Research progress in ultrasound-guided thermal ablation technology for thyroid nodule treatment

Abstract Thyroid nodules (TNs), a common endocrine disorder, have shown a significant increase in global prevalence. The widespread use of high-resolution ultrasound has markedly improved their detection rate. In this context, ultrasound-guided thermal ablation (UTA) has emerged as a pivotal minimally invasive treatment option for benign thyroid nodules (BTNs) and selected low-risk malignant thyroid nodules (MTNs), owing to its precision, efficacy, and repeatability. This review systematically summarizes recent clinical data, evaluating the therapeutic efficacy of UTA across multiple dimensions, including volume reduction rate (VRR), functional improvement, complication rates, and long-term prognosis. For BTNs, UTA achieves substantial VRR and significant relief of compressive and cosmetic symptoms, with microwave ablation (MWA) and radiofrequency ablation (RFA) showing comparable overall efficacy. For MTNs, particularly T1aN0M0 papillary thyroid microcarcinoma (PTMC), accumulating evidence—including long-term 10-year follow-up studies—indicates that UTA achieves complete tumor disappearance and disease-free survival rates comparable to surgery, with fewer complications and shorter hospital stays. Preliminary studies also support its use in T1bN0M0, selected T2N0M0, and multifocal (≤ 3 foci) papillary thyroid carcinoma. Furthermore, this article discusses recent advancements in indication selection, real-time monitoring techniques (e.g., contrast-enhanced ultrasound and microvascular flow imaging), efficacy evaluation systems (including elastography and serum biomarkers like MMP-2/9), and artificial intelligence (AI)-assisted predictive models for personalized treatment planning. Current limitations—such as reliance on retrospective data, lack of ultra-long-term outcomes, and controversies over expanded indications—are also addressed. Finally, we explore future research directions, including AI-driven precision navigation, combination therapies with targeted agents, and the need for large-scale prospective trials to provide evidence-based medical support and promote precision and individualized management of thyroid diseases.