The thyroid gland is commonly excised totally or partially to remove micropapillary cancer, the most common low-aggression thyroid cancer (1)
Currently, thyroid cancer is the fourth most common cancer by incidence in females, but projections through 2030 show that thyroid cancer will become the second most common cancer in females after breast cancer and the third most common cancer in males after prostate and lung/bronchial cancer (2).
Despite this increase, mortality from thyroid cancer will remain low (2-2.5%) after 5-10 years. Deaths will mostly be due to aggressive non-papillary carcinomas, such as medullary, follicular, and anaplastic histologic variants. Because of the limited aggressiveness, Japanese authors initially proposed an Active Surveillance (wait and see) strategy for micropapillary tumors (3). This approach has been shared more recently by Anglo-Saxon authors. (4).
However, active surveillance is poorly accepted by the vast majority of patients. Once a tumor is diagnosed, most patients choose to remove it. To this end, surgery is not the only solution. Ultrasound-guided thermal-ablative therapies (radiofrequency, microwave, laser) have been shown to be as effective as surgery. Long-term follow-up studies of up to 10 years show that micropapillary cancer has the same prognosis after surgery compared with thyroid ablation (5).
Thousands of patients with micropapillary cancer will benefit from the option of thermal ablation. Ultrasound-guided thermal ablation of micropapillary thyroid cancer will allow a less aggressive approach to be used than surgery. It will be possible to avoid surgical scarring, hospitalization, general anesthesia with intubation, and many side effects including injury to the parathyroid glands (hypocalcemia) and recurrent laryngeal nerve (hoarseness). Preservation of normal non-nodular thyroid tissue will avoid replacement therapy with thyroid hormones. The return to daily activities will be rapid and the patient’s quality of life will be improved.
REFERENCES
- Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman Si, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. 2016 Jan 1; 26(1): 1–133. 2015
- Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014 Jun 1;74(11):2913-21
- Miyauchi A, Kudo T, Ito Y, et al. Natural history of papillary thyroid microcarcinoma: kinetic analyses on tumor volume during active surveillance and before presentation. 2019;165(1),25-30
- Lohia S, MD1, Hanson M, R. Tuttle M, Morris LGT. Active surveillance for patients with very low-risk thyroid cancer. Laryngoscope Investigative Otolaryngology. 2020;5:175–182
- Kim HJ, Chung SM, Kim H, Jang JY, Yang JH, Moon JS, Son G, Oh J-R4, Bae JY 5, Yoon. Long-Term Efficacy of Ultrasound-Guided Laser Ablation for Papillary Thyroid Microcarcinoma: Results of a 10-Year Retrospective Study. 2021 Nov;31(11):1723-1729
FIGURES
Fig. 1
B-mode, axial scan: Markedly hypoechogenic nodule 7 mm in diameter, with microcalcifications, no capsular invasion
Fig. 2
B-mode, Axial scan. Thyroid microcarcinoma Radiofrequency ablation. Hyperechoic gas bubbles are released by tumor tissue.
Fig.3
B-mode, axial scan: MPTC ablation with a 2-4 mm safety ring
Fig 4
Vascular color doppler, axial scan. 1 Month (upper panel) and 1 Year (lower panel) after RFA. The hypoechoic non-vascular area corresponding to ablated thyroid tissue and tumor is no longer detectable.
