Image-Guided Thyroid Ablation versus Surgery for T1N0M0 Papillary Thyroid Carcinoma: A Consensus-Aligned Systematic Review and Meta-Analysis

Image-guided thyroid ablation (IGTA), including radiofrequency ablation, microwave ablation, and laser ablation, has emerged as a minimally invasive, organ-sparing treatment strategy for carefully selected patients with low-risk papillary thyroid carcinoma (PTC) and selected patients with recurrent differentiated thyroid carcinoma (DTC). Although accumulating evidence supports favorable local tumor control and low procedure-related morbidity, comparative oncologic and safety outcomes relative to surgery require standardized synthesis using internationally accepted IGTA terminology and reporting criteria. This study aimed to compare IGTA with surgery for T1N0M0 PTC using consensus-aligned terminology, efficacy definitions, and complication reporting. Evidence regarding recurrent DTC is summarized only as contextual clinical background rather than as the primary focus of the meta-analysis. A systematic review and meta-analysis comparing IGTA with surgery for T1N0M0 PTC was conducted using the PubMed, Scopus, and Web of Science databases through June 2026. Outcome definitions, volume-related efficacy measures, and complication categories were aligned with the international consensus statement on IGTA and the PRISMA reporting recommendations. The meta-analysis showed that the odds of overall complications were significantly higher after surgery than after ablation [odds ratio (OR) = 2.75, 95% confidence interval (CI) 1.79-4.22]. No significant between-group differences were observed in tumor progression (OR = 0.81), lymph node metastasis (OR = 0.99), or overall hoarseness (OR = 1.20). However, surgery was associated with significantly lower odds of recurrence (OR = 0.64, 95% CI 0.42-0.97) but higher odds of permanent hoarseness (OR = 2.24) and transient hypoparathyroidism (OR = 5.67). In patients with recurrent DTC, ablation provided significant clinical benefits, including marked reductions in lesion volume and serum thyroglobulin levels. IGTA is a promising, minimally invasive, organ-sparing treatment option for selected patients with T1N0M0 PTC. In the present analysis, surgery was associated with lower odds of recurrence, whereas IGTA was associated with lower procedure-related morbidity, particularly lower rates of overall complications, permanent hoarseness, and transient hypoparathyroidism. Therefore, IGTA should be considered within a multidisciplinary, patient-centered decision-making framework rather than as a universal replacement for surgery. Longer-term prospective comparative studies and standardized registries are needed to determine long-term oncologic equivalence.