery-centered approaches toward image-guided minimally invasive treatments (MITT). What began in 1985 with ultrasound-guided percutaneous ethanol injection evolved into a range of energy-based techniques, including laser ablation (LA), radiofrequency ablation (RFA), microwave ablation (MWA), and high-intensity focused ultrasound (HIFU).This historical review aimed to reconstruct the major milestones in the development of image-guided thyroid ablation. A systematic PubMed literature search and predefined selection criteria were used to identify seminal studies, first clinical applications, major technological innovations, comparative studies, guideline-defining publications, and landmark long-term follow-up studies. Overall, 43 milestone papers were included for qualitative historical analysis. The evolution of thyroid ablation can be divided into five phases: conceptual origins (1985-1999), birth of the thermal procedures' era (2000-2006), methodological standardization (2007-2012), oncologic consolidation and comparative evidence (2013-2018), and final codification by means of international guideline endorsement and long-term validation (2019-2025). Recent 10-year follow-up studies have confirmed the durable efficacy of MITT for benign nodule management and their sustained oncologic control in low-risk papillary thyroid microcarcinoma. Image-guided thyroid ablation has transitioned from experimental innovation to an evidence-based, guideline-supported therapeutic domain, representing a paradigm shift toward precision medicine, organ preservation, and minimally invasive endocrine oncology.