The growing detection of papillary thyroid microcarcinomas (PTMCs) is paralleled by an increase in surgical procedures. Due to the frequent indolent nature, cost, and risk of surgery, active surveillance (AS) and ultrasound-guided minimally invasive treatments (MITs) are in suitable cases of incidental PTMC proposed as alternatives to thyroidectomy. Surgery and radioiodine are the established treatments for relapsing cervical differentiated thyroid carcinoma (DTC) metastases. But radioiodine refractoriness, risk of surgical complications, adverse influence on quality of life, or declining repeat surgery have led to AS and MIT being considered as alternatives for slow-growing DTC nodal metastases. Also, for distant radioiodine-refractory metastases not amenable to surgery, MIT is proposed as part of a multimodality therapeutic approach. The European Thyroid Association and the Cardiovascular and Interventional Radiological Society of Europe commissioned these guidelines for the appropriate use of MIT. Based on a systematic PubMed search, an evidence-based approach was applied, and both knowledge and practical experience of the panelists were incorporated to develop the manuscript and the specific recommendations. We recommend that when weighing between surgery, radioiodine, AS, or MIT for DTC, a multidisciplinary team including members with expertise in interventional radiology assess the demographic, clinical, histological, and imaging characteristics for appropriate selection of patients eligible for MIT. Consider TA in low-risk PTMC patients who are at surgical risk, have short life expectancy, relevant comorbidities, or are unwilling to undergo surgery or AS. As laser ablation, radiofrequency ablation, and microwave ablation are similarly safe and effective thermal ablation (TA) techniques, the choice should be based on the specific competences and resources of the centers. Use of ethanol ablation and high-intensity focused ultrasound is not recommended for PTMC treatment. Consider MIT as an alternative to surgical neck dissection in patients with radioiodine refractory cervical recurrences who are at surgical risk or decline further surgery. Factors that favor MIT are previous neck dissection, presence of surgical complications, small size metastases, and #x3c;4 involved latero-cervical lymph nodes. Consider TA among treatment options in patients with unresectable oligometastatic or oligoprogressive distant metastases to achieve local tumor control or pain palliation. Consider TA, in combination with bone consolidation and external beam radiation therapy, as a treatment option for painful bone metastases not amenable to other established treatments.
Eur Thyroid J

中文翻译：

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欧洲甲状腺协会和欧洲心血管和介入放射学会 2021 年临床实践指南在恶性甲状腺病变中使用微创治疗

越来越多的甲状腺微小乳头状癌 (PTMC) 检测与外科手术的增加并行。由于手术的频繁惰性、成本和风险，主动监测 (AS) 和超声引导的微创治疗 (MIT) 是偶然 PTMC 的合适病例，建议作为甲状腺切除术的替代方案。手术和放射性碘是复发性宫颈分化型甲状腺癌 (DTC) 转移的既定治疗方法。但是放射性碘的难治性、手术并发症的风险、对生活质量的不利影响或重复手术率下降导致 AS 和 MIT 被认为是缓慢生长的 DTC 淋巴结转移的替代方案。此外，对于不适合手术的远处放射性碘难治性转移，MIT 被提议作为多模式治疗方法的一部分。欧洲甲状腺协会和欧洲心血管和介入放射学会委托这些指南来正确使用 MIT。基于系统的 PubMed 搜索，应用了基于证据的方法，并结合了小组成员的知识和实践经验来制定手稿和具体建议。We recommend that when weighing between surgery, radioiodine, AS, or MIT for DTC, a multidisciplinary team including members with expertise in interventional radiology assess the demographic, clinical, histological, and imaging characteristics for appropriate selection of patients eligible for MIT. 对于有手术风险、预期寿命短、有相关合并症或不愿接受手术或 AS 的低风险 PTMC 患者，考虑 TA。由于激光消融、射频消融和微波消融是同样安全有效的热消融 (TA) 技术，因此应根据中心的具体能力和资源进行选择。不推荐使用乙醇消融和高强度聚焦超声进行 PTMC 治疗。对于有手术风险或拒绝进一步手术的放射性碘难治性颈椎复发患者，考虑将 MIT 作为颈外科清扫术的替代方案。有利于 MIT 的因素是先前的颈部清扫、手术并发症的存在、小尺寸转移和 #x3c;4 涉及侧颈淋巴结。在不可切除的寡转移或寡进展性远处转移患者的治疗选择中考虑 TA，以实现局部肿瘤控制或缓解疼痛。考虑TA，
欧洲甲状腺杂志