Image-guided thermal ablation might be a way to compensate for image deriving cancer overdiagnosis: Author reply

Sir,

We thank Dr. Mauri for his interest in our study. We are happy to find that he generally supports our study [1] and we quite agree with his commentary.

As mentioned, it remains to be determined when minimally invasive percutaneous treatments will play an important role in the management of patients with primary thyroid cancers. However, still we have some important issues.

First, although our study presented favourable results in aged people with primary thyroid cancers [1], it must be strictly investigated whether these treatment modalities can play a similar role in younger people, serving as an alternative to active surveillance or surgery in the general population with primary thyroid cancers.

Second, we have limited accuracy to detect lymph node metastasis [2,3]. It is important to carefully evaluate lymph node metastasis to identify best candidates for interventional therapy. To achieve this goal, better diagnostic criteria are needed to identify lymph node metastasis. However, interventional therapy for primary thyroid cancer may be beneficial, even if there are undetectable lymph node metastasis. Whether interventional therapy is beneficial or harmful to patients with lymph node metastasis is undetermined. Dr. Mauri commented the potential systemic effects of local tumour ablation, which could provide rationale for ablative therapy to the primary cancers.

Finally, still we have issues of imaging criteria. We do not know which size criteria, as determined by imaging, are appropriate for interventional therapy. Cancer location may also be an important selection criterion; an example is the distance between cancer and thyroid capsule.

In this regard, we clearly agree with Dr. Mauri’s comment that further well-designed studies are mandatory.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.