Epstein-Barr Virus and Outcomes of Minimally Invasive Thyroid Ablation: A Systematic Review and Meta-Analysis

Abstract

Background: Epstein-Barr virus (EBV), a ubiquitous human herpesvirus, has gained increasing recognition as a potential driver of thyroid pathology through mechanisms extending beyond its classical lymphotropism. Viral latency, periodic reactivation, and molecular mimicry can initiate or amplify chronic thyroid inflammation, trigger autoimmune cascades, and promote nodular transformation. These viral–host interactions disturb the immune–endocrine axis, facilitating immune evasion and diminishing responsiveness to conventional surgical management. Traditional thyroidectomy, which overlooks the virological component, may thus contribute to overtreatment, recurrence, and loss of endocrine integrity. Objectives: This systematic review and meta-analysis aimed to elucidate the relationship between EBV infection and therapeutic outcomes of ultrasound-guided thyroid ablation, determining whether EBV-associated immune profiles influence lesion response, hormonal recovery, and recurrence risk. Methods: A comprehensive literature review and multicenter data synthesis were conducted, encompassing studies that employed radiofrequency ablation (RFA), ethanol ablation (EA), or minimally invasive video-assisted thyroidectomy (MIVAT) for benign or inflammatory thyroid lesions. Cases were stratified by EBV serostatus, viral load, antibody profile, lesion morphology, and inflammatory biomarkers. Clinical, laboratory, and imaging parameters were analyzed following PRISMA 2020 guidelines to assess correlations between EBV-related immune alterations and post-ablation outcomes. Results: Image-guided ablation achieved substantial nodule volume reduction (70 - 90%) and effective hormonal stabilization in most patients. However, EBV-positive cases displayed distinct immunological patterns, characterized by elevated cytokine levels, delayed lesion resolution, and intermittent thyroid function fluctuations, especially in those with active inflammatory phenotypes. Precision ultrasound targeting allowed dynamic energy modulation to preserve surrounding structures, thereby minimizing procedural complications. Conclusions: The findings underscore the importance of adopting a virology-informed approach to thyroid ablation. EBV profiling may serve as a prognostic determinant for optimizing treatment selection, predicting endocrine recovery, and mitigating recurrence risk. Integration of viral diagnostics with image-guided ablation represents a forward step toward targeted, less invasive management of EBV-associated thyroid disease. Future studies should focus on validating EBV-specific biomarkers and developing combined immuno-ablative strategies to enhance long-term durability and precision of treatment outcomes.