Efficacy and Safety of Thermal Ablation Techniques for the Treatment of Primary Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis

Background: The increased incidence of primary papillary thyroid microcarcinoma (PTMC) has led to increased research in the field of nonsurgical therapeutic options for those who refuse surgery or are at high risk for surgery. The study aimed at comprehensively evaluating the efficacy and safety of thermal ablation techniques for the treatment of PTMC via a systematic review and meta-analysis. Methods: The Pubmed MEDLINE and EMBASE databases were searched for studies reporting the efficacy and safety of thermal ablations (radiofrequency-, laser-, and microwave-ablations [RFA, LA, and MWA]) until August 10, 2019. A review of 105 potential papers identified 11 eligible papers, including 715 patients. The pooled proportions of complete disappearance and recurrence, and the pooled estimates of mean volume reduction and its rate of the treated PTMC were assessed by using random-effects modeling. The pooled proportions of overall and major complications were calculated. Subgroup analysis was performed according to the treatment modality. Between-study heterogeneity was explored by using chi(2) statistic for pooled estimates and inconsistency index I-2. Quality of the studies was evaluated by using the Risk of Bias Assessment Tool for Nonrandomized Studies. Results: The pooled proportions of complete disappearance and recurrence of PTMC were 57.6% [95% confidence interval (CI): 35.4-79.8] and 0.4% [95% CI: 0-1.1], respectively. The pooled estimates of mean volume reduction and its rate were 73.5 mm(3) [52.4-94.6 mm(3)] and 98.1% [95% CI: 96.7-99.5], respectively. The pooled proportions of overall and major complications were 3.2% [95% CI: 1.1-5.2] and 0.7% [95% CI: 0-1.5], respectively. Significant between-study heterogeneity was observed for complete disappearance (p < 0.001, I-2: 99%), mean volume reduction (p < 0.001, I-2: 93%), and its rate (p < 0.001, I-2: 86%). Subgroup analysis revealed heterogeneity of the complete disappearance proportion among the treatment modality (I-2 range: 95-100%). RFA showed the highest mean volume reduction rate (99.3%), followed by MWA (95.3%) and LA (88.6%) (p < 0.001). Conclusions: All thermal ablation techniques were effective and safe for the treatment of PTMC. However, each treatment modality had significant heterogeneity with respect to complete disappearance of PTMC. Compared with RFA and MWA, LA was less effective in reducing the volume of PTMC.