Abstract

Over the past few decades, the incidence of papillary thyroid cancer (PTC) has increased, and PTC now has the highest prevalence among endocrine malignancies.Surgical resection,the standard PTC treatment，is associated with an excellent prognosis (1-5).However, surgery is not always desirable due to the potential for postoperative hypothyroidism, the possible adverse effects of lifelong hormone replacement therapy,and possible neck scarring. Several guidelines, including the 2011Japanese Society of Thyroid Surgery and Japan Association of Endocrine Surgeons guidelines, 2015 American Thyroid Association guidelines (6)，2016 Korean 'Thyroid Association guidelines, and 2019 European Society for Medical Oncology guidelines (7), suggest active surveillance for very-low-risk PTC(6-9). However, active surveillance is more of a negative monitoring of the tumor than an effective management strategy.Currently, there is no objective and accurate method to ensure that the tumor consistently remains at a low-risk stage during active surveillance; therefore,active surveillance might not be optimal for some patients because of anxiety and the possibility of tumor progression (10,11).

US-guided thermal ablation—including microwave ablation(heat produced via electromagnetic waves)，radiofrequency ablation (heat produced via high-frequency alternating current),and laser ablation (heat produced via high-energy laser light)——has emerged as a minimally invasive, safe，effective alternative for treating T1aNOMO PTC (12-16) and is gaining traction for T1bNOMO (17,18) and being explored for T2NOMO PTC(19,20).Relevant studies have shown that thermal ablation for PTC lesions has efficacy similar to that of surgical resection, with fewer complications (12,18,21), and has a greater therapeutic impact than active surveillance to avoid tumor progression (22).In addition, studies have shown that the quality of life of patients after thermal ablation is higher than that of patients after surgical resection (23,24), and lifelong hormone replacement therapy is not needed after thermal ablation.

As the benefits of thermal ablation become more widely recognized, both patients and clinicians are showing heightened inter-est in thermal ablation for the management of PTC (15,16,25).Despite its increasing popularity,thermal ablation is performed by operators from diverse specialties，and a lack of uniformity in the indications and technical and practical details of thermal ablation persists.The existing guidelines (7,26) do not fully align with recent research advancements in that they do not mention the role of thermal ablation in the initial management of PTC(15,16,25).To address these gaps,this expert consensus was developed through extensive discussions, comprehensive literature review, and expert evaluations, with the aim of providing up-to-date, high-quality, standardized guidance for US-guided thermal ablation for treating T1NOMO PTC.

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