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Guo MH, Dou JP, Zheng L, Liu FY, Yu J, Cheng ZG, Yu XL, Che Y, Wang SR, Cong ZB, Bai N, Liu C, Hao Y, Yu MA, Xu ZF, Han ZY, Liang P, Chen L. Ultrasound-guided microwave ablation versus surgery for solitary T1bN0M0 papillary thyroid carcinoma: a prospective multicenter study. Eur Radiol 2024; 34:569-578. [PMID: 37548692 DOI: 10.1007/s00330-023-09908-2] [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: 06/22/2022] [Revised: 03/24/2023] [Accepted: 05/02/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Microwave ablation (MWA) has emerged as a minimally invasive technology for papillary thyroid microcarcinoma (PTMC), but it has not been widely applied to treat T1bN0M0 PTC with high-level evidence. This study was designed to compare the real-world efficacy and safety of MWA or surgery for treating T1bN0M0 PTC. METHODS From December 2019 to April 2021, 123 continuous unifocal T1bN0M0 PTC patients without lymph node metastasis (LNM) or distant metastasis (DM) were included from 10 hospitals. Patients were allocated into the MWA or surgery group based on their willingness. The main outcomes were local tumour progression (LTP), new thyroid cancer, LNM, and DM. The secondary outcomes included changes in tumour size and volume, complications, and cosmetic results. Subgroup analyses were conducted to identify influencing factors. RESULTS Fifty-two patients chose MWA, and 71 patients chose surgery. Patients had similar demographic information and tumour characteristics in the two groups. The follow-up durations after MWA and surgery were 10.6 ± 4.2 and 10.4 ± 3.4 months, respectively. The LNM rate was 5.8% in the MWA group and 1.4% in the surgery group (p = 0.177). No LTP, new thyroid cancer, or distant metastasis (DM) occurred in either group. Five (9.6%) of the 52 patients in the MWA group and 8 (11.3%) of the 71 patients in the surgery group had complications (p = 0.27). Better cosmetic results were found in the MWA group (p < 0.01). CONCLUSION MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further. CLINICAL RELEVANCE STATEMENT MWA achieved comparable short-time treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC. KEY POINTS • MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further. • The complication rate in the surgery group was higher than that in the MWA group without a significant difference. • There was no statistically significant difference in the LNM rate between the MWA and surgery groups.
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Affiliation(s)
- Mo-Han Guo
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jian-Ping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - 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
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Zhi-Bin Cong
- Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Nan Bai
- Department of Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Cun Liu
- Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Ying Hao
- Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China
| | - Ming-An Yu
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhi-Feng Xu
- First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, 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.
| | - Lei Chen
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.
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Wang S, Yao N, Guo Z, Mao N, Wu H, Xu F, Li J. Efficacy of ultrasound-guided radiofrequency ablation of papillary thyroid microcarcinoma after one year. Asian J Surg 2024; 47:350-353. [PMID: 37704471 DOI: 10.1016/j.asjsur.2023.08.218] [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: 05/09/2023] [Revised: 07/15/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the feasibility and safety of percutaneous radiofrequency ablation guided by ultrasound for treating papillary thyroid microcarcinoma. METHOD At our institution, fifty people who had been treated for micropapillary thyroid cancer with ultrasound-guided radiofrequency ablation were chosen. Thyroid function was evaluated after one month, and the volume of the ablation region was assessed immediately, 3, 6, and 12 months after treatment. At the same time, the complications or adverse reactions after treatment were evaluated. RESULTS As time passed, the volume of the ablation area decreased gradually, showing a regression trend. There was a significant difference in the volume of the ablation area between adjacent groups (P < 0.05), and the tumor volume reduction ratio (VRR) of the ablation area was a statistically significant difference between adjacent groups (P < 0.05). There was no significant difference between the indexes related to thyroid function before and after treatment(P > 0.05). No local recurrence or distant metastasis was found during follow-up; The most common complication after the operation was a slight pain in the neck. A few patients had toothache and neck swelling symptoms, and the above symptoms subsided within 24 h after the operation. CONCLUSION Ultrasound-guided radiofrequency ablation is safe and effective for treating single-focus micropapillary thyroid carcinoma while retaining thyroid function, with few and minor complications, which can be used as an ideal surgical option.
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Affiliation(s)
- Shixiong Wang
- Department of Thyroid and Breast Surgery, Xian Daxing Hospital, Xian, 0710000, China
| | - Nan Yao
- Xi'an Railway Technician Institute, Xian, 0710000, China
| | - Zhenzhen Guo
- Department of Thyroid and Breast Surgery, Xian Daxing Hospital, Xian, 0710000, China
| | - Ning Mao
- Department of Thyroid and Breast Surgery, Xian Daxing Hospital, Xian, 0710000, China
| | - Hongtao Wu
- Department of Thyroid and Breast Surgery, Xian Daxing Hospital, Xian, 0710000, China
| | - Fan Xu
- Department of Thyroid and Breast Surgery, Xian Daxing Hospital, Xian, 0710000, China
| | - Jinmao Li
- Department of Thyroid and Breast Surgery, Xian Daxing Hospital, Xian, 0710000, China.
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Li X, Li Y, Yan L, Xiao J, Yang Z, Jing H, Zhang M, Luo Y. Sonographic Evolution and Pathologic Findings of Papillary Thyroid Cancer After Radiofrequency Ablation: A Five-Year Retrospective Cohort Study. Thyroid 2024; 34:54-63. [PMID: 37885207 DOI: 10.1089/thy.2023.0415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background: The criteria for determining technical efficacy of thermal ablation for papillary thyroid carcinoma (PTC) are not clearly defined. We analyzed the involution process of the ablation zone with clear pathologic results on core-needle biopsy (CNB) to clarify the relationship between sonographic changes and pathologic findings. Methods: This retrospective cohort study included 382 patients with unifocal T1N0M0 PTC who underwent radiofrequency ablation (RFA) between May 2014 and August 2021. Patients with a single ablation zone biopsy (recommended at 3 or 6 months for T1a and 6 or 12 months for T1b) and regular neck ultrasound (US)/contrast-enhanced ultrasound imaging follow-up at 1, 3, 6, and 12 months and every 6-12 months thereafter after RFA were included. Patients also underwent yearly chest computed tomography. CNB was performed in the target lesion ablation zone's central, peripheral, and surrounding thyroid parenchyma to detect the presence of tumor cells. If the thyrotropin (TSH) was >2 mU/L, levothyroxine was prescribed with the intention of keeping the TSH 0.5-2 mU/L. Technical efficacy was defined as tumor disappearance by imaging follow-up together with the pathologically confirmed absence of tumor cells in the ablation zone. Results: During the mean follow-up period of 67.8 ± 18.2 months (22-110 months), the overall incidence of persistent disease and the technical efficacy rate were 3.9% (15/382; 2.9% of T1a, and 12.2% of T1b) and 96.1%, respectively. Tumor size (p = 0.03) and subcapsular location (p = 0.04) were risk factors associated with persistent disease. The technical success rate was 100%. Of the 367 ablation zones with benign CNB results, 336 (91.6%) showed tumor disappearance on US and no re-emergence of imaging-visible tumors during follow-up. Male sex (p = 0.006), age <40 years (p = 0.003), T1a tumor (p < 0.01), and energy per milliliter (p < 0.03) were significantly associated with tumor disappearance. Conclusions: US-guided RFA is an effective treatment for small low-risk PTC. Tumor disappearance on US after RFA may suggest an excellent prognosis and confirm complete ablation of the macroscopic tumor, but this sonographic finding is generally late and requires histological confirmation.
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Affiliation(s)
- Xinyang Li
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Yingying Li
- 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
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhen Yang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Haoyu Jing
- 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
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
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Gao X, Yang Y, Wang Y, Huang Y. Efficacy and safety of ultrasound-guided radiofrequency, microwave and laser ablation for the treatment of T1N0M0 papillary thyroid carcinoma on a large scale: a systematic review and meta-analysis. Int J Hyperthermia 2023; 40:2244713. [PMID: 37604507 DOI: 10.1080/02656736.2023.2244713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND To analyze the efficacy and safety of radiofrequency ablation (RFA), microwave ablation (MWA) and laser ablation (LA) in T1N0M0 papillary thyroid carcinoma (PTC) patients by evaluating data on several outcomes on a large scale. MATERIALS AND METHODS Literature searches were conducted in PUBMED, EMBASE and the Cochrane Library for studies of thermal ablation (TA) for treating T1N0M0 PTC. Data on the volume reduction rate (VRR) at the 12-month follow-up and final follow-up, complete disappearance rate, local recurrence rate, lymph node metastasis rate, and complication rate of RFA, MWA and LA were evaluated separately. RFA effects were compared between T1aN0M0 and T1bN0M0 patients. RESULTS A total of 36 eligible studies were included. RFA presented superior efficacy than MWA in 12-month VRR. At the final follow-up, the difference was slight in subgroups, showing a significant reduction. The complete disappearance rate of LA (93.00%) was higher than that of RFA (81.00%) and MWA (71.00%). Additionally, the local recurrence rate pooled proportions of MWA and RFA were both 2.00%, lower than that of the LA group (3.00%). There was no event of distant metastasis. The lymph node metastasis rates were similar, as RFA (1.00%) had the lowest. For minor complication rates, the pooled proportions of RFA (3.00%) were smaller than those of LA (6.00%) and MWA (13.00%). T1aN0M0 lesions presented with better outcomes than T1bN0M0 lesions. CONCLUSION RFA, MWA and LA were reliable in curing PTC, and RFA presented advantages in most outcomes. T1aN0M0 patients may experience fewer side effects than T1bN0M0 patients.
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Affiliation(s)
- Xuemeng Gao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yang Yang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yitong Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Tong M, Wang L, Gai Z, Zhu Y, Che Y. Clinical outcomes of radiofrequency ablation for solitary T1aN0M0 versus T1bN0M0 papillary thyroid carcinoma: a propensity-matched cohort study. Int J Hyperthermia 2023; 40:2257908. [PMID: 37848402 DOI: 10.1080/02656736.2023.2257908] [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: 06/22/2023] [Accepted: 09/05/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To conduct a cohort study comparing the treatment outcomes of radiofrequency ablation (RFA) therapy for solitary T1aN0M0 (T1a) versus T1bN0M0 (T1b) papillary thyroid carcinoma (PTC). METHODS This retrospective analysis comprised 310 patients with low-risk PTC undergoing RFA classified into T1a (n = 272) and T1b (n = 38) groups according to the tumor size. A comparative analysis between the two groups was conducted for the volume reduction ratio (VRR), volume, local tumor progression (LTP), and recurrence-free survival (RFS) before and after 1:2 propensity score matching (PSM). Cox analysis was conducted to examine the influence of several variables, including T1b, on recurrence following RFA for PTC. RESULTS The total VRR was 99.99 ± 0.11% throughout the median follow-up duration of 26 months, and the overall incidence of LTP was 2.58% (8/310). No irrecoverable complications occurred after RFA. The variations between the T1a and T1b groups following PSM were insignificant in terms of volume (p = 0.574), VRR (p = 0.574), complete disappearance rate (p = 0.210), LTP incidence (p = 1.000), and RFS rate (p = 0.610). The correlation between T1b and LTP continued to be insignificant (p = 0.686). No distant metastasis or delayed surgery occurred. CONCLUSIONS The presence of T1b did not influence the patients' prognoses following RFA for T1N0M0 PTC. After appropriate patient selection and adequate preoperative assessment, RFA has the potential to serve as an effective therapy for individuals with T1a and T1b PTC.
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Affiliation(s)
- Mengying Tong
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Linchun Wang
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Ziru Gai
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Yalin Zhu
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
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Song B, Lin Z, Feng C, Zhao X, Teng W. Global research landscape and trends of papillary thyroid cancer therapy: a bibliometric analysis. Front Endocrinol (Lausanne) 2023; 14:1252389. [PMID: 37795362 PMCID: PMC10546338 DOI: 10.3389/fendo.2023.1252389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Background Papillary thyroid cancer (PTC) is the most common endocrine malignancy worldwide. The treatment of PTC has attracted extensive attention and discussion from the public and scholars. However, no article has systematically assessed the related literature. Therefore, we conducted a bibliometric and knowledge map analysis to reveal the dynamic scientific developments in the PTC therapy field. Methods We retrieved publications related to PTC therapy from the Web of Scientific Core Collection (WoSCC) on May 1, 2023. The bibliometric package in R software, VOSviewer and CiteSpace software were used to analyze countries/regions, institutions, journals, authors, references, and keywords. Then, we systematized and summarized the research landscape, global trends and hot topics of research. Results This bibliometric analysis spanned from 2012 to 2022 and involved 18,501 authors affiliated with 3,426 institutions across 87 countries/regions, resulting in the publication of 3,954 papers in 860 academic journals. Notably, the number of publications and citations related to PTC therapy research has exhibited a steady increase over the past decade. China and the United States have emerged as leading contributors in terms of publication count, with the United States also being the most cited country. Furthermore, among the top 10 institutions with the highest number of published papers, half were located in China. Among the journals, Thyroid is ranked first in terms of total publications and citations. The most productive individual author was Miyauchi Akira. While previous research primarily focused on surgery and radioactive iodine therapy, the increasing emphasis on health awareness and advancements in medical technology have led to the emergence of active surveillance, thermal ablation, and genomic analysis as prominent areas of research. Conclusion In conclusion, this comprehensive and quantitative bibliometric analysis elucidates the research trends and hotspots within PTC therapy, drawing from a substantial body of publications. This study provides valuable insights into the historical and current landscape of PTC therapy research while also offering guidance for future research directions. This study serves as a valuable resource for researchers and practitioners seeking new avenues of exploration in the field.
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Value of CEUS combined with feeding artery ablation in the microwave ablation of large solid benign thyroid nodules. Eur Radiol 2023; 33:2407-2414. [PMID: 36472698 DOI: 10.1007/s00330-022-09313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the value of contrast-enhanced ultrasound (CEUS) combined with feeding artery ablation in the microwave ablation (MWA) of large solid benign thyroid nodules (LSBTNs) with a diameter ≥ 4 cm. METHODS We retrospectively analyzed 122 patients with LSBTN ≥ 4 cm in diameter treated with MWA. During evaluations before and after MWA, 53 patients who underwent conventional ultrasound examination were classified as the routine group, and 69 patients who underwent CEUS combined with feeding artery ablation were classified as the union group. The differences in ablation energy required per milliliter (AERPM), complication rate, regrowth rate, and volume reduction rate (VRR) were compared between the two groups. RESULTS The AERPM of the union group was significantly less than that of the routine group (956.3 ± 38.5 J/mL vs. 1025.9 ± 121.5 J/mL, p < 0.001). The complication rate of the routine group was significantly higher than that of the union group (13.2% vs. 2.9%, p = 0.031). The regrowth rate of the routine group (22.6%, 12/53) was significantly higher than that of the union group (7.2%, 5/69) (p = 0.015). At the 1st, 3rd, 6th, 12th, 18th, and 24th month after ablation, the mean VRRs of the routine group were significantly less than those of the union group, with p values of < 0.001, < 0.001, 0.002, 0.007, 0.013, and < 0.001, respectively. CONCLUSIONS The application of CEUS combined with feeding artery ablation in the MWA of LSBTNs is helpful to reduce the regrowth rate, improve the ablation efficiency, and reduce bleeding. KEY POINTS • CEUS combined with feeding artery ablation in MWA of LSBTNs is helpful to reduce regrowth rate. • CEUS combined with feeding artery ablation can help improve ablation efficiency than conventional ultrasound in LSBTNs. • CEUS combined with feeding artery ablation helps reduce the incidence of bleeding during MWA.
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Wang F, Zhang L, Jiao J. Diagnostic value of multi-parameter MRI and colour B-ultrasound elastography in benign and malignant thyroid nodules. Technol Health Care 2022; 31:1065-1075. [PMID: 36617802 DOI: 10.3233/thc-220593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The early diagnosis of thyroid cancer depends on the popularisation and development of diagnostic imaging techniques and the continuous improvement of physician diagnosis. OBJECTIVE To investigate the clinical value of multi-parameter magnetic resonance imaging (MRI) and colour B-ultrasound elastography in thyroid nodules. METHODS The clinical and imaging data of 252 patients with thyroid nodules who were admitted to our hospital were collected. All patients underwent preoperative colour B-ultrasound elastography and MRI. The postoperative pathological results were the gold standard for diagnosing benign and malignant thyroid nodules. The accuracy, sensitivity and specificity of MRI, colour B-ultrasound elastography and their combination for diagnosing benign and malignant thyroid nodules were compared. RESULTS This study included 252 patients with 388 nodules. There were 169 patients with solitary nodules and 83 patients with multiple nodules. The maximum diameter of the thyroid nodules was 0.32-1.00 (0.75 ± 0.20) cm. The accuracy of MRI diagnosis (348/388) was 89.69%, the sensitivity was 92.98%, and the specificity was 65.22%. The diagnostic accuracy, sensitivity and specificity of colour B-ultrasound elastography (332/388) were 85.57%, 88.30% and 65.22%, respectively. The accuracy rate of combined diagnosis (376/388) was 96.91%, the sensitivity was 98.25%, and the specificity was 86.96%, which was significantly higher than MRI and colour B-ultrasound elastography alone. The area under the curve (AUC) of MRI, colour B-ultrasound elastography and combined diagnosis were 0.768, 0.791 and 0.926, respectively. The AUC of the three diagnostic methods was > 0.7, indicating that the three diagnostic methods had good diagnostic value. The AUC for combined diagnosis was significantly higher than that of MRI and colour B-mode ultrasound elastography alone. CONCLUSION Combined ultrasound and MRI have high diagnostic accuracy and specificity for benign and malignant thyroid nodules. This diagnostic method can be applied in clinical practice.
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Affiliation(s)
- Fan Wang
- Department of CT/MRI, Maanshan People's Hospital, Maanshan, Anhui, China
| | - Liping Zhang
- Department of Ultrasound, Maanshan People's Hospital, Maanshan, Anhui, China
| | - Junxia Jiao
- Department of Pathology, Maanshan People's Hospital, Maanshan, Anhui, China
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Zhang L, Zhou W, Zhou JQ, Shi Q, Rago T, Gambelunghe G, Zou DZ, Gu J, Lu M, Chen F, Ren J, Cheng W, Zhou P, Spiezia S, Papini E, Zhan WW. 2022 Expert consensus on the use of laser ablation for papillary thyroid microcarcinoma. Int J Hyperthermia 2022; 39:1254-1263. [PMID: 36123039 DOI: 10.1080/02656736.2022.2122596] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE With the aim of standardizing and improving the use of ultrasound-guided PLA on PTMC, a panel of experts from China and Italy, jointly issued this expert consensus on the clinical use of PLA for low-risk PTMC. METHODS This expert consensus was developed by Chinese and Italian experts who have specific competence and expertise in this area. An evidence-based approach combining the knowledge and practical experience of the panelists was utilized. RESULTS Twenty-six expert consensus recommendations were developed, spanning topics including the indications and contraindications of PLA for PTMC, physician training, preoperative preparation of patients, intraoperative technical procedures, possible complications, efficacy assessment, follow-up strategy, the approach to new PTMC and metastatic lymph nodes after treatment, thyroid-stimulating hormone inhibition therapy, and quality control of the entire procedure. CONCLUSION We summarized practical recommendations about standardized and improved PLA treatment for PTMC.
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Affiliation(s)
- Lu Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Qiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Shi
- Department of Ultrasound, The Seventh People's Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Teresa Rago
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Da Zhong Zou
- Department of Ultrasound, The Affiliated Jiangyin Hospital of South-East University Medical College, Jiangsu, China
| | - Jun Gu
- Department of Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Jiangsu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Provincial People's Hospital, Sichuan, China
| | - Fen Chen
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, China
| | - Jie Ren
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Heilongjiang, China
| | - Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Hunan, China
| | - Stefano Spiezia
- Department of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, Naples, Italy
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Wei Wei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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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.
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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,
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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: 0] [Impact Index Per Article: 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.
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Lai L, Liu Z, Zhang J, Ni X, Liu J, Luo T, Dong Y, Zhou J. Effect of Hashimoto's thyroiditis on the extent of the ablation zone in early stages of ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma: a large cohort study of 772 patients. Int J Hyperthermia 2022; 39:397-404. [PMID: 35209788 DOI: 10.1080/02656736.2022.2041736] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the effect of Hashimoto's thyroiditis (HT) on the extent of ablation zone in ultrasound (US)-guided radiofrequency ablation (RFA) for early stages of papillary thyroid microcarcinoma (PTMC). METHOD We selected 772 patients with 797 PTMCs who underwent with RFA from August 2017 to August 2020. They were subdivided into two groups as follows: (i) 216 patients (224 PTMCs) with HT in the 'HT + PTMC' group and (ii) 556 patients (573 PTMCs) with healthy thyroid in the 'PTMC' group. We assessed the extent (maximum diameter and volume) of the ablation zone by contrast-enhanced ultrasound (CEUS) immediately, one day, and 1 week following RFA. RESULTS The ablation zone of the 'HT + PTMC' group was smaller than that of the 'PTMC' group at 1 week of RFA (maximum diameter: 14.6 ± 3.1 mm vs. 15.2 ± 3.2 mm and volume: 0.932 ± 0.498 mL vs. 1.028 ± 0.540 mL, respectively, p < .05). However, there were no differences before, immediately, and one day post-RFA (p > .05). Life-threatening complications did not develop in any of the patients. CONCLUSION RFA-treated PTMCs were smaller in size in patients with HT than in those with a healthy thyroid at 1 week of RFA. However, the exact mechanism underlying this phenomenon and its clinical significance warrant further investigation.
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Affiliation(s)
- Limei Lai
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhenhua Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingwen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaofeng Ni
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Juan Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting Luo
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yijie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianqiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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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.
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Zu Y, Liu Y, Zhao J, Yang P, Li J, Qian L. A cohort study of microwave ablation and surgery for low-risk papillary thyroid microcarcinoma. Int J Hyperthermia 2021; 38:1548-1557. [PMID: 34719323 DOI: 10.1080/02656736.2021.1996643] [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: 12/12/2022] Open
Abstract
BACKGROUND The optimal treatment method for papillary thyroid microcarcinoma (PTMC) is lacking consensus. Here we aimed to compare the efficacy and safety of surgery and microwave ablation (MWA) for PTMC. METHODS The clinical data of 644 patients with PTMC treated between July 2013 and June 2020 were retrospectively analyzed. A total of 320 and 324 patients underwent MWA and surgery, respectively. We observed lesion changes in the MWA group and compared the recurrence, metastasis, complications, and other health economic indicators between the 2 groups. RESULTS The mean follow-up time was 890.7 ± 532.9 (187.9-2679.0) days in the MWA group and 910.9 ± 568.4 (193.8-2821.5) days in the surgery group. In the MWA group, lesion volume increased significantly after ablation and then gradually decreased. The final lesion volume reduction rate was 90.73% ± 7.94%, and 193 lesions (60.3%) disappeared completely. There were no significant intergroup differences in recurrence or metastasis. The incidence of main complications (temporary hypothyroidism, hypoparathyroidism, and temporary hoarseness) was significantly lower in the MWA group than in the surgery group (p < 0.001). The treatment time, intraoperative blood loss, and hospital stay were significantly lower in the MWA group than in the surgery group (p < 0.001). CONCLUSIONS MWA is effective for treating PTMC, with a low incidence of complications and less trauma. The rates of post-treatment recurrence and metastasis are similar to those of surgery, indicating that MWA is a suitable alternative to surgery.
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Affiliation(s)
- Yuan Zu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yujiang Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Junfeng Zhao
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peipei Yang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianming Li
- Department of Interventional Ultrasound, The General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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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.
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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
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Kim HJ, Chung SM, Kim H, Jang JY, Yang JH, Moon JS, Son G, Oh JR, Bae JY, Yoon H. Long-Term Efficacy of Ultrasound-Guided Laser Ablation for Papillary Thyroid Microcarcinoma: Results of a 10-Year Retrospective Study. Thyroid 2021; 31:1723-1729. [PMID: 34445885 DOI: 10.1089/thy.2021.0151] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: The aim of this study was to evaluate the 10-year efficacy and safety of laser ablation (LA) for the treatment of solitary papillary thyroid microcarcinoma (PTMC). Methods: LA was performed on patients with low-risk PTMC (diagnosed using fine-needle aspiration cytology) who refused or were ineligible for surgery between 2008 and 2011. Ultrasonography was performed to evaluate the ablated volumes and potential recurrences on the day after the procedure, as well as at 1 week, 1, 3, and 6 months, and every 6 months thereafter for 10 years. Computed tomography (CT) with contrast enhancement and positron emission tomography/CT was performed to evaluate local recurrences and distant metastases. Results: A total of 90 PTMCs in 90 patients were treated in a single session of LA, and the procedure was well tolerated by the patients. The mean follow-up duration was 112 months. By 3-10 months after the LA, all the ablation areas had disappeared or presented as scars. The disappearance rate was 100% after 12 months. Thyroid hormone and autoantibody levels did not change significantly after the treatment. Three patients experienced transient voice changes, but each recovered within 1 month. Additional PTMC foci were subsequently detected in previously untreated areas in five patients (5.5%) 17-56 months after the treatment. A metastatic lymph node was detected in one patient (1.1%) within two months of the treatment; however, it was determined to be an undetected cancer metastasis, rather than a recurrence. All the patients with recurrence underwent surgery, and there were no instances of recurrence after >5 years. Conclusions: LA is effective and safe for the treatment of low-risk PTMCs. A thorough examination of multifocality and lymph node metastasis status is required before considering LA treatment.
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Affiliation(s)
- Ho Jin Kim
- Department of Internal Medicine, Raphael Hospital, Daegu, Republic of Korea
| | - Seung Min Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Hanbyul Kim
- Department of Internal Medicine, Raphael Hospital, Daegu, Republic of Korea
| | - Ju Young Jang
- Department of Internal Medicine, Raphael Hospital, Daegu, Republic of Korea
| | - Jae Hong Yang
- Department of Internal Medicine, Raphael Hospital, Daegu, Republic of Korea
| | - Jun Sung Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Gitak Son
- Department of Surgery, Raphael Hospital, Daegu, Republic of Korea
| | - Jong-Ryool Oh
- Department of Nuclear Medicine, and Raphael Hospital, Daegu, Republic of Korea
| | - Jong Yup Bae
- Department of Pathology, Raphael Hospital, Daegu, Republic of Korea
| | - Hyundae Yoon
- Department of Internal Medicine, Raphael Hospital, Daegu, Republic of Korea
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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.
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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:
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18
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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.
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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.
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Long-Term Efficacy of Ultrasound-Guided Percutaneous Laser Ablation for Low-Risk Papillary Thyroid Microcarcinoma: A 5-Year Follow-Up Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6616826. [PMID: 34337037 PMCID: PMC8324339 DOI: 10.1155/2021/6616826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/09/2021] [Accepted: 07/06/2021] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous laser ablation (PLA) for the treatment of low-risk papillary thyroid microcarcinoma (PTMC). Methods From June 2012 to May 2015, 105 patients with solitary, pathologically confirmed PTMC lesions were treated with ultrasound-guided PLA. Nodule location, nodule volume, thyroid function, and clinical symptoms were evaluated before ablation. Contrast-enhanced ultrasound (CEUS) was performed 1 h after treatment to evaluate whether the ablation was complete. Ultrasound examination was performed at 1, 3, 6, and 12 months after ablation and every 6 months thereafter to determine the size of the ablation area and search for recurrence in the thyroid parenchyma and lymph node metastasis. Thyroid function was examined before and 1 month after ablation. Fine needle aspiration biopsy was performed for any suspicious metastatic lymph nodes and recurrent lesions in the thyroid. Results All 105 lesions were completely inactivated after one ablation, making the success rate for single ablation 100%. The average ablation time was 2.78 ± 1.05 min, and the average ablation energy was 505 ± 185 J. All patients could tolerate and complete the ablation. No serious complications occurred during the treatment; only minor side effects such as pain and local discomfort were reported. The volume reduction rates were −781.14 ± 653.29% at 1 h posttreatment and −268.65 ± 179.57%, −98.39 ± 76.58%, 36.78 ± 30.32%, 75.55 ± 21.81%, 96.79 ± 10.57%, and 100% at 1, 3, 6, 12, 18, and 24 months after ablation, respectively. This rate remained 100% at the later follow-up times. Overall, 28 (26.67%), 74 (70.48%), 96 (91.43%), and 103 (100%) were completely absorbed by 6, 12, 18, and 24 months after PLA. One patient developed another lesion 12 months after ablation, and two patients had central cervical lymph node metastasis 24 months after ablation. Conclusion PLA is a safe and effective alternative clinical treatment for low-risk PTMC.
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Yan L, Luo Y. Prediction of nodule regrowth after radiofrequency ablation of benign thyroid nodules. Int J Hyperthermia 2021; 38:11-12. [PMID: 33400887 DOI: 10.1080/02656736.2020.1867243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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21
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Yan L, Luo Y, Xie F, Zhang M, Xiao J. Residual vital ratio: predicting regrowth after radiofrequency ablation for benign thyroid nodules. Int J Hyperthermia 2021; 37:1139-1148. [PMID: 32996790 DOI: 10.1080/02656736.2020.1825835] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine a novel quantitative index, residual vital ratio(RVR) by contrast-enhanced ultrasound(CEUS) with conventional Ultrasound(US), to early predict nodule regrowth after radiofrequency ablation (RFA)for benign thyroid nodules. METHODS This retrospective study evaluated 186 patients with 206 benign thyroid nodules underwent RFA. Patients were followed at 1, 3, 6, 12 months and every 12 months thereafter by conventional US, CEUS and clinical evaluation. RVR was defined as the initial ratio of residual vital volume to the total volume calculated by CEUS and conventional US at the first follow-up period after RFA. The relationship between RVR and regrowth was investigated. RESULTS The mean volume of thyroid nodules was 10.09 ± 12.90 ml (range 0.40-71.39 ml), which decreased significantly to 2.33 ± 4.65 ml (range 0-36.75 ml) (p < .001) after a mean follow-up time of 22.50 ± 13.29 months (range 6-68 months) with a mean VRR as 85.26 ± 15.02% (range 32.23-100%). The overall incidence of regrowth was 12.62% (26/206) and the mean timing of regrowth was 20.77 ± 12.03 months (range 6-48 months). Multivariate logistic regression revealed that RVR (OR = 1.050, 95%CI 1.025-1.075), initial volume(OR = 1.033, 95%CI 1.000-1.066), location close to critical structures (OR = 5.967, 95%CI 1.898-18.760) and vascularity (OR = 2.216, 95%CI 1.185-4.143) were independent factors associated with regrowth. According to receiver-operating characteristic curve, the area under curve for RVR to regrowth was 0.819 (95% CI 0.740-0.897, p < .001) with the optimal cutoff value of 44.5% (sensitivity 80.8%, specificity 74.7%). CONCLUSION RVR was not only an independent factor but also an early quantitative predictor for regrowth. If RVR was larger than 44.5%, the nodule tended to regrowth in the follow-up.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.,Health Management Center, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fang Xie
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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22
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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: 111] [Impact Index Per Article: 37.0] [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.
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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
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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.
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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
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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: 26] [Impact Index Per Article: 8.7] [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%.
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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.
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25
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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]
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26
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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: 0] [Impact Index Per Article: 0] [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.
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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
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Yan L, Zhang M, Song Q, Xiao J, Zhang Y, Luo Y. The Efficacy and Safety of Radiofrequency Ablation for Bilateral Papillary Thyroid Microcarcinoma. Front Endocrinol (Lausanne) 2021; 12:663636. [PMID: 34177804 PMCID: PMC8227434 DOI: 10.3389/fendo.2021.663636] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/03/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate the long-term clinical results of radiofrequency ablation (RFA) for bilateral papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS From October 2014 to February 2018, 47 patients (37 females, 10 males, mean age 43.39 ± 9.26 years) with 100 bilateral PTMC (mean volume 75.22 ± 73.87 mm3) treated by RFA were included in this retrospective study. Bilateral PTMC was defined as at least one tumor located in the contralateral lobe. Patients were followed up at 1, 3, 6, 12 months and every 6-12 months thereafter. Volume, volume reduction ratio (VRR) and local tumor recurrence were evaluated during the follow-up period. RESULTS After a mean follow-up period of 47.77 ± 11.54 months, the mean volume of bilateral PTMC decreased from 75.22 ± 73.87 mm3 to 0.09 ± 0.44 mm3. The mean VRR was 99.94 ± 0.28% and the complete disappearance rate was 92.00%. During the follow-up, one patient (2.13%) developed lymph node metastasis and two patients (4.26%) had recurrent PTMC. All the recurrent lesions underwent additional RFA and two of them disappeared completely. No life-threatening or delayed complications occurred. CONCLUSIONS With sufficient preoperative evaluation, RFA might be a promising alternative for bilateral PTMC patients who were unsuitable for surgery or refused surgery.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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Tufano RP, Pace-Asciak P, Russell JO, Suárez C, Randolph GW, López F, Shaha AR, Mäkitie A, Rodrigo JP, Kowalski LP, Zafereo M, Angelos P, Ferlito A. Update of Radiofrequency Ablation for Treating Benign and Malignant Thyroid Nodules. The Future Is Now. Front Endocrinol (Lausanne) 2021; 12:698689. [PMID: 34248853 PMCID: PMC8264548 DOI: 10.3389/fendo.2021.698689] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022] Open
Abstract
Thermal and chemical ablation are minimally invasive procedures that avoid removal of the thyroid gland and target symptomatic nodules directly. Internationally, Radiofrequency ablation (RFA) is among one of the most widely used thermal ablative techniques, and is gaining traction in North America. Surgery remains the standard of care for most thyroid cancer, and in the right clinical setting, Active Surveillance (AS) can be a reasonable option for low risk disease. Minimally invasive techniques have emerged as an alternative option for patients deemed high risk for surgery, or for those patients who wish to receive a more active treatment approach compared to AS. Herein, we review the literature on the safety and efficacy of RFA for treating benign non-functioning thyroid nodules, autonomously functioning thyroid nodules, primary small low risk thyroid cancer (namely papillary thyroid cancer) as well as recurrent thyroid cancer.
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Affiliation(s)
- Ralph P. Tufano
- Division of Otolaryngology – Endocrine Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Ralph P. Tufano,
| | - Pia Pace-Asciak
- Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Jonathon O. Russell
- Division of Otolaryngology – Endocrine Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain
| | - Gregory W. Randolph
- Division of Otolaryngology - Endocrine Head and Neck Surgery, Harvard University, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Fernando López
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
- Institutode Investigación Sanitaria del Principado de Asturias (ISPA), Instituto Universitario de Oncología del Principado de Asturias (IUOPA), University of Oviedo CIBERONC-ISCIII, Oviedo, Spain
| | - Ashok R. Shaha
- Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Antti Mäkitie
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juan P. Rodrigo
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School and Department of Head and Neck Surgery and Otorhinolaryngology Department, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Mark Zafereo
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX, United States
| | - Peter Angelos
- Department of Surgery, Bucksbaum Institute for Clinical Excellence, University of Chicago, Chicago, IL, United States
| | - Alfio Ferlito
- The University of Udine School of Medicine, International Head and Neck Scientific Group, Padua, Italy
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Min Y, Wang X, Chen H, Chen J, Xiang K, Yin G. Thermal Ablation for Papillary Thyroid Microcarcinoma: How Far We Have Come? Cancer Manag Res 2020; 12:13369-13379. [PMID: 33380841 PMCID: PMC7769090 DOI: 10.2147/cmar.s287473] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/05/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose Thermal ablation (TA), as one of the most currently remarkable technologies, has achieved great success in many malignant diseases including but not limited to hepatic and renal carcinoma. In recent years, this technology was gradually introduced to the treatment of papillary thyroid microcarcinoma (PTMC) and even papillary thyroid carcinoma (PTC). Thereby, we summarized the current progress of TA development in the treatment of PTMC. Methods The latest relevant literature from the PubMed database with keywords "thermal ablation", "papillary thyroid microcarcinoma", "microwave ablation", "radio-frequency ablation", and "laser ablation", among others, were comprehensively reviewed in this article. The follow-up outcomes of patients in these articles were analyzed. Results The efficacy and safety of TA including microwave ablation (MWA), laser ablation (LA), and radiofrequency ablation (RFA) in the treatment of PTC and PTC have been intensively studied. Based on existing clinical trials, the relatively long-term follow-up (range, from 6 to 64.2 months) results in MWA, LA, and RFA were satisfactory that tumor volume reduction rate (VRR) reached and even surpass 99%. Compared with routine surgery methods (total thyroidectomy and lobectomy), the incidence rate of complications was relatively lower and the recurrence rate of TA techniques was not statistically significant, whereas the operative time, blood loss, length of hospital stay, and hospital cost were significantly decreased. Conclusion TA presents the same satisfactory therapeutic effects but minimal postoperative trauma can significantly improve the patients' quality of life. However, future larger sample, multicenter, and prospective randomized controlled trials are urgently needed to validate the feasibility of TA in dealing with PTMC.
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Affiliation(s)
- Yu Min
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
| | - Xing Wang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
| | - Hang Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
| | - Jialin Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
| | - Ke Xiang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
| | - Guobing Yin
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
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30
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Teng DK, Li WH, Du JR, Wang H, Yang DY, Wu XL. Effects of Microwave Ablation on Papillary Thyroid Microcarcinoma: A Five-Year Follow-Up Report. Thyroid 2020; 30:1752-1758. [PMID: 32458748 DOI: 10.1089/thy.2020.0049] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Some researchers have achieved favorable efficacy in the treatment of primary papillary thyroid microcarcinoma (PTMC) using microwave ablation (MWA). However, as PTMC is a slowly progressing disease, a long follow-up period is required to confirm treatment efficacy. Our study aim was to investigate the long-term efficacy and safety of ultrasound (US)-guided MWA in PTMC. Methods: In this study, 41 patients with thyroid masses (41 nodules) were diagnosed with PTMC by fine-needle aspiration or core needle biopsy. They underwent US-guided MWA. Preablation ultrasonic images of the thyroid nodules were collected, and the volumes were measured. The patients had follow-up at 1, 3, 6, and 12 months in the first year and every 6 months from the second year on, after MWA. The volume reduction rates (VRRs) of the thyroid nodules were analyzed. Results: In total, 40 of 41 nodules were completely ablated by MWA. After 60 months of follow-up, the volume significantly decreased from a median of 55.78 mm3 (quartile: 21.50, 112.20 mm3) to 0 mm3 (0, 0 mm3) (p < 0.001), with a VRR of 99.37% ± 4.02%. Two patients developed hoarseness after ablation; one recovered within 10 minutes, and the hoarseness in the other patient resolved 2 months after the ablation. No recurrence, metastatic cervical lymph nodes, or distal metastasis was found during the follow-up period. Conclusions: In this five-year follow-up, MWA presented favorable efficacy with satisfactory safety for the treatment of PTMC. It should be considered an alternative therapy to surgery and active surveillance for solitary PTMC.
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Affiliation(s)
- Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wen-Hui Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jia-Rui Du
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dong-Yan Yang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiao-Li Wu
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, China
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Cho SJ, Baek SM, Lim HK, Lee KD, Son JM, Baek JH. Long-Term Follow-Up Results of Ultrasound-Guided Radiofrequency Ablation for Low-Risk Papillary Thyroid Microcarcinoma: More Than 5-Year Follow-Up for 84 Tumors. Thyroid 2020; 30:1745-1751. [PMID: 32375570 DOI: 10.1089/thy.2020.0106] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Despite reports describing favorable short-term results for thermal ablation of thyroid cancer, there remains a need to evaluate long-term results because of its indolent characteristics. The purpose of this study was to evaluate the long-term efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC) over a follow-up period of more than five years. Methods: From a cohort of patients under surveillance after US-guided RFA for primary low-risk PTMC, those with a record of follow-up data of more than five years were selected for this study. Before RFA, all patients underwent US and computed tomography to evaluate the PTMC and the presence of neck metastasis. RFA was performed using thyroid-dedicated electrodes. Follow-up US was performed 6 and 12 months after initial RFA, and then every 12 months. The status of ablated tumors was evaluated according to volume reduction, local tumor progression, newly developed cancers, lymph node (LN) or distant metastasis, and delayed surgery during follow-up. Complications during the procedure and follow-up period were evaluated. Results: A total of 84 nodules from 74 patients were included in this study. All patients tolerated RFA, and the mean follow-up duration was 72 months. After RFA, complete disappearance rates of 98.8% and 100% were achieved at 24 and 60-month follow-up, respectively. Additional ablations were performed in 13 of 84 tumors. The mean number of RFA sessions was 1.2. There were four newly developed cancers in three patients, and these were also treated with RFA and completely disappeared. During the follow-up period, there was no local tumor progression, no LN or distant metastasis, and no patients underwent delayed surgery. The major complication rate was 1.4% (1/74), and there was no delayed complication or procedure-related death. Conclusions: RFA is effective for treating low-risk PTMC patients, without occurrence of local tumor progression, LN or distant metastasis, delayed complications, procedure-related death, or delayed surgery over more than five years of follow-up.
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Affiliation(s)
- Se Jin Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Republic of Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Kang Dae Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Republic of Korea
| | - Jung Min Son
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Pacella CM, Di Stasio E, Guglielmi R, Baroli A, Pedrazzini L, Misischi I, Persichetti A, Papini E. Role of laser ablation in multimodal treatment of radioiodine- refractory bone metastases of thyroid cancer: a retrospective study. Endocrine 2020; 70:338-347. [PMID: 32378155 DOI: 10.1007/s12020-020-02314-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the efficacy, safety, and pain benefits of imaging-guided laser ablation (IGLA) in patients with radioiodine-refractory (RR) bone metastases from differentiated thyroid carcinoma (DTC). PATIENTS AND METHODS The institutional medical records of patients with bone metastases from DTC treated with laser ablation (LA) were reviewed retrospectively. Local response, complications, and effects on pain relief were investigated. RESULTS Six osteolytic lesions in five patients (one male, four females; mean age 65.4 ± 5.1 years, range 58-72) were treated with IGLA. All lesions were osteolytic and all have had previous treatments with high-dose radioiodine therapy followed by external radiotherapy (EBRT). All patients assumed opioid analgesics for severe pain. Overall, the lesions (mean size 5.8 ± 3.2 cm; median 5.0 cm, range 3.0-12.0 cm) underwent nine IGLA sessions (mean 1.8 ± 0.4 sessions; median 2.0 sessions, range 1-2). In four (80%) out five lesions, cross-sectional imaging showed a nearly complete response (CR) while the largest lesion was ablated by 80%. Pain changes were assessed with the Brief Pain Inventory-Short Form, that was administered before IGLA and during a 6-month follow-up. Patients experienced significant reduction in worst pain, average pain, and pain interference. Following IGLA, the average daily opioid requirement rapidly and progressively decreased. Treatments were well-tolerated and no major complications occurred. CONCLUSIONS IGLA is an effective and safe debulking procedure and provides significant pain relief in patients suffering from DTC bone metastases that are not responsive to standard treatments. So, IGLA could be considered as part of a multimodality management of advanced thyroid cancer with RR metastatic skeletal involvement.
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Affiliation(s)
- Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy.
| | - Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of the Sacred Heart, Rome, Italy
- UOC Chemistry, Biochemistry and Clinical Molecular Biology, A. Gemelli University Polyclinic Foundation IRCCS, Rome, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Alberto Baroli
- Department of Nuclear Medicine, Ospedale Busto Arsizio, ASST Valleolona, Varese, Italy
| | - Luca Pedrazzini
- Department of Nuclear Medicine, Ospedale Busto Arsizio, ASST Valleolona, Varese, Italy
| | - Irene Misischi
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Agnese Persichetti
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
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Yan L, Lan Y, Xiao J, Lin L, Jiang B, Luo Y. Long-term outcomes of radiofrequency ablation for unifocal low-risk papillary thyroid microcarcinoma: a large cohort study of 414 patients. Eur Radiol 2020; 31:685-694. [PMID: 32813103 DOI: 10.1007/s00330-020-07128-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/10/2020] [Accepted: 07/31/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the long-term efficacy and safety of radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC) in a large population. METHODS From June 2014 to December 2017, 414 patients (323 females, 91 males, mean age 43.56 ± 9.79 years, range 18-73 years) with unifocal low-risk PTMC confirmed by core-needle biopsy (CNB) were treated by RFA. Patients were followed up at 1, 3, 6, and 12 months and every 6-12 months thereafter by ultrasound and contrast-enhanced ultrasound (CEUS). The volume and the volume reduction ratio (VRR) were calculated. Recurrence and lymph node or distant metastasis were evaluated. RESULTS The mean initial volume was 92.74 ± 83.43 mm3 (range 4.19-490.07 mm3), which decreased significantly to 1.37 ± 7.94 mm3 (range 0-67.97 mm3) at a mean follow-up time of 42.15 ± 11.88 months (range 24-69 months) with a mean VRR of 98.81 ± 6.41% (range 50-100%). No life-threatening or delayed complications occurred. After RFA, 366 tumors (88.41%) completely disappeared. The overall incidence of local tumor progression rate was 3.62%. Among them, one patient (0.24%) was diagnosed to have residual cancer by CNB and underwent additional RFA. Four patients (0.97%) developed metastatic lymph node, and 10 patients (2.42%) had recurrent PTMC. A total of 13 patients underwent additional RFA, and 11 lesions completely disappeared during the follow-up. CONCLUSIONS RFA is an effective and safety treatment for low-risk PTMC after a long-term follow-up period for a large cohort with careful patient enrollment evaluation. KEY POINTS • Radiofrequency ablation is an effective and safe alternative for low-risk PTMC. • The overall incidence of local tumor progression rate was low. • No life-threatening or delayed complications occurred.
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Affiliation(s)
- Lin Yan
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
- Health Management Center, The Second Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian, China
| | - Yu Lan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Lin Lin
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Bo Jiang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yukun Luo
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China.
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China.
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Lim HK, Cho SJ, Baek JH, Lee KD, Son CW, Son JM, Baek SM. US-Guided Radiofrequency Ablation for Low-Risk Papillary Thyroid Microcarcinoma: Efficacy and Safety in a Large Population. Korean J Radiol 2020; 20:1653-1661. [PMID: 31854153 PMCID: PMC6923213 DOI: 10.3348/kjr.2019.0192] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/20/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC) in a large population. MATERIALS AND METHODS Cases of 152 biopsy-proven PTMCs from 133 patients who had undergone RFA for PTMC between May 2008 and January 2017 were included in this study. All patients were either of high surgical risk or refused to undergo surgery. They were followed up for at least 6 months after initial RFA. Ultrasonography (US) and computed tomography were performed to evaluate the PTMC and the presence of neck metastasis before treatment. RFA was conducted using an internally cooled thyroid-dedicated electrode system. Follow-up US was performed at 1 week, and 2, 6, and 12 months, after the initial RFA, and then at every 6-12 months. We evaluated serial changes of ablated tumors, newly developed cancers, lymph node (LN) or distant metastasis and complications. RESULTS Complete disappearance was found in 91.4% (139/152) of ablated tumors. Among the 13 tumors in patients who did not show complete disappearance, no tumor displayed any regrowth of the residual ablated lesion during the follow-up period. The mean follow-up period was 39 months. During the follow-up period, there were no local recurrence, no LN or distant metastasis, and no newly developed thyroid cancers. No patients were referred to surgery. The overall complication rate was 3% (4/133) of patients, including one voice change. There were no life-threatening complications or procedure-related deaths. CONCLUSION Our results suggest that RFA is an effective and safe option for treating low-risk PTMC patients who are of high surgical risk or refuse surgery.
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Affiliation(s)
- Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Se Jin Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kang Dae Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Chang Woo Son
- Department of Radiology, Korean Association of Health Promotion, Busan, Korea
| | - Jung Min Son
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
| | - Seon Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea.
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Yan L, Luo Y, Zhang Y, Zhu Y, Xiao J, Lan Y, Tian X, Song Q, Xie F. The Clinical Application of Core-Needle Biopsy after Radiofrequency Ablation for Low-risk Papillary Thyroid Microcarcinoma: A Large Cohort of 202 Patients Study. J Cancer 2020; 11:5257-5263. [PMID: 32742471 PMCID: PMC7391195 DOI: 10.7150/jca.42673] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/13/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose: To evaluate the clinical application of core-needle biopsy (CNB) for low-risk papillary thyroid microcarcinoma (PTMC) after radiofrequency ablation (RFA) Methods: A total of 202 patients with 211 low-risk PTMCs were included in this study. RFA procedure was used the hydrodissection technique and moving-shot technique. Patients were followed at 1, 3, 6, 12 months and every 6 months thereafter. The volume of ablation area and the volume reduction ratio (VRR) were calculated. At 3 or 6 months after RFA, CNB was performed to the central zone, the peripheral zone and surrounding thyroid parenchyma for post-ablation evaluation. Results: The mean volume of tumors was 102.34±93.84 mm3 (range 4.19-424.10 mm3), which decreased significantly to 1.37±7.74 mm3 (range 0-73.30 mm3) at a mean follow-up time of 24.42±9.15 months (range 3-42 months) with a mean VRR of 99.14±4.18% (range 71.88-100%). A total of 3 ablation areas had positive CNB in the peripheral zone and underwent additional RFA. No recurrent or suspicious metastatic lymph nodes were detected Conclusion: CNB is a feasible and effective evaluation for low-risk PTMC after RFA, which can detect residual cancer cells early.
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Affiliation(s)
- Lin Yan
- Medical School of Chinese PLA, No.28 Fuxing Road, Haidian District, Beijing, China.,Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China.,Health Management Center, The Second Hospital of Dalian Medical University, No.467 Zhongshan Road, Shahekou District, Dalian, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China.,Medical School of Chinese PLA, No.28 Fuxing Road, Haidian District, Beijing, China
| | - Ying Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No.94 Weijing Road, Nankai District, Tianjing, China
| | - Yaqiong Zhu
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No.94 Weijing Road, Nankai District, Tianjing, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No.94 Weijing Road, Nankai District, Tianjing, China
| | - Yu Lan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No.94 Weijing Road, Nankai District, Tianjing, China
| | - Xiaoqi Tian
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No.94 Weijing Road, Nankai District, Tianjing, China
| | - Qing Song
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China
| | - Fang Xie
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China
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Mauri G, Gennaro N, Lee MK, Baek JH. Laser and radiofrequency ablations for benign and malignant thyroid tumors. Int J Hyperthermia 2020; 36:13-20. [PMID: 31537159 DOI: 10.1080/02656736.2019.1622795] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A growing body of evidence is being published regarding the safety and efficacy of minimally invasive image-guided ablation techniques. While clinical applications of these techniques are increasing, international societies have started to publish treatment guidelines and to make efforts to standardize both terminology and reporting criteria for image-guided thyroid ablations. Laser ablation and radiofrequency ablation (RFA) are among the most common ablation techniques either for benign and malignant thyroid nodules. Unlike laser ablation and RFA in the treatment of benign thyroid nodules, where safety and efficacy have been widely demonstrated, evidence regarding local tumor control of thyroid malignancies is still limited. However, preliminary results are encouraging and image-guided thermal ablation techniques can be considered a valid alternative to surgery for the treatment of benign thyroid nodules and recurrent thyroid cancers. This review evaluates the basic concept of RFA and laser ablations, their techniques, clinical outcomes, and complications based on the suggestions of several society guidelines. Multidisciplinary collaboration remains critical to identify patients which may benefit from minimally invasive image-guided thermal ablations, especially if surgery or radioiodine therapy are not feasible options.
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Affiliation(s)
- Giovanni Mauri
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS , Milan , Italy
| | - Nicolò Gennaro
- Training School in Radiology, Humanitas University , Pieve Emanuele , Italy
| | - Min Kyoung Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan , Songpa-gu , Seoul , Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan , Songpa-gu , Seoul , Korea
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37
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Choi Y, Jung SL. Efficacy and Safety of Thermal Ablation Techniques for the Treatment of Primary Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis. Thyroid 2020; 30:720-731. [PMID: 31801432 DOI: 10.1089/thy.2019.0707] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The increased incidence of primary papillary thyroid microcarcinoma (PTMC) has led to increased research in the field of nonsurgical therapeutic options for those who refuse surgery or are at high risk for surgery. The study aimed at comprehensively evaluating the efficacy and safety of thermal ablation techniques for the treatment of PTMC via a systematic review and meta-analysis. Methods: The Pubmed MEDLINE and EMBASE databases were searched for studies reporting the efficacy and safety of thermal ablations (radiofrequency-, laser-, and microwave-ablations [RFA, LA, and MWA]) until August 10, 2019. A review of 105 potential papers identified 11 eligible papers, including 715 patients. The pooled proportions of complete disappearance and recurrence, and the pooled estimates of mean volume reduction and its rate of the treated PTMC were assessed by using random-effects modeling. The pooled proportions of overall and major complications were calculated. Subgroup analysis was performed according to the treatment modality. Between-study heterogeneity was explored by using χ2 statistic for pooled estimates and inconsistency index I2. Quality of the studies was evaluated by using the Risk of Bias Assessment Tool for Nonrandomized Studies. Results: The pooled proportions of complete disappearance and recurrence of PTMC were 57.6% [95% confidence interval (CI): 35.4-79.8] and 0.4% [95% CI: 0-1.1], respectively. The pooled estimates of mean volume reduction and its rate were 73.5 mm3 [52.4-94.6 mm3] and 98.1% [95% CI: 96.7-99.5], respectively. The pooled proportions of overall and major complications were 3.2% [95% CI: 1.1-5.2] and 0.7% [95% CI: 0-1.5], respectively. Significant between-study heterogeneity was observed for complete disappearance (p < 0.001, I2: 99%), mean volume reduction (p < 0.001, I2: 93%), and its rate (p < 0.001, I2: 86%). Subgroup analysis revealed heterogeneity of the complete disappearance proportion among the treatment modality (I2 range: 95-100%). RFA showed the highest mean volume reduction rate (99.3%), followed by MWA (95.3%) and LA (88.6%) (p < 0.001). Conclusions: All thermal ablation techniques were effective and safe for the treatment of PTMC. However, each treatment modality had significant heterogeneity with respect to complete disappearance of PTMC. Compared with RFA and MWA, LA was less effective in reducing the volume of PTMC.
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Affiliation(s)
- Yangsean Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So-Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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38
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Tong M, Li S, Li Y, Li Y, Feng Y, Che Y. Efficacy and safety of radiofrequency, microwave and laser ablation for treating papillary thyroid microcarcinoma: a systematic review and meta-analysis. Int J Hyperthermia 2020; 36:1278-1286. [PMID: 31826684 DOI: 10.1080/02656736.2019.1700559] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: To evaluate the efficacy and safety of radiofrequency ablation (RFA), microwave ablation (MWA) and laser ablation (LA) for treating papillary thyroid microcarcinoma (PTMC).Materials and methods: PUBMED and EMBASE were searched for studies on the efficacy and safety of RFA, MWA and LA for treating PTMC. The standard mean difference of the tumor volume before and after therapy and the proportion of complete disappearance, local recurrence, distant metastasis and complications were assessed using both fixed or random-effects modeling. Heterogeneity among studies was determined using the Q statistic for the pooled estimates and the inconsistency index I2.Results: A total of 12 eligible studies, including a sample size of 1187 patients and 1284 PTMCs, were used. RFA, MWA and LA all showed a significant reduction in tumor volume of PTMCs (p < 0.05). Though MWA demonstrated superior efficacy over the other two therapies for volume reduction, the differences were not statistically significant. Additionally, the pooled proportion of complete disappearance after RFA was the highest (76.2%), and the pooled proportion of recurrence for RFA was the lowest (0.01%) among the three therapeutic methods, but no significant difference was detected. There was no event of distant metastasis during the follow-up in all of these studies. Few major complications were encountered; the pooled proportion of complications for RFA (1.73%), MWA (6.0%) and LA (0.92%) was low, revealing no significant differences (p > 0.05).Conclusion: RFA, MWA and LA are acceptable treatments to manage PTMCs in terms of efficacy and safety for non-surgical candidates.
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Affiliation(s)
- Mengying Tong
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Liaoning, Dalian, P.R. China
| | - Shuang Li
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Liaoning, Dalian, P.R. China
| | - Yulong Li
- Center of Genome and Personalized Medicine, Institute of Cancer Stem Cell, Dalian Medical University, Liaoning, Dalian, P. R. China
| | - Ying Li
- Center of Genome and Personalized Medicine, Institute of Cancer Stem Cell, Dalian Medical University, Liaoning, Dalian, P. R. China
| | - Yue Feng
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Liaoning, Dalian, P.R. China
| | - Ying Che
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Liaoning, Dalian, P.R. China
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Zhou W, Ni X, Xu S, Zhang L, Chen Y, Zhan W. Ultrasound-Guided Laser Ablation Versus Microwave Ablation for Patients With Unifocal Papillary Thyroid Microcarcinoma: A Retrospective Study. Lasers Surg Med 2020; 52:855-862. [PMID: 32216112 DOI: 10.1002/lsm.23238] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The objective of this study is to compare the efficacy and the safety of ultrasound-guided microwave ablation (MWA) and laser ablation (LA) for the treatment of papillary thyroid microcarcinoma (PTMC). STUDY DESIGN/MATERIALS AND METHODS A total of 67 patients with unifocal PTMC were studied retrospectively, including 33 cases who underwent MWA (MWA group) and 34 cases who received LA (LA group). The follow-up consisted of thyroid function tests, ultrasonography, contrast-enhanced ultrasonography (CEUS), and chest X-ray or computed tomography scan. The treatment response and complications were compared between the two groups. RESULTS The follow-up time for the MWA and LA group was 23.3 ± 4.4 and 22.8 ± 4.1 months, respectively. All the ablations were successfully performed as planned without complementary ablations, and it was confirmed by CEUS after treatment in both groups. It was observed that, at the last follow-up, the mean largest diameter decreased from 5.0 ± 1.4 mm to 0.1 ± 0.4 mm (MWA group) and from 4.5 ± 1.6 mm to 0.6 ± 1.2 mm(LA group) (P < 0.05 for both). The average volume reduced from 51.9 ± 40.8 to 0.2 ± 1.0 mm3 (MWA group) and from 38.5 ± 43.0 to 1.3 ± 3.8 mm3 (LA group) (P < 0.05 for both). The complication rates did not differ between the MWA group (9.1%) and the LA group (2.9%) (P > 0.05). No local recurrence or distant metastasis occurred in either group. CONCLUSIONS During the short-term follow-up period, ultrasound-guided MWA and LA were both safe and effective methods in treating patients with unifocal PTMC. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
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Affiliation(s)
- Wei Zhou
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2 Rd, Shanghai, 200025, China
| | - Xiaofeng Ni
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2 Rd, Shanghai, 200025, China
| | - Shangyan Xu
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2 Rd, Shanghai, 200025, China
| | - Lu Zhang
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2 Rd, Shanghai, 200025, China
| | - Yudong Chen
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2 Rd, Shanghai, 200025, China
| | - Weiwei Zhan
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2 Rd, Shanghai, 200025, China
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40
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Zhang M, Tufano RP, Russell JO, Zhang Y, Zhang Y, Qiao Z, Luo Y. Ultrasound-Guided Radiofrequency Ablation Versus Surgery for Low-Risk Papillary Thyroid Microcarcinoma: Results of Over 5 Years' Follow-Up. Thyroid 2020; 30:408-417. [PMID: 31910107 DOI: 10.1089/thy.2019.0147] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Papillary thyroid microcarcinoma (PTMC) typically carries an excellent prognosis regardless of the treatment option pursued. Radiofrequency ablation (RFA) for thyroid disease has been utilized for benign lesions and in patients who are poor surgical candidates for thyroid cancers with compression symptoms, but the efficacy and limitations of RFA as first-line therapy for PTMC has not been described in adequate detail. The purpose of our study was to investigate RFA versus thyroidectomy in terms of efficacy, oncologic outcomes, quality of life, complications, and costs over a 5-year period of follow-up. Methods: From January 2013 to November 2013, 174 consecutive patients with an isolated, solitary intrathyroidal PTMC were identified in a Chinese teaching hospital. Those with more aggressive or advanced PTMCs were not included. Ninety-four patients elected RFA and 80 patients elected surgery for treatment of these PTMC. Nodules were confirmed to be PTMC without an aggressive histological type by core needle biopsy in the RFA group and by final surgical pathology in the surgery group. The extent of surgery was decided based on patient preferences in consultation with the surgeons. Of all the patients, 58 (72.5%) underwent lobectomy, 22 (27.5%) underwent total thyroidectomy, and 53 (66.3%) underwent lymph node dissection. Pre- and post-treatment variables were compared between the two groups, including demographics, tumor characteristics, treatment, local tumor progression, lymph node metastasis, distant metastasis, local recurrence, complications, and quality-of-life findings. Results: Patient-specific variables were similar between groups, as were oncologic outcomes after 5 years of follow-up. When compared with RFA, surgery took longer, had a longer hospitalization time, and was costlier (all p < 0.001). The surgery group had three complications, with 2 (2.5%) permanent recurrent laryngeal nerve injuries and 1 (1.3%) case of permanent hypoparathyroidism, while none was reported in the RFA group (p = 0.095). The surgery group had a lower post-treatment thyroid-related quality of life. Conclusions: For carefully selected low-risk intrathyroidal PTMC, RFA was not oncologically inferior to open surgery, and it was associated with a higher quality of life and lower overall costs.
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Affiliation(s)
- Mingbo Zhang
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ying Zhang
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Zhi Qiao
- Department of General Surgery, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
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Mauri G, Orsi F, Carriero S, Della Vigna P, De Fiori E, Monzani D, Pravettoni G, Grosso E, Manzoni MF, Ansarin M, Giugliano G. Image-Guided Thermal Ablation as an Alternative to Surgery for Papillary Thyroid Microcarcinoma: Preliminary Results of an Italian Experience. Front Endocrinol (Lausanne) 2020; 11:575152. [PMID: 33488514 PMCID: PMC7820745 DOI: 10.3389/fendo.2020.575152] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/06/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To report the results of our preliminary experience in treating patients with papillary thyroid microcarcinoma (PTMC) with image-guided thermal ablation, in particular estimating the feasibility, safety and short-term efficacy. MATERIALS AND METHODS From 2018 patients with cytologically proven PTMC < 10 mm were discussed in a multidisciplinary team and evaluated for feasibility of image-guided thermal ablation. In case of technical feasibility, the three possible alternatives (i.e., image-guided thermal ablation, surgery, and active surveillance) were discussed with patients. Patients who agreed to be treated with image guided thermal ablation underwent radiofrequency (RFA) or laser ablation under local anesthesia and conscious sedation. Treatment feasibility, technical success, technique efficacy, change in thyroid function tests, side effects, minor and major complications, patients satisfaction and pain/discomfort perception during and after treatment, and disease recurrence during follow-up were recorded. RESULTS A total of 13 patients were evaluated, and 11/13 (84.6%) patients (9 female, 2 male, mean age 49.3 ± 8.7 years) resulted suitable for image-guided thermal ablation. All 11 patients agreed to be treated with image-guided thermal ablation. In addition, 3/11 (27.3%) were treated with laser ablation and 8/11 (72.7%) with RFA. All procedures were completed as preoperatively planned (technical success 100%). Technique efficacy was achieved in all 11/11 (100%) cases. Ablated volume significantly reduced from 0.87 ± 0.67 ml at first follow-up to 0.17 ± 0.36 at last follow-up (p = 0.003). No change in thyroid function tests occurred. No minor or major complications occurred. All patients graded 10 the satisfaction for the treatment, and mean pain after the procedure was reported as 1.4 ± 1.7, and mean pain after the procedure as 1.2 ± 1.1 At a median follow-up of 10.2 months (range 1.5-12 months), no local recurrence or distant metastases were found. CONCLUSIONS Image guided thermal ablations appear to be feasible and safe in the treatment of PTMC. These techniques hold the potential to offer patients a minimally invasive curative alternative to surgical resection or active surveillance. These techniques appear to be largely preferred by patients.
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Affiliation(s)
- Giovanni Mauri
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
- Divisione di Radiologia interventistica, Istituto Europeo di Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Franco Orsi
- Divisione di Radiologia interventistica, Istituto Europeo di Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Serena Carriero
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
- *Correspondence: Serena Carriero,
| | - Paolo Della Vigna
- Divisione di Radiologia interventistica, Istituto Europeo di Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Elvio De Fiori
- Unità di Radiologia Clinico Diagnostica, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Dario Monzani
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
- Divisione di Psiconcologia, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
- Divisione di Psiconcologia, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Enrica Grosso
- Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Marco F. Manzoni
- Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Mohssen Ansarin
- Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Gioacchino Giugliano
- Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
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Abstract
Background: Although clinical studies indicate that thermal ablation is effective in treating low-risk papillary thyroid microcarcinomas (PTMCs), the effectiveness of this treatment in patients with low-risk PTMC has not yet been systematically evaluated. Methods: Ovid-MEDLINE and EMBASE databases were searched for studies published through May 1, 2019, which report the efficacy of thermal ablation in patients with low-risk PTMCs. Data were extracted and methodological quality was assessed independently by two radiologists according to PRISMA guidelines. Results: This systematic review identified 503 low-risk PTMCs in 470 patients treated by thermal ablation from 9 studies. During follow-up, no patient experienced local tumor recurrence or distant metastasis, whereas two patients (0.4%) experienced lymph node (LN) metastasis. One patient (0.2%) developed a new PTMC, which was successfully treated by additional ablation. Five patients (1.1%) underwent delayed surgery after ablation, including the two patients with LN metastasis and three additional patients with unknown etiology. Conclusions: Thermal ablation is an excellent local tumor control method in patients with low-risk PTMCs. Strict inclusion criteria and technical expertise are required to obtain favorable results.
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Affiliation(s)
- Se Jin Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Rosario PW, Ward LS, Graf H, Vaisman F, Mourão GF, Vaisman M. Thyroid nodules ≤ 1 cm and papillary thyroid microcarcinomas: Brazilian experts opinion. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:456-461. [PMID: 31482953 PMCID: PMC10522266 DOI: 10.20945/2359-3997000000166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 06/19/2019] [Indexed: 11/23/2022]
Abstract
The indolent evolution of low-risk papillary thyroid microcarcinoma (mPTC) in adult patients and the consequences of thyroidectomy require a revision of the management traditionally recommended. Aiming to spare patients unnecessary procedures and therapies and to optimize the health system in Brazil, we suggest some measures. Fine-needle aspiration of nodules ≤ 1 cm without extrathyroidal extension on ultrasonography should be performed only in nodules classified as "very suspicious" (i.e., high suspicion according to ATA, high risk according to AACE, TI-RADS 5) and in selected cases [age < 40 years, nodule adjacent to the trachea or recurrent laryngeal nerve (RLN), multiple suspicious nodules, presence of hypercalcitoninemia or suspicious lymph nodes]. Active surveillance (AS) rather than immediate surgery should be considered in adult patients with low-risk mPTC. Lobectomy is the best option in patients with unifocal low-risk mPTC who are not candidates for AS because of age, proximity of the tumor to the trachea or RLN, or because they opted for surgery. The same applies to patients who started AS but had a subsequent surgical indication not due to a suspicion of tumor extension beyond the gland or multicentricity. Molecular tests are not necessary to choose between AS and surgery or, in the latter case, between lobectomy and total thyroidectomy. The presence of RAS or other RAS-like mutations or BRAFV600E or other BRAF V600E-like mutations should not modify the management cited above; however, the rare cases of mPTC exhibiting high-risk mutations, like in the TERT promoter or p53, are not candidates for AS.
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Affiliation(s)
- Pedro Weslley Rosario
- Santa Casa de Belo HorizonteMinas GeraisMGBrasilSanta Casa de Belo Horizonte, Minas Gerais, MG, Brasil
| | - Laura Sterian Ward
- Universidade Estadual de CampinasFaculdade de Ciências MédicasUniversidade Estadual de CampinasSão PauloSPBrasilFaculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), São Paulo, SP, Brasil
| | - Hans Graf
- Universidade Federal do ParanáUniversidade Federal do ParanáCuritibaPRBrasilUniversidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
| | - Fernanda Vaisman
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
- Instituto Nacional do CâncerInstituto Nacional do CâncerRio de JaneiroRJBrasilInstituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brasil
| | - Gabriela Franco Mourão
- Santa Casa de Belo HorizonteMinas GeraisMGBrasilSanta Casa de Belo Horizonte, Minas Gerais, MG, Brasil
| | - Mario Vaisman
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
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Biamonte E, Solbiati L, Ierace T, Colombo P, Lavezzi E, Mazziotti G, Lania A. Medullary thyroid carcinoma treated with percutaneous ultrasound-guided radiofrequency ablation. Endocrine 2019; 65:515-519. [PMID: 31273680 DOI: 10.1007/s12020-019-01995-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/23/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Minimally invasive image-guided thermal ablation has been proposed as alternative to surgery for treatment of benign thyroid nodules and recurrent differentiated thyroid carcinoma. Here, we report for the first time the use of radiofrequency ablation (RFA) in a patient with non-metastatic medullary thyroid carcinoma (MTC) who did not undergo surgery due to high anesthesiological risk. METHODS AND RESULTS A 64-year-old woman was referred to our institution for a routine endocrinological visit. No thyroid-related symptoms were present. She had a history of metabolic, cardiovascular and neurological diseases. On clinical examination, a nodular lesion of about 10 mm was palpable in the right thyroid lobe; ultrasonography (US) confirmed the presence of a 13 mm thyroid nodule in the lower pole of the right lobe, that was hypoechoic and with regular margins. Serum calcitonin (Ctn) level was significantly high (647 pg/mL). Fine-needle aspiration (FNA) of the thyroid nodule was negative for malignant cells, but the marked increase of Ctn level in the FNA wash-out fluid confirmed the diagnostic suspicion of MTC. Since patient refused surgery due to high anesthesiological risk, percutaneous US-guided RFA in single session was performed. At 6-months follow-up the serum Ctn level decreased from the initial value of 647 pg/mL, reaching near-normal range (15 pg/mL), and neck ultrasound showed a complete necrosis of the tumour. Afterward, serum Ctn slowly increased to 49 pg/mL at 15-month follow-up. The US performed at 6 and 12 months of follow-up revealed fibrotic tissue in place of the thyroid nodule, without evidence of cervical lymph-node metastases. CONCLUSIONS This clinical case suggests that RFA may be effective and safe for treatment of MTC when surgery cannot be performed.
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Affiliation(s)
- Emilia Biamonte
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, 20089, Rozzano, MI, Italy
- Endocrine, Diabetes and Andrology Unit, Humanitas Clinical and Research Center, 20089, Rozzano, MI, Italy
| | - Luigi Solbiati
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, 20089, Rozzano, MI, Italy
- Department of Radiology, Humanitas Clinical and Research Center, 20089, Rozzano, MI, Italy
| | - Tiziana Ierace
- Department of Radiology, Humanitas Clinical and Research Center, 20089, Rozzano, MI, Italy
| | - Paolo Colombo
- Endocrine, Diabetes and Andrology Unit, Humanitas Clinical and Research Center, 20089, Rozzano, MI, Italy
| | - Elisabetta Lavezzi
- Endocrine, Diabetes and Andrology Unit, Humanitas Clinical and Research Center, 20089, Rozzano, MI, Italy
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, 20089, Rozzano, MI, Italy.
- Endocrine, Diabetes and Andrology Unit, Humanitas Clinical and Research Center, 20089, Rozzano, MI, Italy.
| | - Andrea Lania
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, 20089, Rozzano, MI, Italy
- Endocrine, Diabetes and Andrology Unit, Humanitas Clinical and Research Center, 20089, Rozzano, MI, Italy
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Chen J, Cao J, Qiu F, Huang P. The Efficacy and The Safety of Ultrasound-guided Ablation Therapy for Treating Papillary Thyroid Microcarcinoma. J Cancer 2019; 10:5272-5282. [PMID: 31602278 PMCID: PMC6775625 DOI: 10.7150/jca.36289] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/12/2019] [Indexed: 12/16/2022] Open
Abstract
The prevalence of papillary thyroid microcarcinoma (PTMC) increases rapidly all around the world, but the management of PTMC hasn't reached a consensus. Recently, ultrasound-guided (US-guided) ablation therapy was introduced as a feasible treatment for low-risk PTMC. The clinical application of US-guided ablation therapy needs doctors' effort to investigate the efficacy and the safety of US-guided ablation in treating PTMC carefully. Although the present evidence showed some limitations, such as short-term study time spans and no randomized control design, in our perspective, US-guided thermal ablation therapy has good short-term efficacy and safety and is a promising PTMC's treatment in future clinical practice.
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Affiliation(s)
- Jifan Chen
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jing Cao
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fuqiang Qiu
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Pintong Huang
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Teng DK, Li HQ, Sui GQ, Lin YQ, Luo Q, Fu P, Du JR, Jin CX, Wang H. Preliminary report of microwave ablation for the primary papillary thyroid microcarcinoma: a large-cohort of 185 patients feasibility study. Endocrine 2019; 64:109-117. [PMID: 30771153 DOI: 10.1007/s12020-019-01868-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/08/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the safety and efficacy of microwave ablation (MWA) for primary papillary thyroid microcarcinoma (PTMC) with a large sample of 185 patients. METHODS A total of 185 patients underwent MWA for 206 primary PTMC nodules. They received ultrasound follow-up at 1, 3, 6, and 12 months after MWA and every 6 months thereafter. Nodule volumes were calculated at each follow-up and compared with those before MWA. Additionally, the volume reduction rate (VRR) of the nodules was calculated. Patients' thyroid functions were tested before and 1 month after MWA. RESULTS The mean follow-up time of the 185 patients was 20.7 ± 8.8 months (range 12-36 months). During the follow-up period, the mean volume of the 206 nodules was 100.1 ± 92.9 mm3 (range 3.6-423.9) before MWA, which decreased to 2.2 ± 5.6 mm3 (range 0-20.3 mm3) after MWA (P = 0.000). The mean VRR of the nodules was 98.65 ± 3.60% after MWA (range 83.85-100%). One hundred and seventy four of 206 nodules (84.5%) were fully absorbed. Compared with the preoperative results, no significant variation in thyroid function was observed 1 month after MWA. Thirty-eight patients (20.5%) had different types of complications, ranging from minor to major. Five patients (2.7%) had hoarseness, 11 patients (5.9%) had bleeding, 21 patients (11.4%) had earache or toothache, and one patient had another lesion 1 month after MWA. CONCLUSIONS This preliminary study suggests that MWA is safe and effective in the treatment of primary PTMC and offers a new alternative for clinical treatment.
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Affiliation(s)
- Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - He-Qun Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Guo-Qing Sui
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Yuan-Qiang Lin
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Qiang Luo
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Ping Fu
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Jia-Rui Du
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Chun-Xiang Jin
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China.
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Zhou W, Chen Y, Zhang L, Ni X, Xu S, Zhan W. Percutaneous Microwave Ablation of Metastatic Lymph Nodes from Papillary Thyroid Carcinoma: Preliminary Results. World J Surg 2018; 43:1029-1037. [DOI: 10.1007/s00268-018-04879-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Mauri G, Nicosia L, Della Vigna P, Varano GM, Maiettini D, Bonomo G, Giuliano G, Orsi F, Solbiati L, De Fiori E, Papini E, Pacella CM, Sconfienza LM. Percutaneous laser ablation for benign and malignant thyroid diseases. Ultrasonography 2018; 38:25-36. [PMID: 30440161 PMCID: PMC6323312 DOI: 10.14366/usg.18034] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive image-guided thermal ablation is becoming increasingly common as an alternative to surgery for the treatment of benign thyroid nodules. Among the various techniques for thermal ablation, laser ablation (LA) is the least invasive, using the smallest applicators available on the market and enabling extremely precise energy deposition. However, in some cases, multiple laser fibers must be used simultaneously for the treatment of large nodules. In this review, the LA technique is described, and its main clinical applications and results are discussed and illustrated.
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Affiliation(s)
- Giovanni Mauri
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Luca Nicosia
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Paolo Della Vigna
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Gianluca Maria Varano
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Daniele Maiettini
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Guido Bonomo
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | | | - Franco Orsi
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Luigi Solbiati
- Department of Radiology, Humanitas University, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Elvio De Fiori
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Enrico Papini
- Endocrinology Department, Regina Apostolorum Hospital, Albano Laziale, Italy
| | - Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Rome, Italy
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
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