51
|
Yan L, Li X, Li Y, Xiao J, Zhang M, Luo Y. Comparison of ultrasound-guided radiofrequency ablation versus thyroid lobectomy for T1bN0M0 papillary thyroid carcinoma. Eur Radiol 2022; 33:730-740. [PMID: 35895122 DOI: 10.1007/s00330-022-08963-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/16/2022] [Accepted: 06/11/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To investigate and compare the clinical outcomes between radiofrequency ablation (RFA) and thyroid lobectomy (TL) for T1bN0M0 papillary thyroid carcinoma (PTC). METHODS This retrospective study evaluated 283 patients with solitary T1bN0M0 PTC treated with RFA (RFA group, 91 patients) or TL (TL group, 192 patients) from May 2014 to November 2018. The patients were regularly followed up after treatment. Local tumor progression, lymph node metastasis (LNM), recurrent tumor, persistent tumor, recurrence-free survival (RFS), treatment variables (hospitalization, procedure time, estimated blood loss, and cost), complication, and delayed surgery were compared. RESULTS During the follow-up (median [interquartile ranges], 50.4 [18.0] months), no significant differences were found in the local tumor progression (4.4% vs 3.6%, p = 1.000), LNM (1.1% vs 2.1%, p = 0.917), recurrent tumor (2.2% vs 1.6%, p = 1.000), persistent tumor (1.1% vs 0%, p = 0.146), and RFS rate (95.6% vs 96.4%, p = 0.816) in the RFA and TL groups. Distant metastasis was not detected. Patients in the RFA group had a shorter hospitalization (0 vs 7.0 [3.0] days, p < 0.001), shorter procedure time (5.6 [2.9] vs 90.0 [38.5] min, p < 0.001), lower estimated blood loss (0 vs 20 [20] mL, p < 0.001), lower cost ($1972.5 [0.1] vs $2362.4 [1009.3], p < 0.001), and lower complication rate (0 vs 12/192 [6.3%], p = 0.015) than those in the TL group. No patients in the RFA group underwent delayed surgery. CONCLUSIONS This study revealed comparable 4-year clinical outcomes between RFA and TL for T1bN0M0 PTC in terms of local tumor progression and RFS. As a minimally invasive modality, RFA may be a promising feasible alternative to surgery for the treatment of T1bN0M0 PTC in selected patients after strict evaluation. KEY POINTS • No significant difference in local tumor progression and RFS was found between RFA and TL for T1bN0M0 PTC during a median follow-up period of 50.4 months. • Compared with TL, RFA led to a shorter hospitalization, lower estimated blood loss, lower cost, and lower complication rate. • RFA may be a promising feasible alternative to surgery for the treatment of T1bN0M0 PTC in selected patients after strict evaluation.
Collapse
Affiliation(s)
- Lin Yan
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xinyang Li
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jing Xiao
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Mingbo Zhang
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| |
Collapse
|
52
|
Han Z, Xie L, Wei P, Lei Z, Ding Z, Zhang M. Ultrasound gray scale ratio for differential diagnosis of papillary thyroid microcarcinoma from benign micronodule in patients with Hashimoto's thyroiditis. BMC Endocr Disord 2022; 22:187. [PMID: 35869461 PMCID: PMC9306152 DOI: 10.1186/s12902-022-01028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/15/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To investigate the diagnostic value of ultrasound gray scale ratio (UGSR) in differentiating papillary thyroid microcarcinomas (PTMCs) from benign micronodules (BMNs) in patients with Hashimoto's thyroiditis (HT). METHODS The ultrasound images of 285 PTMCs (from 247 patients) and 173 BMNs (from 140 patients) in the HT group, as well as 461 PTMCs (from 417 patients) and 234 BMNs (from 197 patients) in the non-HT group were retrospectively analyzed. The diagnosis of all cases was confirmed by histopathological examinations. The gray scale values of the nodules and surrounding thyroid tissues were measured and subsequently the UGSRs were calculated. Receiver operating characteristic curve analysis was used to determine the area under the curve (AUC), optimal UGSR threshold, sensitivity and specificity in differentiating PTMCs and BMNs in the two groups. RESULTS The UGSR of PTMC and BMN was 0.52 ± 0.12 and 0.85 ± 0.24 in the HT group (P < 0.001), and 0.57 ± 0.13 and 0.87 ± 0.20 in the non-HT group (P < 0.001), respectively. The difference in PTMC-UGSR was significant between the two groups (P < 0.001), whereas BMN-UGSR did not differ between the two groups (P = 0.416). The AUC, optimal UGSR threshold, sensitivity and specificity of UGSR for differentiating PTMC and BMN in the HT and non-HT group were 0.890 versus 0.901, 0.68 versus 0.72, 91.23% versus 90.67%, and 77.46% versus 82.05%, respectively. CONCLUSIONS The USGR of the HT group was lower than that of the non-HT group. Moreover, UGSR exhibited important diagnostic value in differentiating PTMC from BMN in both HT and non-HT groups.
Collapse
Affiliation(s)
- Zhijiang Han
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lesi Xie
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiying Wei
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhikai Lei
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhongxiang Ding
- Department of Radiology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, 310006, China.
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, China.
| |
Collapse
|
53
|
The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism. Ann Surg 2022; 276:e141-e176. [PMID: 35848728 DOI: 10.1097/sla.0000000000005522] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism. BACKGROUND Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT. METHODS Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.
Collapse
|
54
|
Ou D, Chen C, Jiang T, Xu D. Research Review of Thermal Ablation in the Treatment of Papillary Thyroid Carcinoma. Front Oncol 2022; 12:859396. [PMID: 35847945 PMCID: PMC9283792 DOI: 10.3389/fonc.2022.859396] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022] Open
Abstract
Background Minimally invasive treatment of thyroid tumors has become increasingly common, but has mainly focused on benign thyroid tumors, whereas thermal ablation of thyroid cancer remains controversial. Clinical studies analyzing the efficacy of thermal ablation of papillary thyroid carcinoma (PTC) have been conducted in several countries to verify its safety. Here, we screened and reviewed recent studies on the efficacy and safety of thermal ablation of PTC as well as psychological assessment, patient prognosis, recurrence, and factors affecting ablation. Summary The most significant controversy surrounding ablative treatment of PTC centers on its effectiveness and safety, and >40 studies have been conducted to address this issue. The studies include papillary thyroid microcarcinoma (PTMC) and non-PTMC, single PTC and multiple PTC, and controlled studies of ablative therapy and surgical treatment. In general, ablation techniques can be carefully performed and promoted under certain conditions and with active follow-up of postoperative patients. Ablation is a promising alternative treatment especially in patients who are inoperable. Conclusions Clinical studies on PTC ablation have provided new perspectives on local treatment. However, because PTC grows very slowly, it is an indolent tumor; therefore, studies with larger sample sizes and extended post-procedure follow-ups are necessary to confirm the investigators’ hypotheses.
Collapse
Affiliation(s)
- Di Ou
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Chen Chen
- Graduate School, Wannan Medical College, Wuhu, China
| | - Tian Jiang
- The Postgraduate Training Base, Wen Zhou Medical University, Hangzhou, China
| | - Dong Xu
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
- *Correspondence: Dong Xu,
| |
Collapse
|
55
|
Microwave ablation vs. surgery for papillary thyroid carcinoma with minimal sonographic extrathyroid extension: a multicentre prospective study. Eur Radiol 2022; 33:233-243. [PMID: 35771248 DOI: 10.1007/s00330-022-08962-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/24/2022] [Accepted: 06/11/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Minimal extrathyroid extension (mETE) was removed from the TNM staging system. This study was designed prospectively to compare the safety and efficacy of microwave ablation (MWA) versus surgery for treating T1N0M0 papillary thyroid carcinomas (PTC) with sonographically detected mETE. METHODS From December 2019 to April 2021, 198 patients with T1N0M0 mETE-PTCs evaluated by preoperative ultrasound from 10 hospitals were included. Ninety-two patients elected MWA, and 106 patients elected surgery for treatment. MWA was performed using extensive ablation with hydrodissection. Surgery consisted of lobectomy with ipsilateral central lymph node dissection (CLD), lobe and isthmus excision with ipsilateral CLD and total thyroidectomy with ipsilateral CLD. The rates of technical success, cost, oncologic outcomes, complications and quality of life of the two groups were assessed. RESULTS The follow-up times for the MWA and surgery groups were 12.7 ± 4.1 and 12.6 ± 5.0 months, respectively. The technical success rate was 100% for both groups. Oncological outcomes of the two groups were similar during the follow-up (all p > 0.05). The MWA group had a shorter operation time, less blood loss and lower costs (all p < 0.001). Three complications (3.3%) were reported in the MWA group and 4 (3.8%) in the surgery group (p = 0.846). The surgery group had higher scores for scar problems and anxiety (p < 0.001 and p = 0.003, respectively). CONCLUSIONS Microwave ablation was comparable in the short term to surgery in terms of treatment safety and efficacy in selected patients with T1N0M0 mETE-PTC detected by ultrasound. KEY POINTS • Microwave ablation is comparable to surgery in the safety and short-term efficacy for PTCs with sonographically detected mETE. • Thermal ablation is technically feasible for mETE-PTC treatment. • Patients with mETE-PTC have similar quality of life in the two groups, except for worse scar problems and anxiety in the surgery group.
Collapse
|
56
|
Landry V, Siciliani E, Henry M, Payne RJ. Health-Related Quality of Life following Total Thyroidectomy and Lobectomy for Differentiated Thyroid Carcinoma: A Systematic Review. Curr Oncol 2022; 29:4386-4422. [PMID: 35877210 PMCID: PMC9323259 DOI: 10.3390/curroncol29070350] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/12/2022] [Accepted: 06/17/2022] [Indexed: 11/18/2022] Open
Abstract
Health-related quality of life (HrQoL) is a major concern for patients with differentiated thyroid carcinoma (DTC). We aimed to systematically review the literature comparing HrQol following total thyroidectomy (TT) and hemithyroidectomy (HT) in DTC patients. A systematic review of publications indexed in Medline, Embase, and EBM reviews—Cochrane Central Register of Controlled Trials, which evaluated HrQoL following thyroid surgery for DTC, was conducted. Of 2507 identified records, 25 fulfilled the inclusion criteria. Our results suggest that patients undergoing TT may suffer more impairment in physical and social HrQoL than patients undergoing HT. Psychological-related HrQoL and long-term global HrQoL are, however, equivalent in both groups, which highlights the multidimensional nature of HrQoL and the importance of a multitude of factors aside from treatment modalities and related morbidities, such as the experience of receiving a cancer diagnosis, the fear of cancer recurrence, and other psychosocial factors. Addressing postoperative HrQoL when discussing therapeutic options with patients is an integral part of patient-centered care and informed shared decision-making, and should be approached in a holistic manner, accounting for its physical, psychological, and social aspects. This review supplies evidence regarding HrQoL following thyroid surgery, which can be employed in such decisions.
Collapse
Affiliation(s)
- Vivianne Landry
- Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada;
- School of Communication Sciences and Disorders, McGill University, Montreal, QC H3A 0G4, Canada
| | | | - Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada;
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, QC H4A 3J1, Canada
- Lady-Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Richard J. Payne
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, QC H4A 3J1, Canada
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Correspondence:
| |
Collapse
|
57
|
Jasim S, Patel KN, Randolph G, Adams S, Cesareo R, Condon E, Henrichsen T, Itani M, Papaleontiou M, Rangel L, Schmitz J, Stan MN. American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions. Endocr Pract 2022; 28:433-448. [PMID: 35396078 DOI: 10.1016/j.eprac.2022.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE The objective of this disease state clinical review is to provide clinicians with a summary of the nonsurgical, minimally invasive approaches to managing thyroid nodules/malignancy, including their indications, efficacy, side effects, and outcomes. METHODS A literature search was conducted using PubMed and appropriate key words. Relevant publications on minimally invasive thyroid techniques were used to create this clinical review. RESULTS Minimally invasive thyroid techniques are effective and safe when performed by experienced centers. To date, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Both ultrasound-guided laser and radiofrequency ablation can be safely used for symptomatic solid nodules, both toxic and nontoxic. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. Despite limited data, encouraging results suggest that minimally invasive techniques can also be used in small-size primary and locally recurrent thyroid cancer. CONCLUSION Surgery and radioiodine treatment remain the conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective alternatives when used appropriately and by trained professionals to treat symptomatic or enlarging thyroid masses.
Collapse
Affiliation(s)
- Sina Jasim
- Division of Endocrinology, Metabolism and Lipid Research, School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
| | | | - Gregory Randolph
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Adams
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, Florida
| | - Roberto Cesareo
- Unit of Metabolic Diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leonardo Rangel
- Head and Neck Surgery Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - John Schmitz
- Mayo Clinic Department of Radiology, Rochester, Minnesota
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
58
|
Thermal Ablation for the Management of Papillary Thyroid Microcarcinoma in the Era of Active Surveillance and Hemithyroidectomy. Curr Oncol Rep 2022; 24:1045-1052. [PMID: 35384589 DOI: 10.1007/s11912-022-01268-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE OF REVIEW Thermal ablation presents a therapeutic option other than active surveillance and immediate surgery for patients with low-risk papillary thyroid microcarcinomas (PTMC). Here, we have reviewed the current oncologic outcome of thermal ablation in PTMC cases and compared it with active surveillance and surgery. RECENT FINDINGS Thermal ablation in PTMC cases revealed no tumor progression for pooled 5-year follow-up data. This oncologic outcome of thermal ablation was comparable to that of immediate surgery with less morbidity. Additionally, no patient who underwent thermal ablation received delayed surgery during the follow-up period due to anxiety. However, active surveillance has indicated that a substantial proportion (range, 8-32%) of patients underwent surgery mainly due to anxiety. In a subset of PTMC patients who are high-risk surgical candidates or who refuse surgery, especially those who have failed or are reluctant to pursue active surveillance, thermal ablation can be a good option.
Collapse
|
59
|
van Dijk SPJ, Coerts HI, Gunput STG, van Velsen EFS, Medici M, Moelker A, Peeters RP, Verhoef C, van Ginhoven TM. Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2022; 148:317-325. [PMID: 35142816 PMCID: PMC8832309 DOI: 10.1001/jamaoto.2021.4381] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Papillary microcarcinomas of the thyroid (mPTCs) account for an increasing proportion of thyroid cancers in past decades. The use of radiofrequency ablation (RFA) has been investigated as an alternative to surgery. The effectiveness and safety of RFA has yet to be determined. OBJECTIVE To evaluate the effectiveness and safety of RFA for low-risk mPTC. DATA SOURCES Embase, MEDLINE via Ovid, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and the top 100 references of Google Scholar were searched from inception to May 28, 2021. STUDY SELECTION Articles reporting on adult patients with mPTC treated with RFA were included. Studies that involved patients with pre-ablation lymph node or distant metastases, recurrence of disease, or extrathyroidal extension were excluded. Final article selection was conducted by multiple reviewers based on consensus. The proportion of eligible articles was 1%. DATA EXTRACTION AND SYNTHESIS This meta-analysis was conducted in accordance with the MOOSE guidelines. Random and fixed-effect models were applied to obtain pooled proportions and 95% CIs. MAIN OUTCOMES AND MEASURES The primary outcome was the complete disappearance rate of mPTC. Secondary outcomes were tumor progression and complications. RESULTS Fifteen studies were included in this meta-analysis. A total of 1770 patients (1379 women [77.9%]; mean [SD] age, 45.4 [11.4] years; age range, 42.5-66.0 years) with 1822 tumors were treated with RFA; 49 tumors underwent 1 additional RFA session and 1 tumor underwent 2 additional RFA sessions. Mean (SD) follow-up time was 33.0 (11.4) months (range, 6-131 months). The pooled complete disappearance rate at the end of follow-up was 79% (95% CI, 65%-94%). The overall tumor progression rate was 1.5% (n = 26 patients), local residual mPTC in the ablation area was found in 7 tumors (0.4%), new mPTC in the thyroid was found in 15 patients (0.9%), and 4 patients (0.2%) developed lymph node metastases during follow-up. No distant metastases were detected. Three major complications occurred (2 voice changes lasting >2 months and 1 cardiac arrhythmia). Minor complications were described in 45 patients. CONCLUSIONS AND RELEVANCE The findings of this systematic review and meta-analysis suggest that RFA is a safe and efficient method to treat selected low-risk mPTCs. Radiofrequency ablation could be envisioned as step-up treatment after local tumor growth under active surveillance for an mPTC or initial treatment in patients with mPTCs with anxiety about active surveillance.
Collapse
Affiliation(s)
- Sam P. J. van Dijk
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hannelore I. Coerts
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sabrina T. G. Gunput
- Department of Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Evert F. S. van Velsen
- Department of Internal Medicine and Thyroid Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marco Medici
- Department of Internal Medicine and Thyroid Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robin P. Peeters
- Department of Internal Medicine and Thyroid Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tessa M. van Ginhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
60
|
Chen S, Mao Y, Chen G. Economic effect between surgery and thermal ablation for patients with papillary thyroid microcarcinoma: a systemic review and meta-analysis. Endocrine 2022; 76:9-17. [PMID: 35122627 PMCID: PMC8817154 DOI: 10.1007/s12020-022-02991-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/19/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND At present, there are still many controversies regarding the treatment of papillary thyroid microcarcinoma (PTMC). It is worth noting that thermal ablation has become a viable alternative for patients at high risk of surgery or those who wish to receive more active treatment than active surveillance. OBJECTIVE To investigate the economic benefits, efficacy, and safety of thermal ablation for patients with PTMC. METHODS We searched PubMed, Cochrane Library, Web of Science, and Embase for articles published from the database establishment to August 2021. All of the studies included were retrospective cohort analyses. In addition, meta-analysis was performed using the Stata15.1 versions and Review Manager5.3. Data were extracted according to the PRISMA guidelines by two professional doctors. RESULTS A total of 7 articles (1582 patients) were included in our systematic review and meta-analysis. We discovered that thermal ablation could shorten the hospitalization time (SMD, -3.82[95%CI, -5.25 to -2.40]), operation time (SMD, -5.67[95%CI, -6.65 to -4.68]), cost (SMD, -3.40 [95%CI, -5.06 to -1.75]) and reduce postoperative complications (OR, 0.07 [95%CI, 0.01 to 0.44]) than surgical treatment. In addition, our study also found that compared with surgery, there was no significant difference in the recurrence rate (OR, 1.53 [95% CI, 0.63 to 3.73]) and metastasis rate (OR, 0.47 [95% CI, 0.12 to 1.86]). CONCLUSION On the premise of being safe and effective, thermal ablation has better economic benefits than surgical treatment for patients with PTMC.
Collapse
Affiliation(s)
- Shuqian Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Yaqian Mao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Gang Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China.
| |
Collapse
|
61
|
Ding Z, Chen J, Chen Z, Zeng X, Zheng P, Wang X, Cui X, Sang L. Efficacy and Safety of Thermal Ablation for Treating Lymph Node Metastasis From Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:738299. [PMID: 35433407 PMCID: PMC9010561 DOI: 10.3389/fonc.2022.738299] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/08/2022] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the efficacy and safety of thermal ablation, including radiofrequency ablation (RFA), microwave ablation (MVA), and laser ablation (LA), for treating lymph node metastasis (LNM) from papillary thyroid carcinoma (PTC). Design and Methods PubMed and EMBASE were searched for studies reporting the efficacy and safety of thermal ablation for treating LNM in PTC. After selecting the relevant literature (including 11 papers, 208 patients, 412 lymph nodes), the QUADAS-2 tool was used to evaluate its quality. Then, both the fixed-effects and random-effects models combined with subgroup analysis were used to calculate data on volume changes in metastatic lymph nodes and changes in serum thyroglobulin (Tg) levels. We pooled the proportion of major and overall complication rates and complete disappearance rates and used subgroup forest plots and funnel plots for visual representation. Because of publication bias, we also performed a trim-and-filled model for correction. The rate of recurrence and distant metastasis with ablated details were pooled. Results In the 11 articles (208 patients and 412 diseased lymph nodes), all thermal ablation methods showed effectiveness in reducing lymph node volume (P = 0.02) and serum Tg levels (P < 0.01) which showed no between-group difference. The pooled proportion of major complications was 0%(95% CI: -0.14; 0.15, P = 1) and the overall complication rate was 5% (95% CI: -0.09; 0.20, P = 1), which revealed no significant difference among modalities. The pooled proportion of the complete disappearance rate was 82% (95% CI: 0.43; 0.96, P < 0.01) and the data with statistical significance which contains RFA and LA showed complete disappearance rate was 59% and 81% respectively. Conclusion All thermal ablation methods, including RFA, MWA, and LA, were effective and safe for treating LNM in PTC and were especially suitable for nonsurgical patients. Besides, subgroup analysis showed no significant difference, except for LA is better than RFA in complete disappearance rate.
Collapse
Affiliation(s)
- Zheng Ding
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Juan Chen
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiguang Chen
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xiaoke Zeng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Pengchao Zheng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xuemei Wang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xinwu Cui
- Departmant of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xinwu Cui, ; Liang Sang,
| | - Liang Sang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
- *Correspondence: Xinwu Cui, ; Liang Sang,
| |
Collapse
|
62
|
The Treatment of Thyroid Cancer with Radiofrequency Ablation. Tech Vasc Interv Radiol 2022; 25:100825. [DOI: 10.1016/j.tvir.2022.100825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
63
|
Ding AS, Xie DX, Zhang L, Creighton FX, Russell JO. Public perceptions of radiofrequency ablation versus standard surgery for benign thyroid nodules. Surgery 2022; 172:110-117. [DOI: 10.1016/j.surg.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/03/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
|
64
|
Zheng L, Liu FY, Yu J, Cheng ZG, Yu XL, Dong XC, Han ZY, Liang P. Thermal ablation for papillary thyroid microcarcinoma located in the isthmus: a study with 3 years of follow-up. Future Oncol 2022; 18:471-480. [PMID: 35048734 DOI: 10.2217/fon-2021-0463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aims: To analyze the outcomes of thermal ablation for isthmic papillary thyroid microcarcinoma (PTMC). Patients & methods: Data for 21 isthmic-PTMC patients who underwent microwave ablation under ultrasound guidance were retrospectively collected. General information on patients and characteristics of tumors were collected. The technical effectiveness, tumor recurrence and volume changes and postoperative complications were recorded during the follow-up. Comparisons with 105 nonisthmic-PTMCs were done. Results: The technical effectiveness was 100%. No recurrence or lymph node metastases were detected. Tumor volume decreased significantly with a volume reduction rate of 1.00 ± 0.01 (range: 0.99 to 1.0) at the final evaluation and seven cases (31.8%) were completely resolved. No complication was encountered. No statistical differences were observed in terms of complications, recurrence or the volume reduction rate compared with the nonisthmic group (all p > 0.05). Conclusions: Percutaneous microwave ablation is an effective treatment strategy for isthmic-PTMC.
Collapse
Affiliation(s)
- Lin Zheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Cong Dong
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
65
|
Zhao YZ, He NA, Ye XJ, Jin F, Li MX, Jiang X. Analysis of Risk Factors Associated With Central Lymph Node Metastasis in Papillary Thyroid Carcinoma With cT1N0 Stage. Front Endocrinol (Lausanne) 2022; 13:880911. [PMID: 35733781 PMCID: PMC9207950 DOI: 10.3389/fendo.2022.880911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
AIM Annual T1 stage papillary thyroid carcinoma (PTC) incidence rates continue to rise, yet the optimal treatment for this cancer type remains controversial. Central lymph node metastasis (CLNM) is a critical determinant in the context of treatment decision-making. While several prior studies have evaluated patients with clinica l T1a(cT1a) stage PTC, there have been fewer analyses of clinical T1b(cT1b) disease to date. The present study was thus formulated to explore predictors of CLNM in patients with cT1a and cT1b stage PTC. METHODS A retrospective analysis of data including clinicopathological characteristics and BRAFV600E mutation status was conducted for 452 PTC patients undergoing surgical treatment. Logistic univariate and multivariate analyses were performed to identify risk factors associated with CLNM in particular patients' characteristics and the accuracy of the established logistic regression models was evaluated using the R software platform. RESULTS Respective CLNM incidence rates in cT1a and cT1b disease were 39.39% and 67.21%. Factors associated with a higher risk of CLNM among PTC(cT1a) patients included male sex, young age, tumor size, contact with capsule, and multifocality as determined through comparisons of the area under the curve for logistic regression models. Whereas male sex and age were associated with CLNM risk in PTC(cT1b) patients in univariate and multivariate analyses, age was the only risk factor associated with CLNM incidence among women with PTC(cT1b). CONCLUSION Predictors of CLNM differ between PTC patients with cT1a and cT1b stage disease, and a comprehensive assessment of these risk factors should thus be conducted when designing individualized treatment regimens for PTC patients.
Collapse
|
66
|
Xue J, Teng D, Wang H. Efficacy and safety of ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma: a systematic review and meta-analysis. Int J Hyperthermia 2022; 39:1300-1309. [PMID: 36195326 DOI: 10.1080/02656736.2022.2129101] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 10/10/2022] Open
Abstract
BACKGROUND We comprehensively evaluate the efficacy and safety of US-guided radiofrequency ablation (RFA) in the treatment of papillary thyroid microcarcinoma (PTMC) via a systematic review and meta-analysis. METHODS We searched the PubMed, Embase and Cochrane Library databases for studies published during the time between the establishment of the database through October 2021. We included a 10 non-randomized controlled trial (non-RCT) that reported the application of US-guided RFA in PTMC. The sample size of patients totaled 1279. We evaluated the ablation efficacy by analyzing the volume reduction rate (VRR), complete disappearance rate (CDR) and recurrence rate of PTMC treated by RFA. We analyzed all data using STATA version 15.1 (Stata Corporation, College Station, TX). RESULTS Our pooled results proved RFA treatment significantly reduces the volume of tumors (Weighted Mean Difference [WMD] = -103.20, 95% CI: -111.93 - -94.48, p = 0.000). We also found the VRR at 12 months after RFA was 93.27% (95% CI: 84.68-101.86), and the CDR at 12 months after RFA was 64% (95% CI: 39-89%). Additionally, pooled results showed the incidence of mPTC residue in ablation area, newly discovered mPTC and lymph node metastases after RFA treatment were respectively 0.3% (95% CI: -0.1-0.7%), 2.5% (95% CI: 1.1-3.9%) and 1.0% (95% CI: 0.2-1.9%), and the incidence of complications after RFA treatment was 1.8% (95% CI: 0.7-3.2%). CONCLUSIONS US-guided RFA is effective and safe for treating PTMC. It could be an excellent alternative to the existing treatment options.
Collapse
Affiliation(s)
- JiaNan Xue
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, PR China
| | - DengKe Teng
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, PR China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, PR China
| |
Collapse
|
67
|
Chen WC, Chou CK, Chang YH, Chiang PL, Lim LS, Chi SY, Luo SD, Lin WC. Efficacy of radiofrequency ablation for metastatic papillary thyroid cancer with and without initial biochemical complete status. Front Endocrinol (Lausanne) 2022; 13:933931. [PMID: 35992153 PMCID: PMC9381930 DOI: 10.3389/fendo.2022.933931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The application of radiofrequency ablation (RFA) for recurrent thyroid cancer has been demonstrated to effectively manage lesions at critical locations, such as abutting the trachea, with limited complications. Comprehensive investigation of both biochemical (B) and structural (S) change after RFA remains limited. We herein present the first single-center experience of RFA for the treatment of locoregional recurrent thyroid cancer in Taiwan. DESIGN 23 patients were enrolled, and the treatment responses after RFA were divided into four groups (E, S(+), B(+), and SB(+)), and then compared. The RFA technique, follow-up strategy, changes in pre-and post-operative status, and complications are presented. The volume reduction rate at 1, 3, and 6 months, and the differing responses between lesions abutting/not abutting the trachea are also discussed. RESULTS In patients with pre-RFA structural and biochemical incomplete (SB(+)) status, presenting with lesion with an initial maximum diameter of >3.2cm, a higher rate of structural incomplete status at the 6-month follow-up was noted in ROC analysis, with a sensitivity of 57% and specificity of 91%. Favorable structural remission after RFA was noted, and 60.9% of patients achieved biochemical complete status. No significant correlation was noted between the trachea-abutted lesion number and complete remission (p= 0.474). No significant difference in RFA efficacy was noted between the lesions abutting/not abutting the trachea. CONCLUSIONS This retrospective study reveals that RFA can achieve both structural and biochemical improvements for locoregionally recurrent thyroid cancer, with a low complication rate. Nearly half of the patients achieved an excellent response after RFA, while a favorable treatment response can be achieved despite the lesion abutting the trachea, with a mean VRR of 84.74%.
Collapse
Affiliation(s)
- Wen-Chieh Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Kai Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Lay-San Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Division of General Surgery and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- *Correspondence: Wei-Che Lin,
| |
Collapse
|
68
|
Radiofrequency ablation and thyroid cancer: review of the current literature. Am J Otolaryngol 2022; 43:103204. [PMID: 34537511 DOI: 10.1016/j.amjoto.2021.103204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/04/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thyroid nodules are commonly being diagnosed in general population and have a potential for malignant transformation. Historically, surgery has been considered as the first line treatment for these tumors. However, with passage of time newer minimally invasive techniques such as RFA (radiofrequency ablation) has been adapted. Though, RFA for thyroid tumors has been performed more commonly in Asian and European countries, it is a fairly new technique in North America. The aim of the review is to assess the current data and conclude that whether RFA is likely a valuable option when compared to surgery for treatment of thyroid tumors. MATERIALS AND METHODS A Comprehensive PubMed/MEDLINE, Embase and Web of Science search was performed. To expand our search, references of the retrieved articles were also screened for additional data. After selecting the studies that fulfilled the initial screening, authors independently reviewed the selected studies and screened the full texts to identify those that met the inclusion criteria. RESULTS The comprehensive literature search from PubMed/MEDLINE, Web of Science, and EMBASE databases revealed 1094 studies (Embase 870, PubMed 200, and Web of Science 24). References were imported for screening. Amongst 1094 studies, 138 duplicates removed, and 956 studies were screened against title and abstract. After these 777 studies were excluded the remaining 179 studies were assessed for full-text eligibility. Amongst them 127 studies excluded due to wrong design or setting. Finally, 18 studies were included in the review. CONCLUSION RFA appears to be a safe alternative to surgery in selected cases. However, it is not widely used and there are few randomized controlled trials. Furthermore, it is associated with a low risk profile and has shown promising results in patients who are difficult surgery candidates. Currently large-scale prospective studies are needed in North America to establish the efficacy of RFA and its use as an alternative to surgery for thyroid tumors.
Collapse
|
69
|
Zhang L, Zhang GP, Zhan WW, Zhou W. The feasibility and efficacy of ultrasound-guided percutaneous laser ablation for multifocal papillary thyroid microcarcinoma. Front Endocrinol (Lausanne) 2022; 13:921812. [PMID: 36060950 PMCID: PMC9428260 DOI: 10.3389/fendo.2022.921812] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility and efficacy of percutaneous laser ablation (PLA) for patients with multifocal papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS A cohort of patients who underwent ultrasound (US)-guided PLA for primary PTMC were enrolled in this study. The patients were divided into a multifocal PTMC (multi-PTMC) group and a unifocal PTMC (uni-PTMC) group. Before PLA, conventional US and contrast-enhanced ultrasound (CEUS) were performed to evaluate the PTMC and cervical lymph nodes. The operation time, energy, power, amount of isolation liquid, and complications during PLA were recorded. Patients were followed up at 2 days, 1 month, 3 months, and 6 months, and every 6 months after that. Volume reduction rate (VRR), local tumor recurrence, and lymph node metastasis after PLA were observed. RESULTS The study included 12 patients with 26 PTMCs and 60 patients with 60 PTMCs. The operation time, total energy, and amount of isolation liquid in the multi-PTMC group were more than those in the uni-PTMC group (p = 0.000, 0.007, and 0.020, respectively). The mean follow-up durations in multi-PTMC and uni-PTMC groups were 19.75 ± 11.46 months (6-36 months) and 16.33 ± 10.01 months (4-40 months), with a similar VRR of the ablated lesions in the two groups. One and three cases with newly developed PTMCs were observed in the multi-PTMC group and the uni-PTMC group during follow-up, respectively. There was no regrowth of treated lesions, lymph node metastasis, or distant metastasis. At the end of the follow-up, all the ablated lesions in the two groups completely disappeared or only remained scar strips. CONCLUSION PLA is a safe and effective technique for treating multifocal PTMC, which might be an alternative technique for patients who are not eligible or are unwilling to undergo surgery.
Collapse
|
70
|
Wang MH, Liu X, Wang Q, Zhang HW. Safety and efficacy of ultrasound-guided thermal ablation in treating T1aN0M0 and T1bN0M0 papillary thyroid carcinoma: A meta-analysis. Front Endocrinol (Lausanne) 2022; 13:952113. [PMID: 35966062 PMCID: PMC9363616 DOI: 10.3389/fendo.2022.952113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/21/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Papillary thyroid cancer (PTC) is the most common thyroid tumor, and early diagnosis and treatment can effectively improve prognosis. Many controversies surround the treatment method of T1N0M0 PTC. Recently, thermal ablation (TA) has shown some benefits in the treatment of PTC patients, but the safety and efficacy of its treatment remain controversial. This article performs a meta-analysis of TA in patients with T1aN0M0 and T1bN0M0 PTC. METHODS The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched for retrospective or prospective studies of TA for treating patients with T1N0M0 PTC from the database establishment to May 1, 2022. Data on volume reduction rate (VRR), disease progress, and complication rate were collected. In addition, a meta-analysis was performed using the Stata 12.0 and Review Manager 5.3. RESULTS A total of 9 eligible studies were included. Our study demonstrated the effectiveness of VRR and disease progress. The VRR was reduced after 3 months (-75.90%; 95% CI [-118.46-33.34%]), 6 months (34.33%; 95% CI [15.01-53.65%]), 12 months (78.69%; 95% CI [71.69-85.68%]), and 24 months (89.97%; 95% CI [84.00-95.94%]). The disease progress was 1.9% (95% CI [1.1-3.0]). Safety is justified by the complication rate, which was 6.5% (95% CI [3.5-10.2]). Pain and hoarseness were the most common complications, and no life-threatening complications were reported. Egger's test demonstrated that publication bias was acceptable. CONCLUSIONS TA is an effective and safe method for managing T1aN0M0 and T1bN0M0 papillary thyroid nodules.
Collapse
Affiliation(s)
- Mei-Huan Wang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiao Liu
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Qian Wang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- *Correspondence: Hua-Wei Zhang, ; Qian Wang,
| | - Hua-Wei Zhang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- *Correspondence: Hua-Wei Zhang, ; Qian Wang,
| |
Collapse
|
71
|
Agyekum EA, Fu JH, Xu FJ, Ren YZ, Akortia D, Chen Q, Qian XQ, Wang Y, Wang X. Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules. Front Oncol 2021; 11:761005. [PMID: 34868975 PMCID: PMC8637803 DOI: 10.3389/fonc.2021.761005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/28/2021] [Indexed: 12/07/2022] Open
Abstract
Thyroid nodules are commonly encountered in health care practice. They are usually benign in nature, with few cases being malignant, and their detection has increased in the adult population with the help of ultrasonography. Thyroidectomy or surgery is the first-line treatment and traditional method for thyroid nodules; however, thyroidectomy leaves permanent scars and requires long-term use of levothyroxine after surgery, which makes patients more reticent to accept this treatment. Thermal ablation is a minimally-invasive technique that have been employed in the treatment of benign and malignant thyroid nodules nodules, and have been shown to be effective and safe. Several studies, including long-term, retrospective, and prospective studies, have investigated the use of ablation to treat benign thyroid nodules and malignant thyroid nodules, including papillary thyroid carcinoma. Here, we review the recent progress in thermal ablation techniques for treating benign and malignant nodules, including their technicalities, clinical applications, pitfalls and limitations, and factors that could affect treatment outcomes. Special in-depth elaboration on the recent progress of the application of thermal ablation therapy in malignant thyroid nodules.
Collapse
Affiliation(s)
- Enock Adjei Agyekum
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China.,School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jian-Hua Fu
- Department of Interventional Radiology, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Fei-Ju Xu
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Yong-Zhen Ren
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Debora Akortia
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Qing Chen
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Xiao-Qin Qian
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Yuguo Wang
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Xian Wang
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| |
Collapse
|
72
|
Yan L, Zhang M, Song Q, Luo Y. Ultrasound-Guided Radiofrequency Ablation Versus Thyroid Lobectomy for Low-Risk Papillary Thyroid Microcarcinoma: A Propensity-Matched Cohort Study of 884 Patients. Thyroid 2021; 31:1662-1672. [PMID: 34269611 DOI: 10.1089/thy.2021.0100] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Thermal ablation (TA) has been applied in patients with low-risk papillary thyroid microcarcinoma (PTMC) who refuse surgery or active surveillance (AS). Recently, TA has been proposed as a potential therapeutic option for patients who are suitable for surgery or AS. However, the clinical outcomes of TA versus surgery remains controversial because of a lack of sufficient data. This study aimed to compare the clinical outcomes between radiofrequency ablation (RFA) versus thyroid lobectomy (TL) for low-risk PTMC in a large cohort. Methods: This retrospective study evaluated 884 patients with unifocal low-risk PTMC treated with TL or RFA from June 2014 to March 2018. Among them, 460 patients underwent TL (TL group) and 424 patients, who refused surgery or AS, underwent RFA (RFA group). Patients were regularly followed up after treatment. Local tumor progression, recurrence-free survival (RFS), complications, and treatment variables, including procedure time, estimated blood loss, hospitalization, and cost, were compared after propensity score matching (PSM). Results: After PSM, a total of 332 patients underwent TL (mean ages 43.8 ± 9.5 years) and 332 underwent RFA (mean ages 44.1 ± 9.5 years). During the follow-up (median [interquartile ranges], 48.3 [23.2] months), no significant differences were observed in local tumor progression (1.8% vs. 3.3%, p = 0.209), lymph node metastasis (0.6% vs. 0.6%, p = 1.000), recurrent PTMC (1.2% vs. 2.4%, p = 0.244), persistent lesion (0% vs. 0.3%, p = 0.317), and 4-year RFS rates (98.2% vs. 97.0%, p = 0.223) between the TL and RFA groups. Distant metastasis was not detected. None of the patients who were treated by RFA underwent delayed surgery. Patients undergoing RFA had shorter procedure time (3.4 [2.5] vs. 86.0 [37.0] minutes, p < 0.001), lower estimated blood loss (0 vs. 20 [10.0] mL, p < 0.001), shorter hospitalization (0 vs. 7.0 [3.0] days, p < 0.001), lower cost ($2035.7 [254.0] vs. $2269.1 [943.4], p < 0.001) and lower complication rate (0% vs. 4.5%, p < 0.001) than those treated by TL. The association between treatment modality and recurrence remained nonsignificant after Cox analysis (p = 0.247). Conclusions: This large matched study revealed comparable four-year clinical outcomes between RFA and TL for low-risk PTMC. As a minimally invasive modality, RFA may be a promising alternative to the existing treatment options for low-risk PTMC.
Collapse
Affiliation(s)
- Lin Yan
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
73
|
Zhang Y, Wang K, Liu J, Xu S, Sun Y, Xu M, Wang X. Surgical management of parapharyngeal lymph node metastases from thyroid carcinoma with transcervical approach. Surgery 2021; 171:1233-1239. [PMID: 34711428 DOI: 10.1016/j.surg.2021.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/07/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Parapharyngeal lymph node metastasis is very rare in patients with thyroid carcinoma. In this study, we elucidated on the clinical features, diagnosis, surgical treatment, and outcomes for patients with parapharyngeal lymph node metastases from thyroid carcinoma. METHODS Patients with thyroid carcinoma who had been subjected to surgery through the transcervical approach at our institution between April 1999 and January 2019 were retrospectively enrolled in this study. RESULTS Parapharyngeal lymph node metastases were successfully resected through the transcervical approach in all the 97 patients. There were 32 treatment-naïve patients, while 65 patients had a history of treatment before parapharyngeal lymph node metastases. All 97 cases of parapharyngeal lymph node metastases were detected by enhanced CT scans. Lateral neck lymph nodes metastases were confirmed in 96 patients. Unexpected postoperative neurological side effects were reported in 11 (11%) patients, including dysphagia in 5 (5%) patients, Horner's syndrome in 2 (2%) patients, glossal deviation in 3 (3%) patients, and asymmetrical mouth in 1 (1%) patient. During the follow-up period, 6 of the 97 patients exhibited parapharyngeal lymph node recurrence (recurrence rate 6.2%). The incidence of distant metastases was 44.3% (43 out of 97). The 5- and 10-year disease-specific survival was 93.4% and 88.9%, respectively. CONCLUSION Parapharyngeal lymph node metastases should be considered in patients with widespread cervical lymph node metastases. Enhanced CT scan is one of the best methods for diagnosing such metastases. Surgical resection through the transcervical approach is an effective and safe option for patients with parapharyngeal lymph node metastases from thyroid carcinoma. Moreover, parapharyngeal lymph node metastasis is associated with distant metastases that may lead to poor prognosis.
Collapse
Affiliation(s)
- Ye Zhang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. https://twitter.com/yezhang1220
| | - Kai Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyuan Xu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Sun
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Xu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaolei Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
74
|
Cost-Effectiveness of Follow-up Ultrasound for Incidental Thyroid Nodules on CT. AJR Am J Roentgenol 2021; 218:615-622. [PMID: 34668384 DOI: 10.2214/ajr.21.26786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Thyroid nodules are common incidental findings on CT. Existing professional society recommendations, based primarily on expert opinion, advise follow-up ultrasound for nodules above size cut-offs in patients of all ages. Purpose: To evaluate the cost-effectiveness of current recommendations as well as of other age- and size-based follow-up strategies for thyroid nodules incidentally detected on CT, using a simulation model. Methods: By using a simulation model with 1,000,000 adult patients with nodules measuring ≤40 mm and having no suspicious features, we evaluated size cut-offs from 5 to 25 mm under an age maximum from 25 to 65 years, as well as follow-up versus no follow-up above the age maximum. For each strategy, patient survival was determined by disease-specific and baseline mortality rates, as well as surgical mortality. Costs and quality-adjusted life years (QALYs) were tabulated. A probabilistic sensitivity analysis was performed varying model parameters. Results: All cost-effective strategies recommended no follow-up for patients above the age cut-offs (which varied from 25 to 65 years). In the base case simulation, 8 strategies were cost-effective under a willingness-to-pay threshold of $100,000/QALY. Of these, the strategy yielding the highest QALYs was follow-up for patients <60 years old with nodules ≥10 mm and no follow-up for patients ≥60 years old, with an incremental cost-effectiveness ratio of $50,196/QALY (95% CI $39,233 - $67,479). In the probabilistic sensitivity analysis, if the 10-year disease-specific survival of untreated cancer was >94% of patients with treated cancer, then no follow-up for any nodules was optimal. Conclusion: Follow-up ultrasound for thyroid nodules incidentally detected on CT is likely not cost-effective in older patients. Follow-up for most thyroid nodules in younger patients may be cost-effective. Clinical Impact: Future societal recommendations may account for the limited benefit of obtaining follow-up for incidental thyroid nodules on CT in older patients.
Collapse
|
75
|
Lim LS, Lin WC, Chiang PL, Huang SC, Chen YS, Chang YH, Chen WC, Chi SY, Chou CK. One year follow-up of US-Guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma: The first experience in Taiwan. J Formos Med Assoc 2021; 121:1406-1413. [PMID: 34657768 DOI: 10.1016/j.jfma.2021.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/23/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The incidence of papillary thyroid microcarcinoma (PTMC) has increased rapidly in recent decades, with a favorable overall prognosis. We aimed to evaluate the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for treating low-risk PTMC in Taiwan. METHODS This prospective study included patients with PTMC who were ineligible or refused surgery and underwent US-guided RFA between October 2018 and June 2020. US and computed tomography (CT) were performed before RFA to assess tumor lesions and exclude cervical lymph node metastasis. Sequential US follow-up following RFA was performed after 1, 3, 6, and 12 months, and yearly thereafter. Volume reduction ratio (VRR) and complete disappearance rate of tumor at one year were evaluated. RESULTS 13 PTMCs in 12 patients were enrolled with a mean follow-up of 16.2 ± 8.1 months (range, 1-24 months). The median largest tumor diameter and tumor volume before RFA were 0.76 cm and 0.15 ml (range, 0.02-0.37 ml). The median (interquartile range, IQR) volume and VRR at 12 months post-RFA were 0 (0, 0.03) ml (p = 0.033) and 100% (84.26%, 100%) (p = 0.008). Eight tumors (61.54%) were completely disappeared at 12 months post-RFA and no tumor recurrence, lymph nodes, or distant metastasis were noted. All tumors were successfully treated without complications. CONCLUSION Minimally invasive US-guided RFA is an effective and safe alternative for low-risk PTMC, resulting a satisfied VRR.
Collapse
Affiliation(s)
- Lay San Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun Chen Huang
- Departments of Pathology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Sheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Chieh Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Kai Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| |
Collapse
|
76
|
Sorrenti S, Dolcetti V, Fresilli D, Del Gaudio G, Pacini P, Huang P, Camponovo C, Leoncini A, D’Andrea V, Pironi D, Frattaroli F, Trimboli P, Radzina M, Cantisani V. The Role of CEUS in the Evaluation of Thyroid Cancer: From Diagnosis to Local Staging. J Clin Med 2021; 10:jcm10194559. [PMID: 34640574 PMCID: PMC8509399 DOI: 10.3390/jcm10194559] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/25/2022] Open
Abstract
Ultrasound often represents the first diagnostic step for thyroid nodule evaluation in clinical practice, but baseline US alone is not always effective enough to achieve thyroid nodule characterization. In the last decades new ultrasound techniques, such as CEUS, have been introduced to evaluate thyroid parenchyma as recommended by EFSUMB guidelines, for use in clinical research field, although its role is not yet clear. Several papers show the potential utility of CEUS in the differential diagnosis of benign and malignant thyroid nodules and in the analysis of lymph node involvement in neoplastic pathology. Therefore, we carried out an evaluation of the literature concerning the role of CEUS in three specific areas: the characterization of the thyroid nodule, the evaluation of minimally invasive treatment and loco-regional staging of the lymph node in proven thyroid cancer. According to evidence reported, CEUS can also play an operative role in nodular thyroid pathology as it is able to guide ablation procedures on thyroid nodule and metastatic lymph nodes, to assess the radicality of surgery, to evaluate disease relapse at the level of the margins of ablated regions and to monitor the clinical evolution of necrotic areas in immediate post-treatment setting.
Collapse
Affiliation(s)
- Salvatore Sorrenti
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Vincenzo Dolcetti
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Daniele Fresilli
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Giovanni Del Gaudio
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Patrizia Pacini
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Pintong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou 310009, China;
- Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Chiara Camponovo
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (C.C.); (P.T.)
| | - Andrea Leoncini
- Servizio di Radiologia e Radiologia Interventistica, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
| | - Vito D’Andrea
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Daniele Pironi
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Fabrizio Frattaroli
- Department of Surgery “P. Stefanini”, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (C.C.); (P.T.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia;
- Medical Faculty, University of Latvia; Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1007 Riga, Latvia
| | - Vito Cantisani
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
- Correspondence:
| |
Collapse
|
77
|
Sanabria A, Pinillos P, Lira RB, Shah JP, Tufano RP, Zafereo ME, Nixon IJ, Randolph GW, Simo R, Vander Poorten V, Rinaldo A, Medina JE, Khafif A, Angelos P, Mäkitie AA, Shaha AR, Rodrigo JP, Hartl DM, Kowalski LP, Ferlito A. Current therapeutic options for low-risk papillary thyroid carcinoma: A scoping evidence review. Head Neck 2021; 44:226-237. [PMID: 34590380 DOI: 10.1002/hed.26883] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 01/04/2023] Open
Abstract
Most cases of thyroid carcinoma are classified as low risk. These lesions have been treated with open surgery, remote access thyroidectomy, active surveillance, and percutaneous ablation. However, there is lack of consensus and clear indications for a specific treatment selection. The objective of this study is to review the literature regarding the indications for management selection for low-risk carcinomas. Systematic review exploring inclusion and exclusion criteria used to select patients with low-risk carcinomas for treatment approaches. The search found 69 studies. The inclusion criteria most reported were nodule diameter and histopathological confirmation of the tumor type. The most common exclusions were lymph node metastasis and extra-thyroidal extension. There was significant heterogeneity among inclusion and exclusion criteria according to the analyzed therapeutic approach. Alternative therapeutic approaches in low-risk carcinomas can be cautiously considered. Open thyroidectomy remains the standard treatment against which all other approaches must be compared.
Collapse
Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/IPS Universitaria/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello/Clínica Las Vegas-grupo Quirónsalud, Medellín, Colombia
| | - Pilar Pinillos
- Department of Surgery, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia-Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Renan B Lira
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
| | - Ralph P Tufano
- Director of the FPG Thyroid and Parathyroid Center, Division of Head and Neck Endocrine Surgery, The Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Gregory W Randolph
- Thyroid/Parathyroid Endocrine Surgical Division, Thyroid Surgical Oncology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ricard Simo
- Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, King's College London, London, UK
| | - Vincent Vander Poorten
- Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | | | - Jesus E Medina
- Department of Otolaryngology and Head and Neck Surgery, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Avi Khafif
- Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
78
|
Kim HJ, Cho SJ, Baek JH. Comparison of Thermal Ablation and Surgery for Low-Risk Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis. Korean J Radiol 2021; 22:1730-1741. [PMID: 34585542 PMCID: PMC8484147 DOI: 10.3348/kjr.2020.1308] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 01/26/2023] Open
Abstract
Objective Although thermal ablation is effective in treating low-risk papillary thyroid microcarcinomas (PTMCs), comparison of treatment outcomes between thermal ablation and surgery has not yet been systematically evaluated. This study aimed to compare the efficacy and safety of thermal ablation and surgery for the treatment of low-risk PTMCs. Materials and Methods Ovid-MEDLINE and EMBASE databases were searched for studies reporting comparisons of treatment results between thermal ablation and surgery for patients with low-risk PTMC published up to April 6, 2020. The analysis evaluated the efficacy (local tumor recurrence, occurrence of new tumor, metastasis, and rescue surgery) and safety (complication rate) of thermal ablation and surgery. Results This systematic review included four studies with a total of 339 PTMCs in 339 patients who underwent thermal ablation and 320 PTMCs in 314 patients who underwent surgery. There was no local tumor recurrence or distant metastasis in either group. There was no significant difference in the pooled proportion of lymph node metastasis (2.6% with thermal ablation vs. 3.3% with surgery, p = 0.65), occurrence of new tumors (1.4% with thermal ablation vs. 1.3% with surgery, p = 0.85), or rescue surgery (2.6% with thermal ablation vs. 1.6% with surgery, p = 0.62). However, the pooled complication rate was significantly higher in the surgery group than in the ablation group (3.3% with thermal ablation vs. 7.8% with surgery, p = 0.03). Conclusion Both thermal ablation and surgery are effective and safe options for the management of low-risk PTMCs, with thermal ablation achieving a lower complication rate. Therefore, thermal ablation may be considered as an alternative treatment option for low-risk PTMC in patients who refuse surgery and active surveillance or are ineligible for surgery.
Collapse
Affiliation(s)
- Hyun Jin Kim
- Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| |
Collapse
|
79
|
Zhu Y, Che Y, Gao S, Ren S, Tong M, Wang L, Yang F. Long-term follow-up results of PTMC treated by ultrasound-guided radiofrequency ablation: a retrospective study. Int J Hyperthermia 2021; 38:1225-1232. [PMID: 34402363 DOI: 10.1080/02656736.2021.1963850] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To confirm the long-term efficacy and safety of radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC). METHODS We retrospectively reviewed data of 102 primary papillary thyroid carcinoma patients (82 women, 20 men; mean age: 43 [19] years) treated with radiofrequency ablation and thyroid-stimulating hormone (TSH) suppression therapy before December 2018. All patients were at high surgical risk or refused surgery. They were followed up at 1, 3, 6, 9, and 12 months and every 6-12 months thereafter using ultrasound and contrast-enhanced ultrasound. The volume and volume reduction ratio was calculated. Recurrence and lymph node or distant metastasis were evaluated. RESULTS The mean initial tumor diameter was 0.50 (0.29) cm; the mean initial volume was 0.06 (0.09) mL. At 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after RFA, complete resorption rates were 0, 0, 9.8 (10/102), 33.3 (34/102), 91.2 (93/102), 96.1 (98/102), 99 (101/102), 100, and 100%, respectively. Two patients had developed ipsilateral neck lymph node metastasis in regions IV and VI at 30- and 18-month follow-ups, respectively. After RFA, 3/102 patients (2.9%) developed hoarseness-the main side effect. No life-threatening or delayed complications occurred. The TSH value in the initial period was 0.06 (0.02) µIU/mL; the rate of reaching the TSH target was 85.7%. The TSH value at follow-up was 1.47 (0.91) µIU/mL; the compliance rate was 99.3%. CONCLUSIONS Ultrasound-guided RFA for PTMC is highly effective and safe. RFA can serve as a minimally invasive treatment for PTMC patients who refuse surgery or active surveillance.
Collapse
Affiliation(s)
- Yalin Zhu
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Che
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuhang Gao
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuangsong Ren
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mengying Tong
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lina Wang
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fang Yang
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
80
|
Yan L, Zhang M, Song Q, Xie F, Luo Y. Clinical outcomes of radiofrequency ablation for multifocal papillary thyroid microcarcinoma versus unifocal papillary thyroid microcarcinoma: a propensity-matched cohort study. Eur Radiol 2021; 32:1216-1226. [PMID: 34357450 DOI: 10.1007/s00330-021-08133-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate and compare the clinical outcomes of radiofrequency ablation (RFA) for multifocal papillary thyroid microcarcinoma (PTMC) versus unifocal PTMC in a large cohort. METHODS Patients with low-risk PTMC (n = 487) who underwent RFA were included in this retrospective study and divided into the unifocal group (U group) (n = 432) and the multifocal group (M group) (n = 55) according to the number of lesions. After 1:1 propensity score matching (PSM), volume, volume reduction ratio (VRR), the development of local tumor progression including lymph node metastasis (LNM), recurrent PTMC and persistent lesions, and recurrence-free survival (RFS) rate were evaluated and compared between the two groups. The different impacts of multifocality on recurrence after RFA for PTMC were investigated by Cox analysis. RESULTS During a mean follow-up time of 49.25 ± 12.98 months, the overall VRR was 99.40 ± 4.43% and the overall incidence of local tumor progression was 3.70% (18/487). No complications occurred after RFA. After PSM, no significant differences were found in volume (0.11 ± 0.69 mm3 vs 0 mm3, p = 0.441), VRR (99.87 ± 0.78% vs 100%, p = 0.441), complete disappearance rate (95.61% vs 89.09%, p = 0.201), incidence of local tumor progression (5.45% vs 5.45%, p = 1.000), LNM (1.82% vs 0%, p = 0.317), recurrent PTMC (1.82% vs 5.45%, p = 0.611), persistent lesions (1.82% vs 0%, p = 0.317), and RFS rate (96.36% vs 94.55%, p = 0.632) between the M group and U group. The association between multifocality and local tumor recurrence also remained nonsignificant (p = 0.619). No distant metastasis or delayed surgery occurred. CONCLUSIONS The impact of multifocality on the prognosis after RFA for low-risk PTMC was little. RFA might be a promising treatment for both unifocal and multifocal PTMC in properly selected patients after sufficient preoperative evaluation. KEY POINTS • No significant differences are found in the local tumor progression between the unifocal PTMC and multifocal PTMC. • Multifocality is not associated with higher recurrence after RFA for low-risk PTMC. • RFA is a promising alternative for both unifocal and multifocal PTMC.
Collapse
Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Qing Song
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Fang Xie
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China.
| |
Collapse
|
81
|
Al-Mohammed HI, Sulieman A, Mayhoub FH, Salah H, Lagarde C, Alkhorayef M, Aldhebaib A, Kappas C, Bradley DA. Occupational exposure and radiobiological risk from thyroid radioiodine therapy in Saudi Arabia. Sci Rep 2021; 11:14557. [PMID: 34267237 PMCID: PMC8282852 DOI: 10.1038/s41598-021-93342-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/17/2021] [Indexed: 01/05/2023] Open
Abstract
Worldwide, thyroid cancer accounts for some 10% of total cancer incidence, most markedly for females. Thyroid cancer radiotherapy, typically using 131I (T1/2 8.02 days; β- max energy 606 keV, branching ratio 89.9%), is widely adopted as an adjunct to surgery or to treat inoperable cancer and hyperthyroidism. With staff potentially receiving significant doses during source preparation and administration, radiation protection and safety assessment are required in ensuring practice complies with international guidelines. The present study, concerning a total of 206 patient radioiodine therapies carried out at King Faisal Specialist Hospital and Research Center over a 6-month period, seeks to evaluate patient and occupational exposures during hospitalization, measuring ambient doses and estimating radiation risk. Using calibrated survey meters, patient exposure dose-rate estimates were obtained at a distance of 30-, 100- and 300 cm from the neck region of each patient. Occupational and ambient doses were measured using calibrated thermoluminescent dosimeters. The mean and range of administered activity (AA, in MBq) for the thyroid cancer and hyperthyroidism treatment groups were 4244 ± 2021 (1669-8066), 1507.9 ± 324.1 (977.9-1836.9), respectively. The mean annual occupational doses were 1.2 mSv, that for ambient doses outside of the isolation room corridors were found to be 0.2 mSv, while ambient doses at the nursing station were below the lower limit of detection. Exposures to staff from patients being treated for thyroid cancer were less compared to hyperthyroidism patients. With a well-defined protocol, also complying with international safety requirements, occupational exposures were found to be relatively high, greater than most reported in previous studies.
Collapse
Affiliation(s)
- H I Al-Mohammed
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - A Sulieman
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, P.O. Box 422, Alkharj, 11942, Saudi Arabia.
| | - Fareed H Mayhoub
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hassan Salah
- Nuclear Medicine Department, INAYA Medical Collage, Riyadh, 13541, Saudi Arabia
- College of Medical Radiologic Science, Sudan University of Science and Technology, P.O. Box 1908, Khartoum, 11111, Sudan
| | - Celestino Lagarde
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - M Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
- Department of Physics, Centre for Nuclear and Radiation Physics, University of Surrey, Guildford, GU2 7XH, Surrey, UK
| | - Ali Aldhebaib
- Radiological Sciences Program, College of Applied Medical Sciences (COMAS), King Saud Bin Abdulaziz University for Health Sciences (KSAU-US), King Abdul Aziz Medical City (KAMC), King Abdullah International Medical Research Centre (KAIMRC), National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia
| | - C Kappas
- Department of Medical Physics, Medical School, University of Thessaly, 41110, Larissa, Greece
| | - D A Bradley
- Department of Physics, Centre for Nuclear and Radiation Physics, University of Surrey, Guildford, GU2 7XH, Surrey, UK
- Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, Jalan Universiti, 47500, Bandar Sunway, Selangor, Malaysia
| |
Collapse
|
82
|
Xiao J, Zhang Y, Zhang M, Xie F, Yan L, Luo Y, Tang J. Ultrasonography-guided radiofrequency ablation for the treatment of T2N0M0 papillary thyroid carcinoma: a preliminary study. Int J Hyperthermia 2021; 38:402-408. [PMID: 33719861 DOI: 10.1080/02656736.2021.1895332] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of ultrasonography (US)-guided radiofrequency ablation (RFA) for treating T2N0M0 papillary thyroid cancer (PTC). METHODS This retrospective study was approved by the ethics committee of Chinese PLA General Hospital (S2019-211-01). Twelve patients with T2N0M0 PTC (five men and seven women with a mean age of 41.0 ± 9.2 years (range, 21-61 years)), who were not eligible for or refused surgery, were included in our study. RFA was performed with the moving-shot technique, and the ablation area exceeded the tumor edge by at least 3 mm. US was performed before RFA, immediately, 1, 3 , 6 and 12 months after RFA, and every 6-12 months thereafter. RESULTS All tumors were ablated as planned. The mean follow-up duration was 24.1 ± 6.9 months (range, 13-33 months). The tumor volume decreased significantly from 4.4 ± 2.8 ml to 0.3 ± 0.5 ml, and the volume reduction rate (VRR) was (93.7 ± 7.6)% at the final follow-up with two tumors (16.7%) disappearing. New or recurrent tumors were not found, and no local or distant metastasis were detected during follow-up. No life-threatening or delayed complications were observed. CONCLUSION RFA may be a potential alternative to surgery for the management of T2N0M0 PTC in select patients, especially for those who are ineligible for surgery.
Collapse
Affiliation(s)
- Jing Xiao
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fang Xie
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Jie Tang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| |
Collapse
|
83
|
He H, Song Q, Lan Y, Yan L, Xiao J, Zhang Y, Luo Y. Efficacy and safety of ultrasound-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma in patients aged 55 years or older: a retrospective study. Int J Hyperthermia 2021; 38:604-610. [PMID: 33853489 DOI: 10.1080/02656736.2021.1912416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of radiofrequency ablation for low-risk papillary thyroid microcarcinoma (PTMC) in patients aged 55 years or older. METHODS This retrospective study included 95 patients aged 55 years or older who underwent radiofrequency ablation (RFA) for PTMCs between June 2014 and January 2019. Incidence and duration of postoperative complications were recorded and evaluated. Tumor volume and volume reduction rate (VRR) changes were calculated. Patients were also closely monitored for tumor recurrence, regrowth, and lymph node metastasis. RESULTS All nodules were completely ablated. The mean initial volume of the ablated thyroid nodules was 107.27 ± 99.10 mm3, and the volume decreased significantly during the follow-up time. The VRR in 1st, 3rd, 6th, 12th, 18th, 24th and 36th month were -591.64 ± 623.65%, -170.89 ± 319.51%, 9.74 ± 128.43%, 77.99 ± 45.26%, 99.35 ± 3.61%, 99.45 ± 3.05% and 99.78 ± 1.54%, respectively. No patient had any life-threatening complications. One patient had lymph node metastasis and one had a recurrence; both underwent a second radiofrequency ablation treatment and achieved satisfactory treatment results. CONCLUSIONS Our study suggests that radiofrequency ablation is a safe and effective option for low-risk PTMC in patients aged 55 years or older who are at a high risk of general anesthesia and postoperative complications or those who refuse surgery.
Collapse
Affiliation(s)
- Hongying He
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yu Lan
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jing Xiao
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
84
|
Song Q, Gao H, Ren L, Tian X, Lan Y, Yan L, Luo Y. Radiofrequency ablation versus total thyroidectomy in patients with papillary thyroid microcarcinoma located in the isthmus: a retrospective cohort study. Int J Hyperthermia 2021; 38:708-714. [PMID: 33899651 DOI: 10.1080/02656736.2021.1916625] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This retrospective study aimed to examine the benefits and complications of radiofrequency ablation (RFA) in patients with papillary thyroid microcarcinoma (PTMC) in the isthmus. METHODS This retrospective study included patients with PTMC in the isthmus and treated at the Chinese People's Liberation Army hospital from 05/2014 to 05/2018. The patients were divided into the RFA and total thyroidectomy (TT) groups. The outcomes were operation-related complications, rate of recurrence, metastasis rate, and thyroid carcinoma-specific questionnaire of quality of life (THYCA-QOL). RESULTS Among 218 patients, 115 patients underwent RFA, and 103 underwent TT. The rates of disappearance of the ablation zone at 1, 3, 6, 12, and 18 months after RFA were 0.8% (1/115), 10.4% (12/115), 51.3% (59/115), 90.4% (104/115), and 100% (115/115), respectively. Surgical time, blood loss, hospital stays, and treatment costs were higher with TT than with RFA (all p < 0.001). The final THYCA-QOL score of the RFA group was significantly higher than in the TT group (p < 0.001). Minor pain at the operation site was seen in all patients in the RFA group. No distant metastasis was detected in all patients, but one patient in the RFA group had a recurrence after 6 months. The final THYCA-QOL score of the RFA group was significantly lower than in the TT group (p < 0.001). CONCLUSION These results suggest that RFA for PTMC in the isthmus had similar outcomes than TT. It will have to be confirmed in future studies.
Collapse
Affiliation(s)
- Qing Song
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China.,Department of Ultrasound, Seventh Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Hanjing Gao
- Department of Ultrasound, Second Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Ling Ren
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Xiaoqi Tian
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Yu Lan
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Lin Yan
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| |
Collapse
|
85
|
Jeong SY, Ha EJ, Baek JH, Kim TY, Lee YM, Lee JH, Lee J. Assessment of thyroid-specific quality of life in patients with benign symptomatic thyroid nodules treated with radiofrequency or ethanol ablation: a prospective multicenter study. Ultrasonography 2021; 41:204-211. [PMID: 34517695 PMCID: PMC8696143 DOI: 10.14366/usg.21003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose Radiofrequency ablation (RFA) and ethanol ablation (EA) are effective and safe for benign symptomatic thyroid nodules (BSTNs). However, relatively little is known about the effects of these procedures on patients’ quality of life (QoL). This prospective, multicenter study evaluated the effects of RFA and EA on changes in thyroid-specific QoL in patients with BSTNs and assessed the volume reduction and safety of these procedures. Methods Eighty-six consecutive patients with 86 BSTNs were prospectively included from two medical centers. RFA was performed for 55 BSTNs with solidity ≥50% and EA was performed for 31 BSTNs with solidity <50%. QoL was evaluated using an 11-scale, multiple-choice thyroid-specific QoL questionnaire. Nodule characteristics and QoL were evaluated at diagnosis and 1, 6, and 12 months after treatment. Overall QoL was rated from 0 (good) to 4 (poor). Results The mean longest size and volume of the index nodule were 4.2±1.5 cm and 21.6±22.1 mL, respectively. Patients received 1.1 treatments on average (range, 1 to 2). Significant post-treatment volume reductions were noted; however, the EA group showed a higher volume reduction than the RFA group at 1 (78.7%-16.1% vs. 49.1%-15.8%), 6 (86.3%-21.7% vs. 73.0%-14.5%), and 12 (90.9%-14.9% vs. 80.3%-12.4%) months. The score for each scale of the QoL questionnaire improved significantly during follow-up (all P<0.001). Overall QoL improved significantly, from 1.7±0.9 at diagnosis to 0.6±0.7 at the 12-month follow-up (P<0.001). There were no major complications. Conclusion Both RFA and EA are safe and effective in reducing nodule volume and improving thyroid-specific QoL in patients with BSTNs.
Collapse
Affiliation(s)
- So Yeong Jeong
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu-Mi Lee
- Division of Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeonghun Lee
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
86
|
Shen K, Xue S, Xie Y, Wang H, Li J, Sun Y, Wang K, Xu G, Guo T, Fan B, Zhu L, Ren A. Comparison of thermal ablation and routine surgery for the treatment of papillary thyroid microcarcinoma: a systematic review and Meta-analysis. Int J Hyperthermia 2021; 37:913-924. [PMID: 32722973 DOI: 10.1080/02656736.2020.1777331] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Thermal ablation (TA), as an alternative to surgery, has shown some benefits in the treatment of papillary thyroid microcarcinoma (PTMC) patients, especially for those who are at high risk for surgery or refuse surgery. We performed a systematic review and meta-analysis to evaluate the efficiency, safety, and economy of TA, compared with those of routine surgery (RS), for the treatment of PTMC. METHODS PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases were retrieved from inception to 10 January 2020 to identify relevant original studies on comparison of TA and RS for treatment of PTMC. The recurrence rate, recurrence-free survival (RFS), complication rate, operation time, postoperative length of stay, and cost during the perioperative period were extracted as main indices. The pooled standardized mean difference (SMD) or odds ratio (OR) with 95% confidence intervals (CI) were calculated and analyzed. Chi-square test and I 2 statistic were applied to determine the heterogeneity among studies. The sensitivity analysis was applied to explore the origin of heterogeneity, and the publication bias was evaluated by Egger's test. RESULTS Seven retrospective studies with a total of 867 patients met the eligibility criteria and were included in the final meta-analysis. Our study demonstrated that TA showed significant reduction in complication with a pooled OR 0.24 (95% CI 0.13 to 0.43), postoperative length of stay with a pooled SMD -3.14 (95% CI -4.77 to -1.51) and cost during the perioperative period with a pooled SMD of -1.69 (95% CI -3.18 to -0.20). It also demonstrated that both TA and RS had similar pooled proportion of recurrence of OR 0.93 (95% CI 0.38 to 2.30) and recurrence-free survive (RFS). The sensitivity analysis showed that each included study had no significant effect on the results and the results were stable and reliable. The Egger's test demonstrated publication bias was acceptable. CONCLUSIONS TA may not be oncologically inferior to RS, and it is a relatively safe and economical alternative for the treatment of PTMC.
Collapse
Affiliation(s)
- Kangjie Shen
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Shengbai Xue
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Yi Xie
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Hongye Wang
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Jing Li
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yifan Sun
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Kexuan Wang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Guochao Xu
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Tao Guo
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Boqiang Fan
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingjun Zhu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Anjing Ren
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
87
|
Lan Y, Jin Z, Zhang Y, Song Q, Xiao J, Yan L, Zhu Y, Zhang M, Luo Y. Factors associated with health-related quality of life in papillary thyroid microcarcinoma patients undergoing radiofrequency ablation: a cross-sectional prevalence study. Int J Hyperthermia 2021; 37:1174-1181. [PMID: 33043742 DOI: 10.1080/02656736.2020.1812738] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To explore the association of demographic characteristics, clinical symptoms and the fear of the disease progression factors with the physical and mental summary components of the health-related of life (HRQoL) of the papillary thyroid microcarcinoma (PTMC) patients undergoing radiofrequency ablation (RFA). METHODS 123 PTMC survivors undergoing RFA were enrolled in this study from October 2019 to March 2020. Demographic, clinical symptoms and the fear of the disease progression data were collected. SF-36, THYCA-QoL and FoP-Q-SF were used to evaluate the HRQoL of patients, clinical symptoms and the fear of disease progression. A multivariate regression model was performed to evaluate the association between the independent variable and the HRQoL variable. RESULTS The average self-reported HRQoL score was 81.17 ± 15.48 for the PCS and 73.40 ± 18.03 for the MCS. The multivariate linear regression model shows that the factors related to a poorer PCS were dependent for the female patients, the symptoms of neuromuscular and the throat/mouth, the fear of disease progression; the psychological disorder, symptoms of throat/mouth, inability to concentrate were related to worse scores for the MCS. The condition that was most strongly related to a poorer HRQoL (in both PCS and MCS) was the fear of their physical health. CONCLUSIONS The factors related to significantly worse HRQoL scores across PCS and MCS for PTMC survivors include the female gender, the symptoms of neuromuscular and the throat/mouth, the psychological disorder, inability to concentrate, and the fear of their own physical health. Identification, management, and prevention of these factors are critical to improving the HRQoL of patients.
Collapse
Affiliation(s)
- Yu Lan
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Ultrasound, The People's Hospital of Liaoning Province, Shenyang, China
| | - Zhuang Jin
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Ultrasound, General Hospital of Northern Military Area, Shenyang, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jing Xiao
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yaqiong Zhu
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
88
|
Muhammad H, Santhanam P, Russell JO. Radiofrequency ablation and thyroid nodules: updated systematic review. Endocrine 2021; 72:619-632. [PMID: 33449296 DOI: 10.1007/s12020-020-02598-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE In the thyroid gland, radiofrequency ablation (RFA) is being applied to both benign nodules and cancers internationally, while interest is also growing in the West. Benign thyroid nodules (BTNs) may be candidates for intervention when symptoms develop. For differentiated thyroid cancers (DTC), surgery is currently the first-line treatment. However, for candidates with high surgical risk or those who refuse to undergo repeated surgery, newer techniques such as RFA are an option. Surgery is associated with complications including hypothyroidism, voice change, hypocalcemia, and a scar. RFA has been used in Asian and European institutions as an alternative to surgery, but is relatively new in North America. Although RFA is not associated with significant complications, few randomized control trials have assessed its efficacy. The studies to date suggest a low rate of severe complications and a small need for thyroid hormone replacement following RFA. Further large-scale studies focusing on a Western population are needed. The aim of this review is to evaluate the evidence with respect to the current studies and data about the safety and efficacy of radiofrequency ablation for the management of BTNs and DTC. METHODS We systematically searched the PubMed/MEDLINE, EMBASE, Clinical Queries, and Web of Science databases, for articles published up to April 30th, 2020. RESULTS Total of 75 studies that met the inclusion criteria were included in the review. Thirty-five studies focused on RFA use for solid nodules, 12 studies on predominantly cystic nodules, 10 for autonomously functioning thyroid nodules, and 18 studied were published on differentiated thyroid cancer. CONCLUSIONS RFA seems to be an effective and safe alternative to surgery in high-risk surgical patients with thyroid cancers and for selected BTNs. Additional trials with longer follow-up in North American patients are needed to validate its full role in the armamentarium of thyroid ologists.
Collapse
Affiliation(s)
- Haris Muhammad
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, 21204, USA
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| |
Collapse
|
89
|
Bernardi S, Palermo A, Grasso RF, Fabris B, Stacul F, Cesareo R. Current Status and Challenges of US-Guided Radiofrequency Ablation of Thyroid Nodules in the Long Term: A Systematic Review. Cancers (Basel) 2021; 13:2746. [PMID: 34205994 PMCID: PMC8199252 DOI: 10.3390/cancers13112746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/22/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND US-guided minimally-invasive techniques, such as radiofrequency ablation (RFA) have emerged as an alternative treatment for benign and malignant thyroid nodules. This systematic review aims to provide an overview on the long-term outcomes of US-guided RFA in patients with benign and malignant thyroid nodules. METHODS We systematically searched PubMed/MEDLINE, EMBASE, and Scopus to identify articles reporting the outcomes of thyroid RFA after a follow-up of at least 3 years. RESULTS A total of 20 studies met the inclusion criteria and were included in the review. In patients with benign thyroid nodules, RFA significantly reduced nodule volume and this was generally maintained for the following 5 years. However, a small but not negligible proportion of nodules regrew and some of them required further treatments over time. In patients with malignant nodules, RFA has been used not only to treat differentiated thyroid cancer (DTC) neck recurrences, but also to treat papillary thyroid microcarcinoma (PTMC). In most patients with PTMC, RFA led to complete disappearance of the tumor. When it was compared to surgery, RFA was not inferior in terms of oncologic efficacy but it had a lower complication rate. However, RFA did not allow for final pathology, disease staging and accurate risk stratification. CONCLUSIONS US-guided RFA significantly reduces benign thyroid nodules and destroys most PTMC, and this is generally maintained for at least 5 years after the initial treatment. Further studies addressing the risk of regrowths in patients with benign thyroid nodules, as well as the risk of recurrence in patients with PTMC are needed.
Collapse
Affiliation(s)
- Stella Bernardi
- Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy;
- U.C.O. Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, 34149 Trieste, Italy
| | - Andrea Palermo
- Unità di Endocrinologia e Diabete, Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
| | - Rosario Francesco Grasso
- U.O.S. Radiologia Interventistica, Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
| | - Bruno Fabris
- Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy;
- U.C.O. Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, 34149 Trieste, Italy
| | - Fulvio Stacul
- S.C. Radiologia, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Maggiore Hospital, 34125 Trieste, Italy;
| | - Roberto Cesareo
- U.O.S. Malattie Metaboliche, Ospedale Santa Maria Goretti, 04100 Latina, Italy;
| |
Collapse
|
90
|
Mauri G, Hegedüs L, Bandula S, Cazzato RL, Czarniecka A, Dudeck O, Fugazzola L, Netea-Maier R, Russ G, Wallin G, Papini E. European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical Practice Guideline for the Use of Minimally Invasive Treatments in Malignant Thyroid Lesions. Eur Thyroid J 2021; 10:185-197. [PMID: 34178704 PMCID: PMC8215982 DOI: 10.1159/000516469] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/10/2021] [Indexed: 12/15/2022] Open
Abstract
The growing detection of papillary thyroid microcarcinomas (PTMCs) is paralleled by an increase in surgical procedures. Due to the frequent indolent nature, cost, and risk of surgery, active surveillance (AS) and ultrasound-guided minimally invasive treatments (MITs) are in suitable cases of incidental PTMC proposed as alternatives to thyroidectomy. Surgery and radioiodine are the established treatments for relapsing cervical differentiated thyroid carcinoma (DTC) metastases. But radioiodine refractoriness, risk of surgical complications, adverse influence on quality of life, or declining repeat surgery have led to AS and MIT being considered as alternatives for slow-growing DTC nodal metastases. Also, for distant radioiodine-refractory metastases not amenable to surgery, MIT is proposed as part of a multimodality therapeutic approach. The European Thyroid Association and the Cardiovascular and Interventional Radiological Society of Europe commissioned these guidelines for the appropriate use of MIT. Based on a systematic PubMed search, an evidence-based approach was applied, and both knowledge and practical experience of the panelists were incorporated to develop the manuscript and the specific recommendations. We recommend that when weighing between surgery, radioiodine, AS, or MIT for DTC, a multidisciplinary team including members with expertise in interventional radiology assess the demographic, clinical, histological, and imaging characteristics for appropriate selection of patients eligible for MIT. Consider TA in low-risk PTMC patients who are at surgical risk, have short life expectancy, relevant comorbidities, or are unwilling to undergo surgery or AS. As laser ablation, radiofrequency ablation, and microwave ablation are similarly safe and effective thermal ablation (TA) techniques, the choice should be based on the specific competences and resources of the centers. Use of ethanol ablation and high-intensity focused ultrasound is not recommended for PTMC treatment. Consider MIT as an alternative to surgical neck dissection in patients with radioiodine refractory cervical recurrences who are at surgical risk or decline further surgery. Factors that favor MIT are previous neck dissection, presence of surgical complications, small size metastases, and <4 involved latero-cervical lymph nodes. Consider TA among treatment options in patients with unresectable oligometastatic or oligoprogressive distant metastases to achieve local tumor control or pain palliation. Consider TA, in combination with bone consolidation and external beam radiation therapy, as a treatment option for painful bone metastases not amenable to other established treatments.
Collapse
Affiliation(s)
- Giovanni Mauri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- *Laszlo Hegedüs,
| | - Steven Bandula
- Interventional Oncology Service, University College Hospital, London, United Kingdom
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Oliver Dudeck
- Center for Microtherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Laura Fugazzola
- Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Romana Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gilles Russ
- Thyroid and Endocrine Tumors Unit, La Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Göran Wallin
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Enrico Papini
- Department of Endocrinology & Metabolism, Ospedale Regina Apostolorum, Albano, Italy
| |
Collapse
|
91
|
Ntelis S, Linos D. Efficacy and safety of radiofrequency ablation in the treatment of low-risk papillary thyroid carcinoma: a review. Hormones (Athens) 2021; 20:269-277. [PMID: 33822327 DOI: 10.1007/s42000-021-00283-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/16/2021] [Indexed: 12/23/2022]
Abstract
Ultrasound-guided radiofrequency ablation (RFA) has recently been used for the treatment of thyroid carcinomas. In this study, we aimed to evaluate the efficacy and safety of RFA for treating low-risk papillary thyroid carcinomas (PTCs). We searched the MEDLINE and the SCOPUS databases up to December 29, 2020, for studies assessing the efficacy and safety of RFA in the management of low-risk PTCs. Data on volume reduction ratio (VRR), complete disappearance, carcinoma recurrence, and complication frequency were collected. Thirteen studies with a total of 1389 patients and 1422 tumors were included in the synthesis of this study. Mean VRR varied between 47.8 and 100%, with most studies reporting a ratio of 98.5-100%. The ratio of complete disappearance ranged between 33.7 and 100%, although studies with a prolonged follow-up period reported a frequency of 56-100%. The tumor progression/recurrence frequency was 0-4.5%. Complications occurred in 45 patients (3.2%). Mild-moderate pain and cervical discomfort were the most common complications and no life-threatening complications were reported. Based on these data, we suggest that ultrasound-guided RFA can serve as an efficacious and safe alternative for the treatment of low-risk PTC in patients who are unable or unwilling to receive surgical therapy.
Collapse
Affiliation(s)
- Spyridon Ntelis
- Institute of Preventive Medicine, Environmental and Occupational Health Prolepsis, Maroussi, Greece
| | - Dimitrios Linos
- Department of Surgery, Hygeia Hospital, Maroussi, Greece.
- National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
92
|
Cao XJ, Wang SR, Che Y, Liu J, Cong ZB, He JF, Wang HL, Liu G, Guo JQ, Hao Y, Wang ZH, Zhou Y, Jian M, Shi LL, Qi L, Zhu YL, Wang X, Yan GZ, Shataer A, Liu XF, Wei Y, Zhao ZL, Peng LL, Li Y, Yu MA. Efficacy and Safety of Thermal Ablation for Treatment of Solitary T1N0M0 Papillary Thyroid Carcinoma: A Multicenter Retrospective Study. Radiology 2021; 300:209-216. [PMID: 33904775 DOI: 10.1148/radiol.2021202735] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Microwave ablation (MWA) and radiofrequency ablation (RFA) have recently attracted interest as minimally invasive treatment modalities for papillary thyroid carcinoma (PTC). However, the ablation outcomes of T1N0M0 PTC are not well characterized. Purpose To evaluate the efficacy and safety of thermal ablation (MWA or RFA) of solitary T1N0M0 PTC in patients who were ineligible for (due to presence of comorbid cardiovascular disease, renal failure, other malignancy, etc) or who refused surgery. Materials and Methods This was a retrospective multicenter study of 847 patients (660 women) who underwent thermal ablation for PTC (673 T1a, 174 T1b) between March 2015 and March 2020; of these patients, 645 underwent MWA and 202 underwent RFA. The mean age of patients was 46 years ± 11 (standard deviation) (age range, 18-81 years); the mean follow-up time was 22 months ± 13 (range, 6-60 months). Changes in tumor size and volume and the rates of technical success, tumor disappearance, disease progression, and complications were assessed. Results The technical success rate was 100%. Relative to preablation measurements, the maximum diameter and volume of the ablation zone increased during the 1st month after ablation (P < .001), whereas there was no difference by the 3rd month; subsequently, the tumors showed reduction in size at 6, 9, and 12 months (all P < .001). Complete disappearance of tumors occurred in 68% of patients (577 of 847; 69% [466 of 673] in the T1a group vs 64% [111 of 174] in the T1b group; P < .001). The postablation disease progression rate was 1.1% (nine of 847 patients; 0.9% [six of 673 patients] in the T1a group vs 1.7% [three of 174 patients] in the T1b group; P = .54). The overall complication rate was 3.4% (29 of 847 patients; 2.7% [18 of 673 patients] in the T1a group vs 6.3% [11 of 174 patients] in the T1b group; P = .02). Conclusion This multicenter study provided evidence that thermal ablation is an effective and safe treatment option in selected -patients with solitary T1N0M0 papillary thyroid carcinoma. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Baek and Cho in this issue.
Collapse
Affiliation(s)
- Xiao-Jing Cao
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Shu-Rong Wang
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ying Che
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Juan Liu
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Zhi-Bin Cong
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Jun-Feng He
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Hong-Ling Wang
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Geng Liu
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Jian-Qin Guo
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ying Hao
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Zhong-Hua Wang
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ying Zhou
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Mei Jian
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Li-Li Shi
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Lu Qi
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ya-Lin Zhu
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Xue Wang
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Guo-Zhen Yan
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Aini Shataer
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Xiao-Fang Liu
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ying Wei
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Zhen-Long Zhao
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Li-Li Peng
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Yan Li
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ming-An Yu
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| |
Collapse
|
93
|
Xiao J, Zhang Y, Zhang M, Lan Y, Yan L, Luo Y, Tang J. Ultrasonography-guided radiofrequency ablation vs. surgery for the treatment of solitary T1bN0M0 papillary thyroid carcinoma: A comparative study. Clin Endocrinol (Oxf) 2021; 94:684-691. [PMID: 33128786 DOI: 10.1111/cen.14361] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/09/2020] [Accepted: 10/25/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Ultrasonography-guided radiofrequency ablation (RFA) has been used to treat low-risk small papillary thyroid carcinoma (PTC) and yielded promising results. However, little research has been conducted on the application of RFA for the management of T1bN0M0 PTC. Therefore, this study was to compare the midterm outcome of RFA with that of surgery for the treatment of clinical solitary T1bN0M0 PTC. DESIGN This is a retrospective study. PATIENTS In total, 182 patients with solitary T1bN0M0 PTC between April 2014 and May 2019 were treated with RFA or surgery (n = 91/group). MEASUREMENTS The primary end points were local tumour progression and complication rates. Local tumour progression were defined as: (a) new or persistent PTC confirmed by core needle biopsy; (b) cervical lymph node metastasis (LNM) confirmed by core needle biopsy or surgery; (c) ablation zone increased in the RFA group. RESULTS In the RFA group, local tumour progression was seen in four patients (4.4%, three persistent PTC and one LNM). In the surgery group, two patients (2.2%) developed LNM; no new or persistent PTC was confirmed. There was no significant difference between the two groups in local tumour progression. Permanent hypoparathyroidism was observed in four patients (4.4%) in the surgery group, while no major or minor complications were observed in the RFA group. CONCLUSIONS Ultrasonography-guided RFA is feasible and safe for treating solitary T1bN0M0 PTC, so it may be considered an alternative to surgery in select patients, especially those who are ineligible for or refusal of surgery.
Collapse
Affiliation(s)
- Jing Xiao
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Yu Lan
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
94
|
Cho SJ, Baek SM, Na DG, Lee KD, Shong YK, Baek JH. Five-year follow-up results of thermal ablation for low-risk papillary thyroid microcarcinomas: systematic review and meta-analysis. Eur Radiol 2021; 31:6446-6456. [PMID: 33713168 DOI: 10.1007/s00330-021-07808-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/18/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Confidence in long-term treatment results of thermal ablation for papillary thyroid microcarcinoma (PTMC) is required in comparison with active surveillance. The objective of this meta-analysis is to report 5-year follow-up results of thermal ablation for PTMC. METHODS Ovid MEDLINE and EMBASE databases were searched through May 30, 2020, for studies reporting outcomes in patients with PTMC treated with thermal ablation and followed up for at least 5 years. Data were extracted and methodological quality was assessed independently by two radiologists according to the PRISMA guidelines. RESULTS Three studies, involving 207 patients with 219 PTMCs, met the inclusion criteria through database searches. None of these patients experienced local tumor recurrence, lymph node metastasis, or distant metastasis or underwent delayed surgery during a mean pooled 67.8-month follow-up. Five new tumors appeared in the remaining thyroid gland of four patients, with four of these tumors successfully treated by repeat thermal ablation. The pooled mean major complication rate was 1.2%, with no patient experiencing life-threatening or delayed complications. CONCLUSIONS Thermal ablation is an excellent local tumor control method in patients with low-risk PTMC, with low major complication rates at 5 years. KEY POINTS • No local tumor recurrence, lymph node metastasis, or distant metastasis was noted by thermal ablation during follow-up of 5 years and none underwent delayed surgery. • The pooled mean major complication rate was 1.2%.
Collapse
Affiliation(s)
- Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, 502, Jwadongsunhwan-ro, Haeundae-gu, Busan, 48101, Republic of Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Republic of Korea
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Republic of Korea
| | - Kang Dae Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan, 49267, Republic of Korea
| | - Young Kee Shong
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| |
Collapse
|
95
|
Zhang C, Yin J, Hu C, Ye Q, Wang P, Huang P. Comparison of ultrasound guided percutaneous radiofrequency ablation and open thyroidectomy in the treatment of low-risk papillary thyroid microcarcinoma: A propensity score matching study. Clin Hemorheol Microcirc 2021; 80:73-81. [PMID: 33579830 DOI: 10.3233/ch-201087] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy, safety and costs of ultrasound guided percutaneous radiofrequency ablation (RFA) versus open thyroidectomy for treating low-risk papillary thyroid microcarcinoma (PTMC) by using propensity score matching (PSM). PATIENTS AND METHODS 157 patients who underwent RFA and 206 patients who underwent surgery for low-risk PTMC were included in the study. The patients were followed up at 1, 3, 6, 12 months after treatment, and every half year thereafter. A 1:1 PSM method was applied to balance the pretreatment data of the two groups. In the matched group (133 patients for each), the operative time, length of hospital stay, hospitalization expenses, cosmetic results, complications were assessed and compared between two groups. RESULTS At last follow-up, 39 tumors (29.3%) in the RFA group completely disappeared. Between the well-matched groups, no local recurrence, lymph node metastasis or distant metastases were detected in either group during the follow-up period. After matching, the operation time and hospitalization time in RFA group were shorter than those in surgery group (both P < 0.05). The average hospitalization expense of the patients in RFA group was cheaper than that in surgery group (P < 0.05). Moreover, the cosmetic score was found to be higher in RFA group than that observed in surgery group (P < 0.05). CONCLUSIONS RFA may be an effective and safe method for treating low-risk PTMC with a superior advantage of being low-cost and having a shorter operation time and hospital stay versus surgery.
Collapse
Affiliation(s)
- Chao Zhang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jing Yin
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chenlu Hu
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Department of Interventional Ultrasound, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qin Ye
- Department of Pathology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ping Wang
- Department of Thyroid Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| |
Collapse
|
96
|
The Clinical Application of Radiofrequency Ablation in the Treatment of Primary Low-risk Papillary Thyroid Microcarcinoma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00327-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
97
|
Cao XJ, Liu J, Zhu YL, Qi L, Liu G, Wang HL, Wang ZH, Zhou Y, He JF, Guo JQ, Shi LL, Jian M, Shataer A, Yan GZ, Zhao ZL, Wei Y, Peng LL, Li Y, Che Y, Wang SR, Yu MA. Efficacy and Safety of Thermal Ablation for Solitary T1bN0M0 Papillary Thyroid Carcinoma: A Multicenter Study. J Clin Endocrinol Metab 2021; 106:e573-e581. [PMID: 33107573 DOI: 10.1210/clinem/dgaa776] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ultrasound-guided thermal ablation plays an important role in the management of thyroid disease. The objective of this study was to evaluate the feasibility, efficacy, and safety of thermal ablation for patients with solitary T1bN0M0 papillary thyroid carcinoma (PTC) who are ineligible for or unwilling to undergo surgery. MATERIALS AND METHODS Data pertaining to 172 patients (38 males and 134 females) who received thermal ablation therapy at 12 hospitals between April 2015 and March 2020 were retrospectively analyzed. The mean duration of follow-up was 24.9 ± 14.1 months (range, 12-60). The technical feasibility, technical success, efficacy, and safety of treatment were analyzed. Postablation tumor size at various time points was compared with preablation measurement. RESULTS All patients selected for thermal ablation received enlarged ablation, according to contrast-enhanced ultrasound postablation. The maximum diameter and volume of ablation zone at 6, 12, 18, 24, 36, and 48 months postablation were significantly smaller than those recorded preablation (P < 0.05 for all). At the most recent follow-up, 106 (61.6%) tumors had completely disappeared. The rate of lymph node metastasis was 0.6% (1/172) and the incidence of new tumors was 1.2% (2/172). The overall complication rate was 5.2% (9/172) (major complications: 4.6% [8/172]; minor complications: 0.6% [1/172]). All major complications were relieved within 4 months postablation. CONCLUSION Thermal ablation may be a feasible, effective, and safe treatment option for patients with solitary T1bN0M0 PTC who are ineligible for or unwilling to undergo surgery. It may provide a novel treatment option for selected patients.
Collapse
Affiliation(s)
- Xiao-Jing Cao
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Juan Liu
- Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China
| | - Ya-Lin Zhu
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lu Qi
- Department of Medical Ultrasound, Yantai Affliated Hospital of Binzhou Medical University, Yantai, China
| | - Geng Liu
- Department of Ultrasound, Wuhai People's Hospital, Wuhai, China
| | - Hong-Ling Wang
- Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Zhong-Hua Wang
- Special Inspection Section, Wendeng District People's Hospital, Weihai, China
| | - Ying Zhou
- First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Jun-Feng He
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China
| | - Jian-Qin Guo
- Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China
| | - Li-Li Shi
- Department of Ultrasound, Laixi Municipal Hospital, Laixi, China
| | - Mei Jian
- Department of Ultrasound, Bayannur Hospital, Bayannur, China
| | - Aini Shataer
- Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Guo-Zhen Yan
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China
| | - Zhen-Long Zhao
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shu-Rong Wang
- Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China
- Department of Medical Ultrasound, Yantai Affliated Hospital of Binzhou Medical University, Yantai, China
| | - Ming-An Yu
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
98
|
Hua Y, Yang JW, He L, Xu H, Huo HZ, Zhu CF. Residual tumor and central lymph node metastasis after thermal ablation of papillary thyroid carcinoma: A case report and review of literature. World J Clin Cases 2021; 9:252-261. [PMID: 33511193 PMCID: PMC7809668 DOI: 10.12998/wjcc.v9.i1.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/06/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Debate exists regarding the use of thermal ablation (TA) to treat papillary thyroid carcinoma (PTC). Some studies have recommended TA as a new, efficient and safe technology for PTC. In this article, we report one case of a residual tumor and central lymph node metastasis (CLNM) after TA for PTC.
CASE SUMMARY A 63-year-old female underwent bilateral ultrasound (US)-guided radiofrequency ablation for PTC. Three months later, she was diagnosed as thyroid cancer with suspected CLNM by US and contrast-enhanced computed tomography. The subsequent fine-needle aspiration (FNA) biopsies were negative. Due to her strong personal preference, she underwent total thyroidectomy and central lymph node dissection. Local tissue adhesion and a difficult dissection were noted during the operation. The pathology of the frozen sections during the operation was still negative. The final pathology results of paraffin-embedded sections revealed residual tumor cells at the edge of the PTC and CLNM.
CONCLUSION TA may lead to a residual tumor in patients with PTC. Follow-up using US and FNA biopsy may not be adequate to evaluate the residual tumor. TA should be carefully considered in PTC treatment.
Collapse
Affiliation(s)
- Yu Hua
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Jia-Wen Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Liu He
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Hua Xu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Hai-Zhong Huo
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Chen-Fang Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| |
Collapse
|
99
|
Current Practice of Percutaneous Ablation Technologies for Thyroid Nodules 2020. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00323-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
100
|
Huang H, Xu S, Wang X, Liu S, Liu J. Patient Age Is Significantly Related to Distant Metastasis of Papillary Thyroid Microcarcinoma. Front Endocrinol (Lausanne) 2021; 12:748238. [PMID: 35002953 PMCID: PMC8733652 DOI: 10.3389/fendo.2021.748238] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Distant metastasis in papillary thyroid microcarcinoma (PTMC) is rare but fatal, and its relationship with patient age remains unclear. The objective of this study was to examine the association between age at diagnosis and metachronous distant metastasis in PTMC. METHODS Consecutive patients who underwent thyroidectomy for PTC measuring 10 mm or less at a tertiary hospital from January 2000 to December 2016 were enrolled. Patients who had evidence of distant metastasis at diagnosis or underwent postoperative radioiodine (RAI) ablation were excluded. A Cox proportional hazards model with restricted cubic splines (RCS) was applied to examine the association between age at diagnosis and distant metastasis. RESULTS A total of 4,749 patients were evaluated. The median age was 44 years (range, 8-78 years), and 3,700 (78%) were female. After a median follow-up of 65 months, 21 distant metastases (20 lung, 1 liver) were recognized. A univariate Cox proportional model using a 5-knot RCS revealed a significant overall (p = 0.01) and a potential nonlinear association (p = 0.08) between distant metastasis and age at diagnosis. In multivariate analysis, age at diagnosis, extrathyroidal extension (ETE), and lymph node metastasis (pN+) were independent risk factors for distant metastasis. Compared with the middle-aged group (30-45 years old), younger and older patients had a higher risk of distant metastasis [HR, 95% CI, p-value, age ≤ 30, 4.54 (0.91-22.60), 0.06, age > 45, 6.36 (1.83-22.13), <0.01]. CONCLUSION Age at diagnosis is associated with metachronous distant metastasis of PTMC, and patients with younger or older age have a higher risk of distant metastasis than middle-aged patients.
Collapse
Affiliation(s)
| | | | | | | | - Jie Liu
- *Correspondence: Jie Liu, ; Shaoyan Liu,
| |
Collapse
|