Thermal Ablation vs. Conventional Neck Dissection for Recurrent Low-Burden Lymph Node Metastasis in Thyroid Cancer: A Dual-Center Retrospective Cohort Study

Objective: To compare ultrasound-guided thermal ablation (TA) with conventional neck dissection (CND) for recurrent low-burden lymph node metastasis (≤3 lesions, <2 cm) in thyroid cancer, aiming to guide precision therapy. Methods: A dual-center retrospective study (2016–2022) analyzed 230 patients with recurrent lymph node metastasis, stratified into TA ( n = 115) and reoperation groups ( n = 115). Endpoints included recurrence-free survival, complications, thyroglobulin (Tg) dynamics, quality of life (EORTC QLQ-C30), and healthcare costs. Results: Oncological Outcomes: No significant difference in 36-month recurrence rates (Log-rank p = 0.54; Bonferroni-corrected p = 1.00). Safety: Similar complication rates (nerve injury, hypocalcemia, hematoma, infection; all p > 0.7). TA Advantages: Shorter operative time, less blood loss, faster recovery, shorter hospital stays, and lower costs. 50% of TA-treated patients achieved complete lymph node volume reduction (100% VRR) within 36 months. Conclusion: TA demonstrates non-inferior oncological efficacy to CND for strictly selected patients with recurrent low-burden lymph node metastasis, offering minimally invasive precision therapy with superior procedural efficiency and quality-of-life benefits.