Patient’s brief condition: I was found to have a suspected cancerous focus on the left side of the thyroid gland in an ultrasound examination in a tertiary hospital (Hospital A) in May 2015, size 8mm X 7mmx8mm, and again in another tertiary hospital (Hospital B) in August by an ultrasound specialist, size 30pxx27.500000000000004px, the doctor said that because of unclear borders, the size was estimated. For this reason that month and returned to the ultrasound department of hospital A for another examination, the size was 8mmx6mm, with little change compared to May, and said it was difficult to puncture to due to calcification, the probability of puncturing to the lesion was only 30%, and recommended direct surgery. Patient Question: Dear Director Zhang, you are an admirable doctor who dares to explore the truth and think about patients! I have seen the medical, surgical and ultrasound departments, and the ultrasound department (which also does ablation) all recommend surgery, and only one doctor who does both surgery and ablation recommends surgery one moment and ablation the next, with repeated opinions. Some doctors thought that ablation would cause adhesions, which would be unmanageable if surgical treatment was to follow, and that you should choose ablation unless you don’t want to die; some doctors said that for malignant nodes, ablation would be more likely to cause metastasis; a famous surgeon said that he had been doing ablation for several years, but only for benign ones, saying that ablation was not complete and was a palliative surgery, which could not achieve the therapeutic effect, and suggested that surgery was better. These opinions put a lot of pressure on me. After all, ablation has been developed for a short period of time, so would I become a “guinea pig” if I chose the wrong treatment plan in the case of a radical surgical procedure? I have some questions: 1. Is ablation an incomplete treatment and only a palliative treatment for a few years? According to the ultrasound, the boundary of malignant tumor is not very definite, and the distribution of cancer cells seems to be scattered in some data, not necessarily all concentrated in the nodule. In your reply to a patient, you said that the recurrence rate of your ablation patients is only a few percent, which is very low. I was very happy to read that. Then I thought, “Could this observation period be only 1 or 2 years? Will the recurrence rate keep increasing the longer it takes? And the surgery removed the thyroid gland on the problematic side completely to achieve a radical cure. After all, I have seen a patient with a metastatic case before, metastasizing to the brain, lungs, cervical vertebrae, and the larynx was also removed, and the severity of the consequences were quite frightening. To a certain extent, I also understand the attitude of some surgeons who would rather kill a thousand wrongly than let one go. Second, how to confirm the diagnosis of ablation? It is understood that the accuracy rate of FNA is 90-95%, and the level of puncture in China is even lower. Does this mean that the diagnosis of malignancy cannot be 100% confirmed by ablation, especially if the puncture result is benign, there is always a 10% or more possibility of malignancy? In my case, an ultrasonographer said that the possibility of puncturing the lesion was only 30%. Is there any real statistics to support whether the probability of hoarseness or injury to the laryngeal nerve is greater or lesser than that of surgery? 4. Does ablation lead to faster metastasis? Why do some famous surgeons in the field say that it will metastasize faster? Why are so many ultrasound departments that perform ablation limited to benign ones and not malignant ones? Finally, in my case, is ablation or surgery better? How many points out of 100 can be given to each of the two quantitative assessments? I would like to ask Mr. Zhang for his clarification. Thank you very much! Prof. Zhang replied: At present, based on your ultrasound images, I judge that the left nodule may not necessarily be cancerous, and calcification and cancer cannot be equated. Even so, I suggest you not to classify this nodule as cancer at once at the moment. If it is indeed cancerous, then it can only be confirmed by fine needle aspiration biopsy or gross needle aspiration biopsy or pathological diagnosis after open surgical excision. In the case of your nodule, fine needle should be chosen for a puncture biopsy because the calcifications are coarser and the coarse needle may not be able to obtain a suitable specimen. Instead, the fine needle can obtain a certain amount of cellular debris by deftly avoiding stones or calcifications. However, pathological diagnosis is not a matter for the puncturing physician, it depends on the level of the pathologist, which is still a bottleneck, but fortunately there are indeed some very diligent and well-educated people whose pathological diagnosis is still satisfactory. If the pathology confirms that it is indeed papillary carcinoma, then in the current state of the nodule, ablation therapy can completely cover the cancer and create a wealth of safe ablation margins. Ablation is a high temperature that can be reached instantly, and the so-called high temperature is not so high as to be topless, but it completely meets the degree of killing tumor cells. I believe that those who hold such a view do not have much experience in ablation, and even individual P doctors who have both surgery and ablation will not have much experience in ablation. I firmly believe that the effect of ablation on papillary carcinoma is no worse than surgery, and this conclusion will definitely be supported by more data. Because the scientific theory is developed logically. Metastasis is a complex issue, but in general papillary cancer prefers to metastasize to lymph nodes, and lymph node metastasis always has better consequences than blood metastasis, because lymph node metastasis is still a local problem in general, and the lethality rate is obviously lower than blood metastasis. For those tumors that are more metastatic, even if all the thyroid gland is removed, it will still metastasize repeatedly, so there is the case of repeated surgical removal and repeated metastasis back then. A doctor is both a social science worker and a natural science worker, and experience must be based on experience. A rational doctor he is exploring scientifically, not blindly and blindly, let alone not doing it at night. At least my team has not used any patients as “guinea pigs” so far, we are working together scientifically and voluntarily for one purpose only: to benefit more patients.