Microwave Ablation for T1N0M0 Papillary Thyroid Carcinoma Adjacent to Berry’s Ligament

To investigate the efficacy and safety of microwave ablation (MWA) in treating T1N0M0 papillary thyroid carcinoma (PTC) adjacent to Berry's ligament (BL). This retrospective study examined 141 patients who underwent MWA for BL-adjacent PTC between January 2015 and December 2023. All procedures utilized perithyroidal fascial space-based hydrodissection and standardized ablation protocols.Of the 141 patients initially enrolled, hydrodissection failed in 3 cases, who were subsequently treated with surgery. The remaining 138 patients successfully received MWA. Technical success, tumor disappearance, complications, and progression-free survival were assessed. Among the 138 patients analyzed (95 women, 43 men), the median age was 39 years (IQR, 24-60 years). Technical success was achieved in all cases. During a median follow-up period of 24.4 months, complete tumor disappearance occurred in 67.3% of cases, with T1a tumors showing markedly superior outcomes compared to T1b lesions (82.1% versus 34.8%, P=0.042). Disease progression was observed in 2.9% of patients, including newly detected tumors (1.4%) and lymph node metastasis (1.4%). No local recurrence or distant metastasis was documented. The major complication was transient hoarseness, affecting 10.1% of patients, and all cases resolved spontaneously within six months. Subgroup analysis further identified T1b tumors as an independent risk factor for this complication (P = 0.027). Progression-free survival showed no significant difference between T1a and T1b classifications (P=0.633). MWA offers an effective treatment option for selected patients with BL-adjacent T1N0M0 PTC, achieving favorable local tumor control with acceptable complication rates.