# Thermal Ablation vs. Surgery for Small Papillary Thyroid Cancer: A Patient's Guide to the Latest Research

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SUMMARY paragraph:
This study compared two minimally invasive heat-based treatments—radiofrequency ablation (RFA) and laser ablation (LA)—against traditional surgery for patients with very small papillary thyroid cancers (5 mm or less). Among 162 patients followed for one year, both thermal ablation techniques provided cancer control comparable to surgery, with dramatically shorter procedure times (about 5–6 minutes versus nearly an hour for surgery) and hospital stays of roughly one day versus about four days. No major complications occurred in the thermal ablation groups, and patients reported significantly better quality of life during recovery, with scores returning to baseline within a year. The findings suggest that RFA and LA may become standard treatment options for carefully selected small thyroid cancers.

# Thermal Ablation vs. Surgery for Small Papillary Thyroid Cancer: A Patient's Guide to the Latest Research

## Table of Contents

- Key Points
- Understanding Papillary Thyroid Carcinoma
- Why This Research Matters
- How the Study Was Conducted
- Key Findings: How Well Each Treatment Worked
- Key Findings: Safety and Side Effects
- Quality of Life: The Patient's Perspective
- What Happened After Treatment
- What This Means for Patients
- Study Limitations
- Questions to Ask Your Doctor
- Frequently Asked Questions
- Source Information

## Key Points

- In a one-year study of 162 patients with papillary thyroid cancer of 5 mm or less, radiofrequency and laser ablation controlled cancer comparably to surgery.
- Average procedure time was about 5–6 minutes for ablation versus 58.6 minutes for surgery; hospital stays were about 1 day versus 4.2 days.
- No major complications occurred in the ablation groups; minor complication rates were 4.7% for radiofrequency and 9.7% for laser ablation.
- Quality of life declined at 3 months in all groups but returned to baseline by 12 months only in the ablation groups.
- The authors call for larger trials with longer follow-up before thermal ablation becomes standard for small papillary thyroid cancer.

## Understanding Papillary Thyroid Carcinoma

Papillary thyroid carcinoma (PTC) is the most common form of thyroid cancer, accounting for the vast majority of all endocrine malignancies. It is a cancer that begins in the follicular cells of the thyroid gland—the butterfly-shaped organ located in the front of your neck that regulates metabolism, heart rate, and body temperature.

The good news for patients is that PTC is generally slow-growing and highly treatable, especially when detected early. In recent years, the widespread use of high-resolution ultrasound and increased health awareness have led to the detection of more and more cases where the primary tumor is 1.0 cm (10 mm) or smaller in diameter, with no visible enlargement of lymph nodes in the neck. These tiny cancers are often referred to as "low-risk" or "microcarcinomas."

Historically, surgery has been the standard treatment for PTC. However, surgery carries certain risks and downsides, including the need for general anesthesia, visible scarring, and a longer recovery period. This has led researchers to explore less invasive options—particularly thermal ablation techniques that destroy cancer cells using heat, such as radiofrequency ablation (RFA) and laser ablation (LA).

## Why This Research Matters

Previous studies on thermal ablation for PTC have shown promising results, including high feasibility, effective local disease control, and minimal complications. Several meta-analyses (studies that combine and analyze data from multiple research papers) have even suggested that, compared to surgery, thermal ablation offers comparable quality of life and non-inferior outcomes at a lower cost.

However, many of these earlier studies had important limitations. Most were retrospective (meaning they looked back at past medical records rather than following patients forward in time), and the comparison of quality of life between thermal ablation and endoscopic (minimally invasive) surgery remained unclear.

One particularly important consideration the researchers wanted to address was the issue of **occult metastasis**—meaning cancer cells that have silently spread to lymph nodes without being detectable on standard imaging. This matters because delayed detection of such spread can lead to increased surgical complications later. Previous research has shown that occult metastasis can develop in more than 50% of cases of cT1N0 PTC (cancer limited to the thyroid with no clinically detectable lymph node involvement), and tumor size plays a major role. According to existing evidence, the risk of lymph node metastasis is nearly **five times higher** in cases of PTC larger than 5 mm compared to PTC of 5 mm or smaller.

This new prospective study was designed to fill these gaps by following patients forward in time and focusing specifically on the smallest, lowest-risk cancers—those measuring 5 mm or less.

## How the Study Was Conducted

The research team at Henan Cancer Hospital in Zhengzhou, China, carried out a prospective investigation from January 2021 to January 2022. "Prospective" means they enrolled patients at the start of the study and followed them forward through time, rather than looking backward at existing records—a more rigorous scientific approach.

**Who was included:** Patients diagnosed with solitary PTC measuring 5 mm or less (cN0, meaning no clinically detectable lymph node involvement). All patients underwent preoperative fine needle aspiration biopsy (a procedure where a thin needle is used to extract cells from the nodule for examination) and genetic mutation profiling, testing for mutations in seven genes: BRAF, RAS, RET, CTNNB1, TERT, PAX8-PPARg, and PTEN. Only patients whose nodules were classified as Bethesda category V (suspicious for malignancy) or VI (malignant) were included.

Patients who had two or more gene mutations were recommended to undergo surgery rather than thermal ablation. The choice of treatment ultimately depended on patient preference and the expertise of the surgical team. Patients with a history of prior cancer or other specific characteristics were excluded.

**The three treatment groups:**

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**Radiofrequency ablation (RFA):** 42 patients. This technique uses electrical energy delivered through a thin needle electrode to generate heat and destroy cancer cells.
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**Laser ablation (LA):** 31 patients. This technique uses laser light energy at a wavelength of 1064 nm, delivered through an optical fiber, to generate heat and destroy cancer cells.
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**Surgery:** 89 patients. This included endoscopic surgery (performed through incisions in the armpit/axilla area for cosmetic benefit) or open surgery (through a standard anterior neck incision), involving removal of one lobe of the thyroid (unilateral thyroidectomy) along with central lymph node dissection.

Thermal ablation procedures were performed by the same two physicians, both with 5 years of experience, under local anesthesia. All surgeries were performed by a professor with 20 years of experience.

Before treatment and at 3, 6, and 12 months afterward, all patients completed the **Thyroid Cancer-Specific Quality of Life (THYCA-QoL)** questionnaire, which assesses seven scales (neuromuscular, voice, concentration, sympathetic, throat/mouth, psychological, and sensory problems) plus six single items (scar concerns, chilly sensation, tingling, weight gain, headache, and anxiety). Each item is rated from 1 ("not at all") to 4 ("very much"), and scores are converted to a 0–100 scale, with higher scores indicating more complaints and poorer quality of life.

## Key Findings: How Well Each Treatment Worked

A total of 162 participants were included in the analysis. Their average age was 50.9 ± 12.5 years, and the group included 68 men (42.0%) and 94 women (58.0%). The average volume of the malignant nodules was 32.3 ± 13.4 mm³. Hashimoto's thyroiditis (an autoimmune condition affecting the thyroid) was present in 17 patients (10.5%), and hypothyroidism (underactive thyroid) was observed in two patients (1.2%). Central lymph node metastasis was identified in three patients (3.3%) who underwent surgery. These characteristics were evenly distributed across all three groups, meaning the groups were well-matched for comparison (all p > 0.05).

**Procedure time:** The difference was dramatic. The mean operation time was just **5.5 ± 4.3 minutes** for RFA and **6.1 ± 3.9 minutes** for LA, compared to **58.6 ± 23.5 minutes** for surgery. This difference was highly statistically significant (p < 0.001), meaning there is less than a 0.1% chance it was due to random chance.

**Hospital stay:** Patients treated with RFA or LA stayed in the hospital for approximately one day (1.0 ± 0.3 days for both groups), while surgery patients stayed an average of **4.2 ± 1.3 days**—another highly significant difference (p < 0.001).

**Complete disappearance of nodules:** At the final follow-up, complete disappearance of the treated nodules was seen in **71.4% of RFA-treated cases** (30 out of 42 patients) and **71.0% of LA-treated cases** (22 out of 31 patients). The difference between these two techniques was not statistically significant (p = 0.966), meaning they were equally effective.

**Tumor volume reduction:** The researchers tracked the volume reduction ratio (VRR)—the percentage by which the treated area shrank over time. Both techniques showed a steady, comparable reduction:

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**RFA group:** 26.6% ± 9.4% at 3 months, 76.4% ± 14.3% at 6 months, and 93.1% ± 14.2% at 12 months
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**LA group:** 25.8% ± 7.6% at 3 months, 81.0% ± 10.5% at 6 months, and 94.0% ± 11.3% at 12 months

**Recurrence:** There were **no instances of cervical lymph node or distant metastasis** in the RFA and LA groups during the follow-up period. In the surgery group, 2 patients (2.2%) experienced recurrence—a difference that was not statistically significant (p = 0.502). Notably, no patients in the RFA or LA groups developed hypothyroidism, whereas this was tracked in the surgery group.

## Key Findings: Safety and Side Effects

Safety was a central focus of this study. The researchers classified complications into two categories: **major** (life-threatening, causing significant disability, or requiring intervention—such as vocal paralysis lasting more than 6 months, neck hematoma requiring surgery, surgical site infection, lymphatic fistula, or permanent hypoparathyroidism) and **minor** (transient problems like temporary voice changes, bleeding that resolved with local pressure, or moderate pain requiring medication).

**Major complications:** No major complications occurred in either the RFA or LA groups. In the surgery group, four major complications were reported (vocal paralysis in one patient, voice change in one, neck hematoma in one, and surgical site infection in one). The difference between groups was not statistically significant (p = 0.179).

**Minor complications:** A total of 13 minor complications were documented across all groups:

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**RFA group:** 2 patients (4.8%)—one with vocal paralysis and one with bleeding
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**LA group:** 3 patients (9.7%)—one each with voice change, bleeding, and pain
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**Surgery group:** 8 patients (9.0%)—bleeding was most common (3 patients), followed by voice change (2), pain (2), and vocal paralysis (1)

These differences were not statistically significant (p = 0.733).

The overall complication rates in this study were 4.7% for RFA and 9.7% for LA. These figures are slightly higher than some earlier reports (Tong et al. reported rates of 4.0% for RFA and 2.0% for LA), which the authors attribute to several factors: differences in how complications were classified, the location of tumors (those near the trachea or in the posterior thyroid near the recurrent laryngeal nerve carry higher risk of nerve injury), variations in operator expertise, and the relatively modest sample size of this study.

## Quality of Life: The Patient's Perspective

All 162 participants completed the quality-of-life questionnaire at every time point, resulting in a perfect 100% response rate—a remarkable achievement for a prospective study.

At baseline (before treatment), quality of life scores were similar across all three groups: 3.0 ± 2.1 for RFA, 2.2 ± 2.0 for LA, and 3.2 ± 3.0 for surgery. Remember: lower scores mean fewer complaints and better quality of life on this questionnaire.

**At 3 months:** All patients experienced a decline in quality of life, which is expected after any treatment. However, the decline was much steeper in the surgery group. The mean quality of life score in the surgery group rose to **17.3 ± 10.2**—significantly higher (worse) than both thermal ablation groups (both p < 0.001).

**At 6 months:** Quality of life began to improve across all groups, but surgery patients were still struggling. The surgery group scored **12.2 ± 8.6**, still significantly worse than the RFA group (**6.2 ± 4.2**) and the LA group (**5.5 ± 4.3**), with both comparisons reaching statistical significance (p < 0.001).

**At 12 months:** Quality of life tended to return to baseline levels for all patients. However, surgery patients still had higher (worse) scores compared to RFA patients (p = 0.005) and LA patients (p = 0.004).

The pattern was clear: the adverse effects on quality of life were most pronounced at the 3-month mark across all groups, but patients in the thermal ablation groups bounced back to their baseline levels, whereas surgery patients continued to report more complaints even at the one-year mark. The authors suggest this may reflect the inherently minimally invasive nature of RFA and LA, whereas even endoscopic thyroid surgery—though cosmetically appealing—creates scar tissue within the surgical cavity that begins a healing process lasting months.

## What Happened After Treatment

At the 12-month follow-up, ultrasound scans identified residual (remaining) lesions in 12 patients treated with RFA and nine patients treated with LA. Fine needle aspiration biopsies were performed on all of these lesions.

The results were reassuring: **all biopsies confirmed the absence of cancer cells**. The remaining tissue was composed of fibrous connective tissue and necrotic (dead) cells—in other words, the scar tissue left behind as the body breaks down and absorbs the destroyed tumor. This is a normal and expected part of the healing process after thermal ablation.

The researchers point out that complete disappearance of a treated tumor takes time. The body's immune system gradually clears away the dead tissue, and this process can take many months. Earlier studies have shown similarly variable rates of complete disappearance: Choi et al. reported rates of 48.7% for LA and 65.2% for RFA, while Gao et al. reported rates as high as 93% for LA and 81% for RFA. One study by Teng et al. demonstrated a dramatic reduction in median tumor volume from 55.78 mm³ to 0 mm³ (p < 0.001) at 60 months after treatment—showing that complete resolution can take up to five years in some cases.

## What This Means for Patients

The authors describe the most important finding of this study as the establishment of **safety and efficacy for both RFA and LA** in treating PTC of 5 mm or smaller, yielding outcomes comparable to surgery with fewer risks and a better quality of life during recovery.

For patients facing a diagnosis of a small papillary thyroid cancer, these results offer a genuine alternative to surgery. Consider what this means in practical terms:

- A procedure that takes about 5–6 minutes under local anesthesia instead of nearly an hour under general anesthesia
- A hospital stay of about 1 day instead of 4 or more days
- No major surgical complications and no visible neck scar
- No risk of hypothyroidism requiring lifelong thyroid hormone replacement (in this study, no RFA or LA patients developed hypothyroidism)
- A faster return to normal quality of life, with fewer voice, physical, and psychological complaints

The researchers also emphasize the importance of the **psychological dimension** of cancer care. There is a global divergence in how small, low-risk PTC is managed. In some countries, "active surveillance" (watchful waiting with regular ultrasound checks) is considered appropriate for small, intrathyroidal PTC without aggressive features. However, the authors note that Chinese patients often experience significant anxiety and nervousness at the mere diagnosis of any cancer, even a tiny one, and typically seek immediate treatment. In China, official guidelines mandate preoperative fine needle biopsy and allow for definitive therapy based on the patient's psychological state.

This study suggests that for patients who cannot tolerate the uncertainty of active surveillance, thermal ablation offers a middle path: immediate treatment that is far less invasive than surgery, with excellent cancer control and better quality of life outcomes.

Previous studies have echoed these benefits. In a prospective study by Zheng et al., 92 patients underwent thermal ablation and 106 had surgery, with the surgery group showing more scar-related issues and higher anxiety. Li et al. found that thermal ablation patients reported better global health, physical well-being, and emotional stability compared to surgery patients. Studies by Lan et al. also found RFA produced better quality of life outcomes than surgery, though those studies were limited by retrospective designs.

An important caveat from the researchers: occult metastasis is heavily influenced by tumor size. PTC larger than 5 mm carries an additional 4-fold risk of lymph node metastasis compared to PTC of 5 mm or smaller. This is precisely why this study focused on the smallest cancers—the group where thermal ablation appears to be a particularly safe and effective option.

## Study Limitations

The authors are transparent about the limitations of their research:

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**Modest sample size:** With only 162 patients total (42 RFA, 31 LA, 89 surgery), the statistical power of the findings is limited. The authors call for a larger trial to confirm the results.
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**Tumor size restriction:** The study was limited to patients with PTC measuring 5 mm or less. The findings cannot be automatically applied to larger tumors, which carry higher risks of occult lymph node metastasis.
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**Short-term follow-up:** While 12 months of follow-up is meaningful, longer observation periods are needed to fully assess recurrence rates and long-term outcomes.
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**Treatment selection bias:** The choice of treatment was based on patient preference and surgical team expertise, which could introduce bias despite the groups being well-matched on baseline characteristics.

## Questions to Ask Your Doctor

If you or a loved one has been diagnosed with a small papillary thyroid carcinoma (5 mm or less), this research provides valuable information for conversations with your medical team. Consider asking the following questions:

1. Is my tumor small enough (≤5 mm) and low-risk enough to be a candidate for thermal ablation?
1. What is the location of my tumor? (Tumors near the trachea or in the posterior thyroid near the recurrent laryngeal nerve may carry higher risks for thermal ablation.)
1. Have I had genetic mutation testing? (Patients with multiple gene mutations may be better served by surgery.)
1. What is your experience with RFA and LA procedures? (Operator expertise affects outcomes and complication rates.)
1. What are the expected procedure times, hospital stays, and recovery periods for each option in my specific case?
1. What quality of life differences can I expect during the first year after each treatment?
1. Would I need to take thyroid hormone replacement medication after treatment? (In this study, no thermal ablation patients developed hypothyroidism.)
1. What kind of follow-up monitoring will I need after thermal ablation compared to surgery?
1. Am I a candidate for active surveillance instead? (This is a legitimate option for some patients, but it depends on your psychological comfort and the tumor's characteristics.)

Remember that every patient's situation is unique. The best treatment choice depends on your specific tumor characteristics, anatomical considerations, personal values, and psychological state. This study provides strong evidence that for the smallest papillary thyroid cancers, thermal ablation deserves serious consideration as a first-line treatment option alongside surgery.

As the authors conclude: "These findings underscore the promise of RFA and LA as potential standard treatments for small PTCs, subject to further confirmation in future studies." The key phrase is "subject to further confirmation"—more research with larger patient populations and longer follow-up periods will help solidify the role of thermal ablation in standard clinical practice.

## Frequently Asked Questions

### I have a papillary thyroid cancer that is 5 mm or smaller. Could I be a candidate for thermal ablation instead of surgery?

In a one-year study of 162 patients with solitary papillary thyroid cancer measuring 5 mm or less and no detectable lymph node involvement, radiofrequency ablation and laser ablation controlled the cancer comparably to surgery. Patients with two or more gene mutations were advised to have surgery. Whether you are a candidate depends on your tumor's size, location, genetic testing results, and your medical team's assessment.

### How long do radiofrequency ablation and laser ablation take, and how long would I stay in hospital?

In the 162-patient study, the average procedure time was about 5.5 minutes for radiofrequency ablation and 6.1 minutes for laser ablation, compared with 58.6 minutes for surgery. Hospital stays averaged roughly one day for both ablation techniques versus 4.2 days for surgery. These figures come from one study and individual experiences may differ.

### Will I need to take thyroid hormone replacement after thermal ablation?

In this one-year study of 162 patients, none of those treated with radiofrequency ablation or laser ablation developed hypothyroidism, so none needed thyroid hormone replacement. Hypothyroidism was tracked in the surgery group. This finding applies to patients with papillary thyroid cancer of 5 mm or less; your own need for medication should be discussed with your doctor.

### What does it mean if a scan still shows a leftover lesion after thermal ablation?

At the 12-month follow-up, ultrasound found residual lesions in 12 radiofrequency patients and 9 laser patients. Biopsies of all these lesions showed no cancer cells; the remaining tissue was fibrous scar and dead cells being cleared by the body. Complete disappearance of a treated tumor can take many months, so a leftover lesion does not necessarily mean treatment failed.

### Does thermal ablation work as well as surgery for controlling small papillary thyroid cancer?

In this 162-patient study followed for one year, no radiofrequency or laser ablation patient developed cervical lymph node or distant metastasis, and 2 surgery patients (2.2%) had recurrence. Complete disappearance of treated nodules occurred in about 71% of both ablation groups. The authors call for larger trials with longer follow-up to confirm these results.

### I have a papillary thyroid cancer that is 5 mm or smaller — when should I get a second opinion about choosing thermal ablation instead of surgery?

A second opinion is worth seeking when your tumor is 5 mm or less and you are deciding between radiofrequency ablation, laser ablation, and surgery. It helps to confirm the nodule is truly solitary, cN0, and Bethesda V or VI, and to review genetic mutation testing, since patients with two or more gene mutations are recommended for surgery. Tumor location also matters, as tumors near the trachea or recurrent laryngeal nerve carry higher ablation risk. Diagnostic Detectives Network provides independent expert second opinions.

## Source Information

**Original article title:** Comparison between thermal ablation and surgery in low risk papillary thyroid carcinoma

**Authors:** Yu Lan, Wenbo Gong, Runfang Zhang, Songtao Zhang, Yifei Zhai, Chen Zheng, and Dongyan Zhang

**Corresponding author:** Songtao Zhang, Department of Thyroid and Head & Neck Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China

**Journal:** Frontiers in Endocrinology, Volume 15, Article 1398208

**Publication date:** August 1, 2024

**DOI:** 10.3389/fendo.2024.1398208

**Funding:** The research was sponsored by the Henan Provincial Medical Science and Technology Research Project (Project No. LHGJ20200181).

**Ethical approval:** Approved by the Institutional Research Committee of Henan Cancer Hospital (No. 2020-LC156). All patients provided written informed consent.

*Note: This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and does not constitute medical advice. Always consult with qualified healthcare professionals about your individual medical situation.*


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