Thyroid Sparing Cancer Care Moves Into Mainstream

Principles for patient selection, technique and establishing a successful percutaneous ablation service

BY CINDY ZINKOVICH April 30, 2026

Huber

Treatment for thyroid cancer, which affects nearly 1 million people in the U.S. and is on the rise, once followed a predictable path: surgery, radioactive iodine and lifelong hormone replacement.

Percutaneous ablation has emerged as a safe, effective and gland-sparing option for certain patients with well-differentiated thyroid cancer or limited recurrent disease. However, significant misperceptions about the procedure persist.

“Many providers still think percutaneous ablation for thyroid cancer is new or experimental when, in reality, these techniques have been used internationally for more than 20 years,” said Timothy Huber, MD, vice chief of interventional radiology at Jefferson Radiology in Hartford, CT, and the lead author of a clinical review of the topic published in Radiology: Imaging Cancer.

Dr. Huber is also president of the North American Society for Interventional Thyroidology, a society created to promote safe integration of ablative thyroid technologies into clinical practice. The organization provides a collaborative environment supporting education and research in the field.

In their review, Dr. Huber and his coauthors address thyroid cancer biology, treatment techniques and patient selection, as well as practical guidance for implementing a thyroid ablation program in clinical practice.

Patient Selection and Tumor Considerations

To understand where ablation fits into clinical practice, Dr. Huber said it’s essential to examine several critical factors, including patient selection, tumor biology, anatomy and molecular risk stratification. He noted that the strongest data for ablation support two groups:

Intrathyroidal papillary thyroid microcarcinomas (PTMC = PTC ≤1 cm, T1a): These are the most straightforward cases, where complete ablation can often be achieved with relative technical ease. PTMC shows a 99% or greater average volume reduction at two and five years, with no tumor recurrence or metastases in a published meta-analysis.

Select papillary thyroid cancers up to 2 cm (T1b): Increasingly supported by the literature, though they demand greater technical skill.

Lymph node recurrences after thyroidectomy, particularly those showing growth or threatening adjacent structures, also may be candidates for ablation. Such cases require hydrodissection to protect nerves, vessels and the aerodigestive tract.

According to Dr. Huber, they are technically more complex, but data show outcomes comparable to repeat surgery when performed by experienced interventionalists.

Well-differentiated papillary cancers generally have favorable biology, while aggressive variants carry higher risks of invasion and metastasis. High-risk mutations, such as TERT promoter or TP53, are better suited for surgery, where full pathologic staging and lymph node assessment are possible, he explained.

One trade-off of percutaneous ablation is the lack of a surgical pathology specimen. “We don’t get information on lymphovascular invasion or extrathyroidal extension,” Dr. Huber said. “Instead, patients require close ultrasound surveillance for local recurrence or nodal disease. In well-selected, well-differentiated cancers, recurrence rates appear similar between ablation and surgery.”

Ablation may also be an option for high-risk surgical patients who are ineligible for or decline surgery.

lung cancer screening and mammography feature

Technique and Experience Matter

Thyroid cancer ablation is not the same as treating benign nodules, Dr. Huber emphasized. Tumors are smaller, margins are tighter and hydrodissection is often essential, leaving little room for error and making experience is critical.

“This is a very operator-dependent procedure,” Dr. Huber said. “I strongly recommend starting with 2- to 4-cm benign nodules to understand how the ablation zone develops and build confidence before moving into cancer cases. Many of the techniques will be familiar to those with experience in liver and renal tumor ablation, but the scale is much smaller.”

Learning curve studies suggest 40 to 50 cases are needed to reliably achieve consistent volume reductions, although this varies based on the individual.

Technique selection also plays a role. Thermal ablation methods include radiofrequency ablation (RFA), microwave ablation, laser ablation and cryoablation. In thyroid applications, RFA, with a major complication rate of 1.4%, remains the most extensively studied modality and offers gentler energy delivery near critical neck structures, Dr. Huber said. Microwave ablation (MWA) is rapidly evolving, with newer systems designed to mimic RFA-like energy profiles.

“In my opinion, starting with RFA is safer for most providers,” Dr. Huber said, noting that outcomes between RFA and MWA are increasingly similar in recent literature.

“With the variety of treatment options and complexity of thyroid cancer, having more specialties involved in the decision-making process allows for a more personalized approach. When all the parties involved, including the patient, understand the options, risks and benefits, then a truly informed decision can be made.”

— TIMOTHY C. HUBER, MD

Early Program Building Tips

With the technical foundation in place, attention shifts from how to perform thyroid cancer ablation to how to implement it responsibly within a clinical program. Multidisciplinary collaboration and early successes are crucial to establishing and growing a percutaneous ablation service.

“With the variety of treatment options and complexity of thyroid cancer, having more specialties involved in the decision-making process allows for a more personalized approach,” Dr. Huber said. “When all the parties involved, including the patient, understand the options, risks and benefits, then a truly informed decision can be made.”

He recommends engaging early with endocrinology and surgery specialists and participating in endocrine or thyroid tumor boards.

“Expect a slow start,” Dr. Huber advised. “Not everyone will be supportive, but it only takes a few referrers to fill your clinic. Once patients return happy, referrals follow, and patients, for their part, are highly motivated—they want to avoid surgery.”

With a dedicated CPT code (60660) for thyroid nodule RFA introduced in 2025, momentum is building. Other specialties are learning these techniques, as well.

Many training options exist, including institutional, societal, industry-led hands-on courses and proctoring by an experienced thyroid interventionalist.

“If interventional radiologists don’t educate themselves on nodular thyroid disease, others will fill the void,” Dr. Huber said. “This is a period of rapid advancement. For clinicians, now is the time to learn.”