In a 10-year follow-up of small papillary thyroid cancers treated with thermal ablation (radiofrequency or microwave), the share of patients who stayed free of disease progression did not differ statistically from patients who had surgery. Researchers at the China-Japan Union Hospital of Jilin University followed 134 patients with papillary thyroid cancer of 1 cm or less and no lymph node or distant spread for 120 months, and published the results in European Radiology in September 2026.
Patients treated with ablation kept normal thyroid function and did not need thyroid hormone tablets, and permanent complications occurred only in the surgery group. This article explains who thermal ablation for papillary thyroid microcarcinoma suits, the 10-year results, the numbers from an 883-patient multicenter study, and how ablation compares with surgery and active surveillance.
Treatment status · Surgery is the standard treatment for papillary thyroid cancer, and active surveillance is widely used in Japan. Thermal ablation is offered at experienced hospitals in China, Europe and Latin America to patients who prefer not to have, or cannot have, surgery, and the European Thyroid Association and international consensus statements describe it as an option to consider in experienced centers. The 10-year study is a single-center retrospective study. This article is general information, not a recommendation of any procedure.
What is new
Papillary carcinoma is the most common thyroid cancer and usually grows slowly. Tumors of 1 cm or less (papillary microcarcinoma) are often found by chance on ultrasound check-ups. The standard treatment has been lobectomy, removing one side of the thyroid, and in Japan active surveillance, regular ultrasound monitoring instead of immediate surgery, has also been used for decades.
Thermal ablation is a third option. Guided by ultrasound, the doctor inserts a thin needle through the skin of the neck and uses heat from the needle tip to destroy the tumor together with a small rim of normal tissue. Radiofrequency and microwave are the main energy sources, and some centers use laser. The main differences from surgery are that no neck scar is left and most of the thyroid is preserved.
Until now most published ablation results covered about five years. This study followed patients treated in 2014 for ten years, which matters because long follow-up is especially important for slow-growing cancers.
Which patients are eligible
All patients in the study had a single T1aN0M0 papillary carcinoma confirmed by ultrasound and cytology: one tumor of 1 cm or less with no sign of spread to neck lymph nodes or other organs. Mean age was 43.5 years, and 99 of the 134 patients were women.
| Item | When ablation may be considered | When other treatment comes first |
|---|---|---|
| Tumor size | 1 cm or less (T1a) | Larger than 1 cm |
| Number of tumors | One | Several |
| Lymph node or distant spread | None (N0M0) | Present |
| Location | Away from the trachea and voice nerve | Growing outside the thyroid or touching key structures |
Based on the eligibility criteria of Wang ZQ, et al. Eur Radiol 2026 and the multicenter cohort (Mayo Clin Proc Innov Qual Outcomes 2026). Actual eligibility is decided by the treating doctor.
10-year follow-up results
The researchers followed patients treated with ultrasound-guided microwave ablation or surgery between June and October 2014 for 120 months. Progression-free survival showed no statistically significant difference between the two groups, meaning the effect of ablation on small papillary cancers lasted ten years.
| Outcome | Microwave ablation | Surgery |
|---|---|---|
| 10-year progression-free survival | No statistical difference from surgery | No statistical difference from ablation |
| Overall complications | Numerically fewer, mostly transient | More |
| Permanent complications | None during follow-up | Occurred only in this group |
| Thyroid function | Normal, no hormone tablets needed | Depends on extent of removal |
Wang ZQ, Sui GQ, Teng DK, Wang H, et al. Eur Radiol 2026;36(9):7256–7265. Exact group sizes and complication rates are in the tables of the full paper.
The authors concluded that microwave ablation is a safe and effective option alongside surgery for selected patients. Keeping the thyroid and avoiding lifelong hormone tablets is especially welcome for younger patients.
Numbers from an 883-patient multicenter study
A single-center study has limits. A prospective study from 12 tertiary hospitals in China, published in February 2026 in Mayo Clinic Proceedings: Innovations, Quality & Outcomes, adds broader data. Over one year from December 2019, 883 patients with a single papillary cancer of 1 cm or less chose their treatment after multidisciplinary counselling: 444 had microwave ablation and 439 had lobectomy.
| Item | Microwave ablation (444) | Lobectomy (439) |
|---|---|---|
| Disease progression | 2.48% (11) | 1.14% (5) |
| Lymph node metastasis | 2.03% (9) | 1.14% (5) |
| Complications | 2.48% (11) | 4.55% (20) |
| Procedure time | About 30 min | About 92 min |
| Hospital stay | 1.9 days | 5.9 days |
Mean follow-up about 42.5 months. Differences in progression (p=0.13) and lymph node metastasis (p=0.32) were not statistically significant. Mayo Clin Proc Innov Qual Outcomes 2026;10(2):100696.
Over about three and a half years, more than 97 of every 100 ablation patients stayed free of progression. Mean cost was also lower with ablation (20,129 yuan vs 27,234 yuan for surgery), and the surgery group scored higher for scar concern and anxiety on quality-of-life questionnaires. The authors described ablation as an option that lightens the treatment burden for patients who prefer to avoid surgery.
Radiofrequency ablation data are also growing. A June 2026 review in Frontiers in Surgery by Italian researchers reported complete tumor disappearance in 92% to 100% of cases after radiofrequency ablation and recurrence of 0% to 0.4%. Major complications were 0% to 1.3%, and temporary voice change 0.4% to 1.1%.
Surgery, active surveillance and ablation compared
All three approaches give excellent long-term results for small papillary cancers. In 30-year data from Kuma Hospital in Japan, covering 5,646 patients with microcarcinoma from 1993 to 2019, no patient died of thyroid cancer in either the surveillance or immediate-surgery group. So the choice is less about which works better and more about which lifestyle and burden a patient prefers.
| Item | Surgery (lobectomy) | Active surveillance | Ablation (RF or microwave) |
|---|---|---|---|
| Method | Neck incision, one side of thyroid removed | Regular ultrasound checks | Tumor destroyed with a needle |
| Scar | Neck scar | None | Needle mark only |
| Hospital stay | Several days | None | Mean 1.9 days (12-hospital study in China) |
| Thyroid hormone tablets | May be needed | Not needed | Usually not needed |
| Points to note | Possible voice change or low parathyroid function | Some switch to surgery later | Should be done at an experienced hospital |
A general comparison based on Miyauchi A, et al. Thyroid 2023, Wang ZQ, et al. Eur Radiol 2026, and the 2026 multicenter cohort.
Active surveillance avoids any procedure, but some patients choose surgery because they feel uneasy living with the tumor. The Italian review notes that tumors grew in about 8% of surveillance patients and that 8% to 32% eventually had surgery. Ablation removes the tumor while preserving the thyroid, so it attracts patients looking for a middle path.
How needle-based ablation works and where it is used is covered in our RFA (radiofrequency ablation) guide and RFA results by cancer type. Ablation of benign nodules is compared in thyroid nodule radiofrequency vs microwave ablation, and possible after-effects are in radiofrequency ablation side effects.
Where it is available
| Region | Current status | Basis |
|---|---|---|
| China | Most experience with microcarcinoma ablation; many long-term and multicenter studies | Eur Radiol 2026; 12-hospital cohort 2026 |
| Europe | European Thyroid Association and international consensus describe it as an option in experienced centers | Frontiers in Surgery 2026 review |
| Latin America | Multicenter early results from the Latin American Interventional Thyroidology Association (LAITA) | Thyroid 2026 |
| Japan | Surgery and active surveillance are mainstream; 30 years of surveillance data | Miyauchi A, et al. Thyroid 2023 |
Availability and cost of ablation vary by hospital and should be confirmed directly.
Japan has the longest experience with active surveillance of microcarcinoma, so Japanese hospitals often recommend either surgery or surveillance. If you want ablation, first ask whether the hospital performs it for microcarcinoma and how many cases it treats each year. International patients are often not covered by the host country's public insurance, so check costs in advance.
What to check and questions for your doctor
When requesting a consultation abroad, prepare your thyroid ultrasound images and report, fine-needle aspiration (FNA) cytology result, and neck CT if available. The distance between the tumor and the trachea or voice nerve is key information for deciding whether ablation is possible.
- Does my tumor's size and location make me a candidate for ablation?
- How many microcarcinoma ablations has this hospital performed, and what are its long-term results?
- Will you use radiofrequency or microwave, and why?
- When, and for how many years, will I have follow-up ultrasound?
- If the tumor reappears, what treatment comes next?
See also five questions to ask before an RFA consultation. For catheter and needle-based treatment in general, see our IVR (interventional radiology) guide.
Frequently asked questions
Can thyroid cancer be treated with radiofrequency ablation?
For a single small papillary cancer of 1 cm or less without spread, experienced hospitals abroad offer radiofrequency or microwave ablation. In a 10-year study, progression-free survival did not differ statistically from surgery. Eligibility is decided by a doctor who has reviewed your ultrasound and cytology.
Will I need thyroid hormone tablets after ablation?
Ablation destroys only the tumor area and preserves most of the thyroid. In the 10-year study, ablation patients kept normal thyroid function and did not need hormone tablets.
How long do the procedure and hospital stay take?
In the 12-hospital study in China, microwave ablation took about 30 minutes on average with a mean stay of 1.9 days, compared with about 92 minutes and 5.9 days for surgery.
How do radiofrequency and microwave differ?
Both destroy the tumor with heat. Radiofrequency produces heat with electrical current and microwave with electromagnetic waves. Microwave heats faster over a wider area, while radiofrequency allows fine control of the treated zone. Both have shown good results for small papillary cancers.
This article summarises overseas official sources and studies as general information and is not medical advice. Discuss treatment choices with a doctor who has examined you.
Sources (checked November 3, 2026)
- Wang ZQ, Sui GQ, Wang QM, Dong P, Yu WY, Teng DK, Wang H. Microwave ablation versus surgical resection for unifocal T1aN0M0 papillary thyroid carcinoma: a 10-year follow-up study. European Radiology. 2026;36(9):7256–7265.
- Microwave Ablation Versus Thyroid Lobectomy for Solitary cT1aN0M0 Papillary Thyroid Carcinoma: A Prospective Multicenter Cohort Study. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2026;10(2):100696.
- Radiofrequency ablation of papillary thyroid microcarcinoma. Frontiers in Surgery. 2026;13:1828150.
- American Thyroid Association. Active surveillance vs surgery in adults with low risk thyroid cancer (summary of Miyauchi A, et al. Thyroid 2023).
- Dueñas JP, et al. Early Outcomes of Thermal Ablation for Low-Risk Papillary Thyroid Cancer: A Multicenter Study from Latin American Interventional Thyroidology Association (LAITA). Thyroid. 2026.
- EMJ. 10-Year Thyroid Cancer Outcomes Support Microwave Ablation. August 12, 2026.