Comparison of ultrasound-guided percutaneous radiofrequency ablation and reoperation for nerve-adjacent cervical lymph node recurrence of papillary thyroid carcinoma: a propensity score–matched study

Objectives To compare the short-term efficacy and safety of ultrasound-guided percutaneous radiofrequency ablation (RFA) and reoperation (RO) for recurrent papillary thyroid carcinoma presenting as solitary cervical lymph node metastasis (R-PTC-SCLNM) located in perineural regions (PNRs). Methods This retrospective study included patients with R-PTC-SCLNM in PNRs who underwent RFA or RO. Propensity score matching was performed to balance baseline characteristics. Kaplan–Meier analysis was used to assess recurrence-free survival, and treatment outcomes and complications were compared between groups. Subgroup analyses were conducted according to the anatomical relationship between metastatic lymph nodes and adjacent nerves. Results After PSM, 71 matched pairs were included. In the RFA group, the mean volume reduction ratio (VRR) at 24 months was 0.97 ± 0.04, and 42.3% of metastatic lymph nodes had completely disappeared. The overall local recurrence rate did not differ significantly between the RFA and RO groups, consistent with the Kaplan–Meier analysis. The RFA group had significantly lower overall complication rates than the RO group (P<0.001), including both nerve-related complications (P = 0.009) and non-nerve-related complications (P = 0.002). Subgroup analysis showed that this safety difference was most evident in Type II lesions. The pre-PSM sensitivity analysis showed a similar trend. In addition, compared with RO, RFA was associated with significantly shorter procedure time, shorter hospital stay, less intraoperative blood loss, and smaller postoperative scar length (all P<0.001). Conclusion In carefully selected patients with nerve-adjacent R-PTC-SCLNM, RFA demonstrated acceptable short-term local control and a minimally invasive profile characterized by faster recovery and a lower complication burden. RFA may serve as a potential treatment option for patients who are unsuitable for or unwilling to undergo reoperation.