Ultrasound-guided thermal ablation for T1b and selected T2 papillary thyroid carcinoma: current evidence, evolving guideline recommendations, and an ultrasound-based clinical workflow

Thermal ablation (TA) is established for benign thyroid nodules, recurrent thyroid carcinoma, and low-risk papillary thyroid microcarcinoma. Its role in papillary thyroid carcinoma (PTC) remains unsettled. This review examines evidence and guideline recommendations for TA in T1b and selected T2 PTC. T1b studies suggest encouraging local control and low permanent morbidity, but retrospective, geographically concentrated, heterogeneous evidence leaves surgery as the reference treatment. Four retrospective T2 reports indicate a narrower procedural safety margin. The same anatomical selection criteria apply across T1a, T1b, and T2 disease; however, as tumors enlarge, fewer patients meet oncological and technical requirements, and incomplete staging or margins have greater consequences.