Minimally invasive treatment for thyroid cancer has been widely promoted in various media, including the internet, and many people are concerned whether they are suitable for this treatment after finding thyroid nodules. From a professional oncology perspective, I would like to share my opinion here. Minimally invasive treatment for thyroid disease includes two types of treatment, one is the lumpectomy of thyroid gland, which has been very popular in recent years, and I will discuss this in detail. The other type is radiofrequency ablation treatment. Traditional thyroid surgery requires a surgical incision in the front of the neck, which inevitably leaves surgical scars in the front of the neck and becomes a lingering shadow on the psyche of some patients, especially young women. Therefore, many scholars have developed the needle ablation treatment, which has no wound but a needle scar, as an alternative to thyroid surgery. Radiofrequency ablation is mainly used for “local ablation” of certain highly malignant early tumors in the chest, abdomen and pelvis, such as liver, lung or metastatic cancer, as well as breast cancer, uterine fibroids and other solid tumors, with strict indications. When applied to thyroid nodule ablation treatment, the ablation needle is inserted into the nodule under the guidance of B-ultrasound, and the nodule is “ablated” through the principle of high-energy physical heat generation such as microwave, radiofrequency or laser, and also through chemical methods such as injection of anhydrous alcohol, which causes nodule degeneration and necrosis. It has the advantage of minimal trauma and no scarring on the body surface. For some thyroid diseases, this is indeed a new idea in terms of modality alone. For thyroid malignant tumors, there are two different or completely opposing views on the use of radiofrequency ablation. In fact, it is a conflict of two treatment philosophies. In primary hospitals or even some large general hospitals, basically, the treatment is department-centered, and whatever the department or a certain doctor is “good” at, the method is adopted. “Most of them have limited experience in the overall treatment of thyroid cancer due to their professional background. In a specialized oncology hospital, it is usually tumor-centered and requires systematic and planned comprehensive treatment from various departments. Even for thyroid tumors, careful examination and evaluation of proper individualized treatment plan is required before treatment. Doctors with different professional backgrounds have different treatment concepts for thyroid cancer treatment, so their perceptions and treatment decisions will definitely be different, and the treatment effect can be imagined. For most of the thyroid cancers with slow progression and long natural survival, this “effect” may not necessarily be seen in a short time. There is a perception that once thyroid nodules are detected, most of them will gradually develop, increase in size, become calcified and even become cancerous. In fact, there is no evidence that thyroid cancer comes from nodular goiter. Most benign nodules develop slowly, do not affect health, and even stay with us for life. Many scholars at home and abroad who have long experience in treating thyroid diseases advocate that small thyroid nodules can be observed for a long time without any intervention, even for some low-risk papillary carcinomas, which may even coexist with tumors in the body for a long time. Enthusiasts believe that minimally invasive thyroid ablation therapy is extremely less damaging and cost-effective. This is indeed true for patients with well-defined benign nodules and strong cosmetic needs, which is also recommended by the World Health Organization (WHO). The belief that minimally invasive ablative treatment of microscopic thyroid cancer is “as effective” as traditional open surgery and that the recurrence rate of nodules is significantly lower than that of traditional surgery is not based on clinical science and is unprofessional to say the least. Many patients do seem to get the “same effect” on the surface, which is fortunate because most papillary thyroid cancers develop slowly and have a good prognosis, and frankly speaking, the absence of recurrence is the “luck” of patients with this type of inert tumors. In short, the absence of recurrence is the “luck” of patients with this type of inert tumors, and it has not been proven to benefit from the advantages of tumor treatment with this technology. In China, the ablation subcommittee of the Special Committee on Minimally Invasive Interventions (note: its membership is not specialized in thyroid tumor treatment) has written the minimally invasive ablation treatment of microscopic thyroid cancer into the “expert consensus”, which only provides the “technical specification” for ablation treatment, but should not be used as the “treatment specification”. It should not be used as a “treatment standard” and is by no means a “consensus” of all doctors. Microwave therapy cannot make pathological judgment, and even if there is sometimes “puncture”, the diagnosis is not comprehensive and reliable; it has superficial understanding of the benign and malignant status of nodules and metastasis; it cannot provide intraoperative three-dimensional observation and judgment of tumor and its surrounding tissues and all-round understanding and control; it cannot replace the manual recognition of experienced doctors. For malignant tumor treatment, experience has shown that these are exactly what is needed to provide precise treatment procedures to reduce recurrence. From the patients who have been seen after ablation of thyroid cancer, some problems have been revealed, which have become common in recent years, besides the increase of neurovascular collateral damage, the main problem is under-treatment, tumor omission and increased risk of residual recurrence. In many cases, after ablation, the patient was transferred to other hospitals and asked for another operation (Figure 1). After ablation of papillary thyroid carcinoma, the thyroid lobes were surgically excised and the ablated tumor tissue was observed to be heterogeneous and partially degenerated (Figure 2). Figure 2. Tumor tissue of ablated thyroid nodule specimens showed heterogeneous partial degeneration Pathology observed that some of them were only partially regressed and necrotic tumor cells with moderate post-treatment response, (Figure 3) Figure 3. And some of them left lymph nodes (7/11) with paratracheal metastases (Figure 4) without being “ablated “. Figure 4. Lymph nodes with paratracheal metastases (7/11) were left behind and not “ablated”. For malignant tumors, the first thing to focus on when evaluating the advantages or advancement of an innovative treatment that breaks with tradition is the safety and effectiveness of the method. Safety includes two aspects: treatment process safety and tumor treatment safety. In the case of minimally invasive ablative therapy, the process safety and immediate advantages are obvious and easily accepted by patients, while tumor treatment safety is easy to be selectively ignored. Traditional treatment methods are not unchangeable. Some scholars say that the development of emerging technologies should not be suppressed, and there is always a recognition process for the emergence of new things. But the correct cognition is based on practice and experience where scientific evidence can be obtained. So far, all clinical reports, mainly focus on aesthetic results, recovery time, length of hospital stay, how much bleeding, and daily recovery, etc. Few people have bothered to compare in parallel issues such as patients’ recurrence rate and related treatment consequences (because it is often time-consuming and laborious to follow up their long-term effects and obtain valid evidence of oncology). In the field of oncology treatment, we (National Cancer Center) never reject advanced treatment concepts and technological innovations, and dozens of hundreds of basic or clinical studies are conducted every year. If new treatments are available, active experimentation and exploration are encouraged, but first, well-designed protocols with valid evidence-based medical evidence are needed before scientific exploration and research can be conducted; at the same time, ethical requirements must be met, and patients should not only understand the benefits but also be fully aware of the possible risks of these unproven treatments, especially the unknown and potential oncological risks, before receiving new treatments. Risks. It is important to remember that any innovation should be aimed at maximizing the ultimate benefit to the patient. After all, “oncologic safety is more important than cosmetic requirements”. If you choose ablative treatment, either for clinical trials or standard treatment options, you should have an informed conversation with your physician about the treatment modality. It is important for patients to know both of the following and then choose which procedure to undergo based on your knowledge of thyroid cancer as an oncologic disease and your actual situation and needs The main advantage of this treatment is that it is quick and aesthetic, with no scars on the front of the neck. For patients with benign thyroid nodules, benign thyroid tumors, nodular goiter and other benign diseases, patients who urgently want to be treated and have a strong desire for neck aesthetics, ablation therapy is indeed a good choice, and it is only suitable for smaller nodules. In fact, most small, well-defined benign thyroid nodules can be left untreated. 2. This treatment modality is still in the exploratory stage and it remains to be proven whether the treatment is as effective for malignant tumors. For thyroid cancer patients, the doctor may tell you that minimally invasive thyroid ablation is “non-invasive, painless, scarless and complication-free, safe, thorough and fast”, but “forget” to inform you that “tumor removal may not be complete and easy to recur”. But “forget” to inform you that “tumor removal may not be complete and may be prone to recurrence”. Of course, recurrence can also occur with traditional surgery, but with the inadequate treatment in the former approach, you may have a higher chance of being “trapped”, and many cases of such unregulated treatment have been found. Therefore, patients should weigh the aesthetic and tumor safety concerns and decide carefully which is more important to you. Due to the specific needs of certain jobs or occupations; a strong desire to maintain aesthetics; and the understanding that while there is a risk of tumor residual and recurrence, most thyroid cancers have a good prognosis, you may be more concerned with cosmetic outcomes, or you may receive minimally invasive ablative treatment, preferably by an experienced oncologic surgeon, with close oncologic follow-up after treatment. Welcome to spread the word! As a side note, neck incision surgery can sometimes be managed properly and scars may be minimal:.