微波消融术（MWA）已成为治疗乳头状甲状腺微小癌（PTMC）的一种微创技术，但在T1bN0M0 PTC的治疗中，尚未有高水平证据证明其被广泛应用。本研究旨在比较MWA和手术治疗T1bN0M0 PTC的实际疗效和安全性。从2019年12月至2021年4月，从10家医院共纳入123例连续的单发T1bN0M0 PTC患者，患者无淋巴结转移或远处转移。根据患者的意愿，将患者分为MWA组和手术组。主要观察指标包括局部肿瘤进展（LTP）、新发甲状腺癌、淋巴结转移和远处转移（DM）。次要观察指标包括肿瘤大小和体积变化、并发症和美容效果。进行亚组分析以确定影响因素。52例患者选择了MWA，71例患者选择了手术。两组患者的人口统计学信息和肿瘤特征相似。MWA和手术后的随访时间分别为10.6±4.2个月和10.4±3.4个月。MWA组的淋巴结转移率为5.8%，手术组为1.4%（p=0.177）。两组均未发生局部肿瘤递进、新发甲状腺癌或远处转移。MWA组有5例（9.6%）并发症，手术组有8例（11.3%）（p=0.27）。MWA组的美容效果更好（p<0.01）。MWA取得了与手术相当的短期治疗效果。MWA可能是T1bN0M0 PTC低风险患者手术的可选选择，但对淋巴结转移的担忧需要进一步研究。手术组的并发症率高于MWA组，但差异无统计学意义。MWA组和手术组的淋巴结转移率无显著差异。 © 2023. 作者(们)专属许可给欧洲放射学协会。

Microwave ablation (MWA) has emerged as a minimally invasive technology for papillary thyroid microcarcinoma (PTMC), but it has not been widely applied to treat T1bN0M0 PTC with high-level evidence. This study was designed to compare the real-world efficacy and safety of MWA or surgery for treating T1bN0M0 PTC.From December 2019 to April 2021, 123 continuous unifocal T1bN0M0 PTC patients without lymph node metastasis (LNM) or distant metastasis (DM) were included from 10 hospitals. Patients were allocated into the MWA or surgery group based on their willingness. The main outcomes were local tumour progression (LTP), new thyroid cancer, LNM, and DM. The secondary outcomes included changes in tumour size and volume, complications, and cosmetic results. Subgroup analyses were conducted to identify influencing factors.Fifty-two patients chose MWA, and 71 patients chose surgery. Patients had similar demographic information and tumour characteristics in the two groups. The follow-up durations after MWA and surgery were 10.6 ± 4.2 and 10.4 ± 3.4 months, respectively. The LNM rate was 5.8% in the MWA group and 1.4% in the surgery group (p = 0.177). No LTP, new thyroid cancer, or distant metastasis (DM) occurred in either group. Five (9.6%) of the 52 patients in the MWA group and 8 (11.3%) of the 71 patients in the surgery group had complications (p = 0.27). Better cosmetic results were found in the MWA group (p < 0.01).MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further.MWA achieved comparable short-time treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC.• MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further. • The complication rate in the surgery group was higher than that in the MWA group without a significant difference. • There was no statistically significant difference in the LNM rate between the MWA and surgery groups.© 2023. The Author(s), under exclusive licence to European Society of Radiology.