Ultrasound-guided microwave ablation versus surgery for low-risk solitary papillary thyroid microcarcinoma: a propensity-matched cohort study.

OBJECTIVE

To evaluate the therapeutic effects of microwave ablation (MWA) versus surgery in treating low-risk papillary thyroid microcarcinoma (PTMC) and to assess recurrence-free survival (RFS) in patients with and without the BRAFV600E mutation.

METHODS

Between August 2016 and September 2022, 158 patients diagnosed with low-risk PTMC treated with MWA and 288 patients who underwent surgical treatment were retrospectively analyzed. All patients were followed-up for over a year. Local tumor progression (LTP), RFS and adverse events associated with both treatments were monitored. Following propensity score matching (PSM), comparisons were made regarding LTP, RFS, complications and treatment variables.

RESULTS

Prior to matching, MWA patients were younger than those in the surgery group (38 (30.75, 47) vs 43 (34, 50.75), P = 0.000). Tumors treated with MWA had smaller maximum diameters (5.7 (4.6, 7.0) vs 6.9 (5.8, 8.6), P = 0.000) and volumes (70.7 (35.2, 120.9) vs 122.0 (63.9, 228.8), P = 0.000). After 1:1 PSM, each group contained 141 patients with comparable baseline characteristics. During the follow-up, LTP developed in nine patients: six in the MWA group and three in the surgery group. There were no cases of distant metastasis or cancer-related deaths. Adjusting for age, sex, tumor location and largest diameter, there was no significant association between treatment modality and recurrence (HR = 3.75, 95% CI: 0.94-14.98, P = 0.062). There were no significant differences in RFS between patients with and without the BRAFV600E mutation in both groups (P = 0.45 and 0.74, respectively). Furthermore, the incidence of complications was comparable between treatments.

CONCLUSION

Both MWA and surgical treatment offer similar efficacy and safety profiles for managing low-risk PTMC. MWA may represent a viable alternative to conventional surgical approaches, especially for patients harboring the BRAFV600E mutation.