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The ATA opened the door.

The evidence held it open.

2025 ATA Cancer Guideline ·
Recommendation 11

For the first time, the American Thyroid Association formally lists ultrasound-guided percutaneous ablation as a management option for low-risk papillary thyroid carcinoma. Here’s what changed, and the data behind it.

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The Recommendation

What it actually says

“Ultrasound-guided percutaneous ablation may be considered as an alternative to active surveillance or resection for cT1aN0M0 PTC in selected patients. Shared clinical decision-making between the patient and clinical team regarding risks and benefits of this approach is essential.”
— 2025 ATA Differentiated Thyroid Cancer Guidelines, Recommendation 11B
Conditional recommendation, Low certainty evidence
  • Eligible patients: Carefully selected adults with cT1aN0M0 papillary thyroid carcinoma — unifocal, ≤1 cm, no nodal or distant disease.
  • Position in care: Listed alongside active surveillance and surgical resection, not as a last resort.
  • Required process: Shared decision-making between physician and patient; selection criteria mirror those used for active surveillance.

The Evidence

Why the ATA included it

The recommendation rests on the body of evidence the task force reviewed in detail.

91%

Complete tumor disappearance (cT1a)

2–3%

Local recurrence

1–2%

Nodal metastasis

Meta-analysis of thermal ablation for cT1N0M0 PTC, 36 studies, cited in the 2025 ATA Guideline.

  • Volume reduction: RFA produced the highest pooled volume reduction rate at 99%, vs. MWA (95%) and laser (89%), p < 0.001.
  • Complete tumor disappearance: 91% for cT1a PTC and 60% for cT1b PTC across 36 studies.
  • Head-to-head: RFA vs. surgery for multifocal microcarcinoma over >5 years showed no significant difference in recurrence-free survival (97.7% vs. 96.2%).

Patient Selection

Who the guideline points toward

Selection criteria mirror those used for active surveillance. The guideline emphasizes particular caution for posterior or subcapsular tumors.

Appropriate to consider

Not appropriate

cT1aN0M0 PTC (≤1 cm, unifocal)

Aggressive cytopathology on review

No invasion of recurrent laryngeal nerve, trachea, or esophagus

Imaging signs of extrathyroidal extension

No regional or distant metastases

Regional or distant metastases

Patient declines surgery or active surveillance

Posterior tumors abutting trachea or RLN

Capacity for long-term ultrasound follow-up

Inability to comply with surveillance

This summary is for clinical education and does not replace the full guideline. Clinical judgment and shared decision-making remain essential.

Our Role

Built for this moment

For 24 years, STARMED has been the platform behind much of the published thyroid RFA evidence — including studies referenced by the 2025 ATA Guideline.

Cited in over 300 thyroid RFA studies. A long, documented track record in the literature. (Data on file.)

VIVA combo RF Ablation System & star RF Electrode — FDA-cleared for percutaneous and intraoperative coagulation and ablation of tissue.
Training, proctoring & reimbursement support for CPT® 60660 / 60661.

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See how thyroid RFA could fit into your practice. A STARMED clinical specialist will follow up.

  1. Ringel MD, Sosa JA, Baloch Z, Bischoff L, Bloom G, Brent GA, Brock PL, Chou R, Flavell RR, Goldner W, Grubbs EG, Haymart M, Larson SM, Leung AM, Osborne JR, Ridge JA, Robinson B, Steward DL, Tufano RP, Wirth LJ. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025 Aug;35(8):841- 985. doi: 10.1177/10507256251363120. Erratum in: Thyroid. 2025 Nov;35(11):1350. doi: 10.1177/10507256251387671. PMID: 40844370; PMCID: PMC13090833. (See Recommendation 11.)

Download the Thyroid RFA clinical data sheet

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