Advances in the study of indications for thermal ablation therapy of thyroid nodules

Thyroid nodules, a common endocrine tumor, have shown a significant increase in incidence globally. The total incidence rate of thyroid nodules worldwide is about 25% from 2000 to 2022, of which the incidence of malignant thyroid nodules is 4.0% to 6.5%. In recent years, the application of thermal ablation technology in the treatment of thyroid nodules has been steadily increasing, with broader indications and fewer contraindications. Thermal ablation techniques have been widely applied in the treatment of benign thyroid nodules. Studies have demonstrated that radiofrequency ablation (RFA) and microwave ablation (MWA) significantly reduce nodule volume and alleviate symptoms. For retrosternal thyroid nodules, the post-treatment volume reduction rate exceeds 90%. For calcified benign nodules, a five-year follow-up showed an average volume reduction rate of 92.95%. Studies on follicular tumors indicated that more than half of the nodules achieved a 90%-volume reduction one year after thermal ablation, with a low incidence of complications in the treatment group. In the treatment of malignant thyroid tumors, thermal ablation has shown promising results in T1aN0M0 solitary low-risk papillary thyroid microcarcinoma (PTMC), with a disease progression rate as low as 3.6%. For T1bN0M0-T2N0M0 primary solitary papillary thyroid carcinoma (PTC), the prognosis following thermal ablation is comparable to surgery, with a lower incidence of complications. In patients with multifocal PTC, the success rate of thermal ablation was 100%, with a low rate of local tumor progression during follow-up. For PTMC located in the isthmus, adjacent to the trachea, or close to the thyroid capsule, thermal ablation demonstrated similar efficacy to surgery, with lower rates of complications and recurrence. This review summarizes the current indications of thermal ablation technology in the treatment of thyroid nodules and provides a reference for clinical applications.