Radiofrequency Ablation in the Management of Papillary Thyroid Carcinoma: Literature Review
https://doi.org/10.24060/2076-3093-2026-16-1-62-70
Abstract
Thyroid cancer is one of the most common endocrine malignancies worldwide. Surgical resection remains the standard care; however, minimally invasive approaches are increasingly being investigated for patients with low-risk cases, particularly papillary thyroid microcarcinoma (PTMC). This review summarizes current evidence on the use of radiofrequency ablation (RFA) in the management of differentiated thyroid carcinoma, with a primary focus on papillary thyroid carcinoma. 27 key publications were analyzed, including international guidelines, meta-analyses, and prospective and retrospective studies. Available data indicate that RFA achieves local tumor control and recurrence-free survival rates comparable to those of surgical management in appropriately selected low-risk patients, while significantly reducing procedure-related morbidity and preserving thyroid function. The technique demonstrates particular efficacy in patients with solitary tumors of up to 1 cm (T1aN0M0) without evidence of metastasis. This review provides a comprehensive evaluation of accumulated clinical data, direct comparison between RFA and thyroid surgery, and an analysis of long-term outcomes as reflected in major guidelines from 2022–2025. Current evidence suggests that RFA represents an emerging organ-preserving strategy that maintains oncologic efficacy in low-risk papillary thyroid carcinoma. Further randomized trials are required to define its role within standardized treatment algorithms.
About the Authors
V. A. Solovov
Samara Regional Clinical Oncology Dispensary
Russian Federation
Russian Federation
Viacheslav A. Solovov — Dr. Sci. (Med.), Prof., Interventional Diagnostics and Treatment Unit.
Samara
A. A. Fedulov
Samara State Medical University
Russian Federation
Russian Federation
Andrey A. Fedulov — Resident.
Samara
References
1. Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A., et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49. DOI: 10.3322/caac.21660
2. Boucai L., Zafereo M., Cabanillas M.E. Thyroid cancer: a review. JAMA. 2024;331(5):425–35. DOI: 10.1001/jama.2023.26348
3. Dolidze D.D., Shabunin A.V., Mumladze R.B., Vardanyan A.V., Covantsev S.D., Shulutko A.M., et al. Narrative review of preventive central lymph node dissection in patients with papillary thyroid cancer — a necessity or an excess. Front Oncol. 2022;12:906695. DOI: 10.3389/fonc.2022.906695
4. Chen D.W., Lang B.H.H., McLeod D.S.A., Newbold K., Haymart M.R. Thyroid cancer. Lancet. 2023;401(10387):1531–44. DOI: 10.1016/S0140-6736(23)00020-X
5. Bray F., Laversanne M., Sung H., Ferlay J., Siegel R.L., Soerjomataram I., et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–63. DOI: 10.3322/caac.21834
6. Li M., Dal Maso L., Pizzato M., Vaccarella S. Evolving epidemiological patterns of thyroid cancer and estimates of overdiagnosis in 2013-17 in 63 countries worldwide: a population-based study. Lancet Diabetes Endocrinol. 2024;12(11):824–36. DOI: 10.1016/s2213-8587(24)00223-7
7. Haymart M.R., Reyes-Gastelum D., Caoili E., Norton E.C., Banerjee M. The relationship between imaging and thyroid cancer diagnosis and survival. Oncologist. 2020;25(9):765–71. DOI: 10.1634/theoncologist.2020-0159
8. Edwards M.K., Iñiguez-Ariza N.M., Singh Ospina N., Lincango-Naranjo E., Maraka S., Brito J.P. Inappropriate use of thyroid ultrasound: a systematic review and meta-analysis. Endocrine. 2021;74(2):263–9. DOI: 10.1007/s12020-021-02820-z
9. Ghai S., Goldstein D.P., Sawka A.M. Ultrasound imaging in active surveillance of small, low-risk papillary thyroid cancer. Korean J Radiol. 2024;25(8):749–55. DOI: 10.3348/kjr.2024.0148
10. Li B., Qian Y., Huang Y., Li Z. Efficacy and safety of thermal ablation modalities for the treatment of papillary thyroid microcarcinoma: Systematic Review and network meta-analysis. Heliyon. 2024;10(3):e25536. DOI: 10.1016/j.heliyon.2024.e25536
11. Sun Y.D., Zhang H., Zhu H.T., Wu C.X., Chen M.L., Han J.J. A systematic review and meta-analysis comparing tumor progression and complications between radiofrequency ablation and thyroidectomy for papillary thyroid carcinoma. Front Oncol. 2022;12:994728. DOI: 10.3389/fonc.2022.994728
12. Al-Qurayshi Z., Nilubol N., Tufano R.P., Kandil E. Wolf in sheep’s clothing: papillary thyroid microcarcinoma in the US. J Am Coll Surg. 2020;230(4):484–91. DOI: 10.1016/j.jamcollsurg.2019.12.036
13. El Hag I.A., Tallab R. Papillary thyroid carcinoma measuring 1.0 cm or less: an epidemiological and clinicopathological study. Front Oncol. 2025;15:1678065. DOI: 10.3389/fonc.2025.1678065
14. Abraham P.J., Wu C., Wang R., Herring B., Zmijewski P., Gillis A., et al. The overtreatment of papillary thyroid microcarcinoma in the community. Am J Surg. 2024;233:132–5. DOI: 10.1016/j.amjsurg.2024.03.004
15. Zhang Q., Gu X., Liu S., Fu R., Wang Y., Hegarty J., et al. Decisional conflicts in patients with low-risk papillary thyroid microcarcinomas considering active surveillance. JAMA Otolaryngol Head Neck Surg. 2024;150(11):952–9. DOI: 10.1001/jamaoto.2024.2718
16. Papini E., Basile M., Novizio R., Paoletta A., Persichetti A., Samperi I., et al. Cost analysis and resource allocation in the management of benign thyroid nodules: a comparison of surgery and thermal ablation techniques. J Endocrinol Invest. 2025;48(8):1769–80. DOI: 10.1007/s40618-025-02597-2
17. Kuo E.J., Oh A., Hu Y., McManus C.M., Lee J.A., Kuo J.H. If the price is right: Cost-effectiveness of radiofrequency ablation versus thyroidectomy in the treatment of benign thyroid nodules. Surgery. 2023;173(1):201–6. DOI: 10.1016/j.surg.2022.08.048
18. Miller J.R., Tanavde V., Razavi C., Saraswathula A., Russell J.O., Tufano R.P. Cost comparison between open thyroid lobectomy and radiofrequency ablation for management of thyroid nodules. Head Neck. 2023;45(1):59–63. DOI: 10.1002/hed.27213
19. Ito Y., Miyauchi A. Active surveillance of low-risk papillary thyroid microcarcinomas. Gland Surg. 2020;9(5):1663–73. DOI: 10.21037/gs-2019-catp-03
20. Ringel M.D., Sosa J.A., Baloch Z., Bischoff L., Bloom G., Brent G.A., et al. 2025 American thyroid association management guidelines for adult patients with differentiated thyroid cancer. Thyroid. 2025;35(8):841–85. DOI: 10.1177/10507256251363120
21. Cho S.J., Suh C.H., Baek J.H., Chung S.R., Choi Y.J., Chung K.W., et al. S Active surveillance for small papillary thyroid cancer: a systematic review and meta-analysis. Thyroid. 2019;29(10):1399–408. DOI: 10.1089/thy.2019.0159
22. Won H.R., Koo B.S. Active surveillance or surgery in papillary thyroid microcarcinoma: an ongoing controversy. Clin Exp Otorhinolaryngol. 2022;15(2):123–4. DOI: 10.21053/ceo.2022.00605
23. Lee C.R. A review of active surveillance of papillary thyroid microcarcinoma. J Endocr Surg. 2022;22(1):1–9. DOI: 10.16956/jes.2022.22.1.1
24. Miyauchi A., Ito Y., Fujishima M., Miya A., Onoda N., Kihara M., et al. Long-term outcomes of active surveillance and immediate surgery for adult patients with low-risk papillary thyroid microcarcinoma: 30-year experience. Thyroid. 2023;33(7):817–25. DOI: 10.1089/thy.2023.0076
25. Orloff L.A., Noel J.E., Stack B.C. Jr, Russell M.D., Angelos P., Baek J.H., et al. Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association. Head Neck. 2022;44(3):633–60. DOI: 10.1002/hed.26960
26. Kim J.H., Baek J.H., Lim H.K., Na D.G. Summary of the 2017 thyroid radiofrequency ablation guideline and comparison with the 2012 guideline. Ultrasonography. 2019;38(2):125–34. DOI: 10.14366/usg.18044
27. Yan L., Zhang M., Song Q., Luo Y. Ultrasound-guided radiofrequency ablation versus thyroid lobectomy for low-risk papillary thyroid microcarcinoma: a propensity-matched cohort study of 884 patients. Thyroid. 2021;31(11):1662–72. DOI: 10.1089/thy.2021.0100
28. Yue W.W., Qi L., Wang D.D., Yu S.J., Wang X.J., Xu H.X., et al. US-guided microwave ablation of low-risk papillary thyroid microcarcinoma: longer-term results of a prospective study. J Clin Endocrinol Metab. 2020;105(6):dgaa128. DOI: 10.1210/clinem/dgaa128
29. Papini E., Guglielmi R., Novizio R., Pontecorvi A., Durante C. Management of low-risk papillary thyroid cancer. Minimally-invasive treatments dictate a further paradigm shift? Endocrine. 2024;85:584–92. DOI:10.1007/s12020-024-03864-7
30. Han Z.Y., Dou J.P., Zheng L., Xu M., Ren J., Wang H., et al. Chinese guidelines for ultrasound-guided thermal ablation of thyroid nodules (2024 edition). Int J Surg. 2025;111(2):1699–710. DOI: 10.1097/JS9.0000000000002209
31. Zhao Z.L., Wang S.R., Kuo J., Çekiç B., Liang L., Ghazi H.A., et al. 2024 International Expert Consensus on US-guided thermal ablation for T1N0M0 papillary thyroid cancer. Radiology. 2025;315(1):e240347. DOI: 10.1148/radiol.240347
32. Haddad R.I., Bischoff L., Ball D., Bernet V., Blomain E., Busaidy N.L., et al. Thyroid carcinoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20(8):925–51. DOI: 10.6004/jnccn.2022.0040
33. Chen S., Mao Y., Chen G. Economic effect between surgery and thermal ablation for patients with papillary thyroid microcarcinoma: a systemic review and meta-analysis. Endocrine. 2022;76(1):9–17. DOI: 10.1007/s12020-022-02991-3
34. Li S., Yu M.A., Zhao Z.L., Wei Y., Peng L.L., Li Y. Changes in thyroid function after thermal ablation of thyroid nodules. Front Endocrinol (Lausanne). 2025;16:1557725. DOI: 10.3389/fendo.2025.1557725
35. Cooper D., Kaur R., Ayeni F.E., Eslick G.D., Edirimanne S. Hypothyroidism after hemithyroidectomy: a systematic review and meta-analysis. Thyroid Res. 2024;17(1):18. DOI: 10.1186/s13044-024-00200-z
36. Tuttle R.M., Li D., Ridouani F. Percutaneous ablation of low-risk papillary thyroid cancer. Endocr Relat Cancer. 2023;30(3):e220244. DOI: 10.1530/ERC-22-0244
37. Jeong S.Y., Baek S.M., Shin S., Son J.M., Kim H., Baek J.H. Radiofrequency ablation of low-risk papillary thyroid microcarcinoma: a retrospective cohort study including patients with more than 10 years of follow-up. Thyroid. 2025;35(2):143–52. DOI: 10.1089/thy.2024.0535
38. van Dijk S.P.J., Coerts H.I., Gunput S.T.G., van Velsen E.F.S., Medici M., Moelker A., et al. Assessment of radiofrequency ablation for papillary microcarcinoma of the thyroid: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2022;148(4):317–25. DOI: 10.1001/jamaoto.2021.4381
39. Kim H.J., Cho S.J., Baek J.H. Comparison of thermal ablation and surgery for low-risk papillary thyroid microcarcinoma: a systematic review and meta-analysis. Korean J Radiol. 2021;22(10):1730–741. DOI: 10.3348/kjr.2020.1308
40. Lui M.S., Patel K.N. Current guidelines for the application of radiofrequency ablation for thyroid nodules: a narrative review. Gland Surg. 2024;13(1):59–69. DOI: 10.21037/gs-23-18
41. Mauri G., Hegedüs L., Bandula S., Cazzato R.L., Czarniecka A., Dudeck O., et al. European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical practice guideline for the use of minimally invasive treatments in malignant thyroid lesions. Eur Thyroid J. 2021;10(3):185–97. DOI: 10.1159/000516469
42. Chung S.R., Baek J.H., Choi Y.J., Lee J.H. Ten-year outcomes of radiofrequency ablation for locally recurrent papillary thyroid cancer. Korean J Radiol. 2024;25(9):851–8. DOI: 10.3348/kjr.2024.0208
43. Kong X., Wang L., Sun Y., Zhu D., Yang C. Comparison of radiofrequency ablation and surgery for thyroid papillary microcarcinoma: efficacy, safety and life quality. Front Endocrinol (Lausanne). 2024;15:1352503. DOI: 10.3389/fendo.2024.1352503
44. Navin P.J., Thompson S.M., Kurup A.N., Lee R.A., Callstrom M.R., Castro M.R., et al. Radiofrequency ablation of benign and malignant thyroid nodules. Radiographics. 2022;42(6):1812–28. DOI: 10.1148/rg.220021
45. Cavalheiro B.G., Shah J.P., Randolph G.W., Medina J.E., Tufano R.P., Zafereo M., et al. Management of recurrent well-differentiated thyroid carcinoma in the neck: a comprehensive review. Cancers (Basel). 2023;15(3):923. DOI: 10.3390/cancers15030923
46. Liang N., Zhang H., Sui C., Du R., Li C., Li J., et al. Surgical resection of recurrent differentiated thyroid cancer: patterns, detection, staging, and treatment of 683 patients. Front Endocrinol (Lausanne). 2023;14:1301620. DOI: 10.3389/fendo.2023.1301620
47. Rao K.N., Satpute S., Nagarkar N.M., Singh A. Revision thyroid surgery. Indian J Surg Oncol. 2022;13(1):199–207. DOI: 10.1007/s13193-021-01467-6
48. Kim J.H., Yoo W.S., Park Y.J., Park D.J., Yun T.J., Choi S.H., et al. Efficacy and safety of radiofrequency ablation for treatment of locally recurrent thyroid cancers smaller than 2 cm. Radiology. 2015;276(3):909–18. DOI: 10.1148/radiol.15140079
49. Yang Z., Zhang M., Yan L., Xiao J., Li Y., Li X., et al. Value of radiofrequency ablation for treating locally recurrent thyroid cancer: a systematic review and meta-analysis for 2-year follow-up. Endocrine. 2024;85(3):1066–74. DOI: 10.1007/s12020-023-03660-9
50. Ha E.J., Lee M.K., Baek J.H., Lim H.K., Ahn H.S., Baek S.M., et al. Radiofrequency ablation for recurrent thyroid cancers: 2025 Korean Society of Thyroid Radiology Guideline. Korean J Radiol. 2025;26(1):10–28. DOI: 10.3348/kjr.2024.0963
51. Li R., Yang L., Xu M., Wu B., Liu Q., An Q., et al. Current evidence and strategies for preventing tumor recurrence following thermal ablation of papillary thyroid carcinoma. Cancer Imaging. 2025;25(1):88. DOI:10.1186/s40644-025-00908-7
52. Ito Y., Miyauchi A., Kihara M., Fukushima M., Higashiyama T., Miya A. Overall survival of papillary thyroid carcinoma patients: a single-institution long-term follow-up of 5897 patients. World J Surg. 2018;42(3):615–622. DOI: 10.1007/s00268-018-4479-z
53. Kim M.J., Moon J.H., Lee E.K., Song Y.S., Jung K.Y., Lee J.Y., et al. Active surveillance for low-risk thyroid cancers: a review of current practice guidelines. Endocrinol Metab. 2024;39(1):47–60. DOI: 10.3803/EnM.2024.1937
54. Cho S.J., Baek S.M., Lim H.K., Lee K.D., Son J.M., Baek J.H. Long-term follow-up results of ultrasound-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma: more than 5-year follow-up for 84 tumors. Thyroid. 2020;30(12):1745–51. DOI: 10.1089/thy.2020.0106
55. Li X., Yan L., Xiao J., Li Y., Yang Z., Zhang M., et al. Long-term outcomes and risk factors of radiofrequency ablation for T1N0M0 papillary thyroid carcinoma. JAMA Surg. 2024;159(1):51–8. DOI:10.1001/jamasurg.2023.5202
56. Kawano S., Miyauchi A., Ito Y. Routine chest computed tomography at presentation does not identify distant metastasis in cT1aN0 papillary thyroid carcinoma. Thyroid. 2020;30(11):1620–4. DOI: 10.1089/thy.2020.0073
57. Ito Y., Miyauchi A. Active surveillance may be the best initial management for papillary thyroid microcarcinoma. J Endocr Soc. 2023;7(7):bvad063. DOI: 10.1210/jendso/bvad063
58. Xu D., Ge M., Yang A., Cheng R., Sun H., Wang H., et al. Expert consensus workshop report: Guidelines for thermal ablation of thyroid tumors (2019 edition). J Cancer Res Ther. 2020;16(5):960–6. DOI: 10.4103/jcrt.JCRT_558_19
59. Bosset M., Bonjour M., Castellnou S., Hafdi-Nejjari Z., Bournaud-Salinas C., Decaussin-Petrucci M., et al. Long-term outcome of lobectomy for thyroid cancer. Eur Thyroid J. 2021;10(6):486–94. DOI: 10.1159/000510620
60. Kaur J., Nadarajan A., Janardhan D., George N.A., Thomas S., Varghese B.T., et al. Predictive factors for nodal recurrence in differentiated thyroid cancers. Cancer Treat Res Commun. 2023;36:100728. DOI: 10.1016/j.ctarc.2023.100728
61. Jung C.K., Lee S., Bae J.S., Lim D.J. Late-onset distant metastases confer poor prognosis in patients with well-differentiated thyroid cancer. Gland Surg. 2020;9(5):1857–66. DOI: 10.21037/gs-20-416
Review
For citations:
Solovov V.A., Fedulov A.A. Radiofrequency Ablation in the Management of Papillary Thyroid Carcinoma: Literature Review. Creative surgery and oncology. 2026;16(1):62-70. (In Russ.) https://doi.org/10.24060/2076-3093-2026-16-1-62-70
Views:
64
JATS XML
Email this article 