Percutaneous thermal and chemical ablation in differentiated thyroid carcinoma in the era of personalized medicine

Abstract

The management of differentiated thyroid carcinoma has evolved toward a personalized approach based on risk stratification, driven by the overdiagnosis of low-risk tumors. This has favored less aggressive strategies than surgery, such as active surveillance. In this context, ultrasound-guided percutaneous ablation has emerged as an intermediate alternative between observation and surgery. Ablation techniques include chemical modalities, such as ethanol injection, and thermal modalities, such as radiofrequency, microwave, laser, and focused ultrasound. All induce tissue necrosis with real-time ultrasound guidance, allowing for the preservation of critical structures. Radiofrequency is the most studied technique and offers high tumor reduction rates and a low risk of complications, while microwave offers greater speed and ablation volume. Laser is notable for its precision, and ethanol for its usefulness in cystic lesions or lymph node recurrences. In low-risk papillary microcarcinomas, ablation shows promising results, with high local control comparable to surgery and lower morbidity. Compared to active surveillance, it provides definitive treatment with minimal invasiveness. Its main established indication is locoregional recurrence, especially in patients at high surgical risk. Appropriate patient selection is key, considering tumor size, location, and biological characteristics. Although complications are infrequent and generally mild, the available evidence is still limited, based on retrospective studies. In conclusion, ablation is a relevant therapeutic option within a personalized medicine model, complementary to surgery and active surveillance.