The Efficacy and Safety of RFA for PTMC in Long-Term Cohort Study: Do Above and Beyond

Jung Hwan BaekSouth Korea Speaker Standard and Advanced Techniques for Thyroid RFAThermal ablation, especially radiofrequency ablation (RFA), is promising technique not only for benign thyroid nodules but also for thyroid cancers. In various thyroid tumors, RFA effectively improves tumor-related symptoms and cosmetic problems by reducing tumor volume. RFA is recently adopted to recurrent and primary thyroid cancers. In terms of complication, major complication rate was reported as 1.4% - 8% according to the types, locations and size of the thyroid tumors. Therefore, proper techniques and experience of operators are key factors to achieve effective and safe RFA. To maximize efficacy and to minimize complications, the Korean Society of Thyroid Radiology Guidelines (KSThR Guidelines 2012, 2017, and 2025) recommend the use of standard techniques; the perithyroidal lidocaine injection to control pain, trans-isthmic approach, moving-shot technique and hydrodissection (HD) technique. Furthermore, KSThR Guidelines recommend advanced techniques, such as vascular ablation, bolus injection of cold water (to manage nerve damage problems) or tracheal stent assisted RFA. In this lecture, therefore I will introduce various standard and advanced techniques to maximize the ablation zone and to minimize injury of surrounding critical structures. Furthermore, I will briefly touch “how to combine proper device and techniques” for thyroid RFA.The Efficacy and Safety of RFA for PTMC in Long-Term Cohort Study: Do Above and BeyondThe incidence of thyroid cancer has increased not only in Korea, but in worldwide. This situation is mainly due to an increase in the over detection of small papillary thyroid carcinomas (PTCs) using high-resolution ultrasonography (US). Almost all newly detected thyroid cancers are small papillary thyroid cancers (PTCs), while the incidence of large PTCs and aggressive histological types has remained stable. In addition, mortality of thyroid cancer has remained stable in Korea. Therefore, several studies have suggested over-diagnosis of small thyroid cancers, especially papillary thyroid microcarcinomas (PTMC). Since the majority of PTMCs progress slowly and show excellent outcome and considering the drawbacks of surgery including voice change or hypoparathyroidism, it is time to re-evaluate the role of surgery (especially immediate surgery) for all biopsy proven PTMCs. According to publications from South Korea and other countries, the incidence of thyroid carcinoma had increased 15-fold between 1993 and 2011; however, its mortality rate did not decrease. Moreover, the number of patients who suffered from surgical complications increased significantly. Considering the exceedingly low disease-specific mortality rate of PTMCs and the potential complications of thyroidectomy, it is imperative to consider alternative management strategies for PTMC management. Therefore, this lecture will review the current oncologic outcome (in both short and long-term follow-up studies) of thermal ablation in PTMC and compare it with the results of active surveillance and surgery.