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Yang Z, Zhang M, Yan L, Xiao J, Li Y, Li X, Luo Y. Value of radiofrequency ablation for treating locally recurrent thyroid cancer: a systematic review and meta-analysis for 2-year follow-up. Endocrine 2024:10.1007/s12020-023-03660-9. [PMID: 38801598 DOI: 10.1007/s12020-023-03660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating locoregional recurrent thyroid cancer (LRTC) after a 2-year follow-up time. METHODS PubMed, Embase and Cochrane Library were searched from inception until 20 September 2022 to find studies reporting the safety and efficacy of RFA in LRTC patients after a 2-year follow-up. Two radiologists performed the data extraction and methodological quality assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS We analyzed 6 studies, 229 LRTC patients with 319 locally recurrent tumors were treated with RFA. The mean follow-up time of each study was ≥24 months. The pooled changes in the largest diameter and volume were 7.22 mm (95% confidence interval (CI), 6.35-8.09 mm) and 164.28 mm3 (95% CI, 87.78-240.77 mm3), respectively; the pooled volume reduction rate was 95.03% (95% CI, 87.56-102.49%). The total complete disappearance rate after treatment was 92% (95% CI, 83-100%). The pooled decrease of serum thyroglobulin levels was 0.02 ng/ml (95% CI, -0.00-0.04 ng/ml). The pooled proportion of recurrence rate was 6% (95% CI, 0-13%). The pooled complication rate was 5% (95% CI, 0-10%). The major complications were voice change and hoarseness, only one patient developed permanent vocal cord paralysis; minor complications were cough and pain. CONCLUSIONS Ultrasound-guided RFA is an effective and safe treatment for LRTC based on 2-year follow-up results.
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Affiliation(s)
- Zhen Yang
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Lin Yan
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Xinyang Li
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China.
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Xiao X, Zhu Y, Li L, Liao Y, Li N. The effectiveness and safety of thermal ablation for thyroid carcinoma lymph node metastasis are affected by the diameter of metastatic lymph nodes: A meta-analysis. Surgery 2024:S0039-6060(24)00233-2. [PMID: 38777658 DOI: 10.1016/j.surg.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/17/2024] [Accepted: 04/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND To explore the diameter of lymph nodes with metastatic thyroid carcinoma and the effectiveness and safety of thermal ablation. METHODS Several databases were searched for literature on the treatment of thyroid carcinoma metastatic lymph nodes by thermal ablation. A subgroup analysis was performed according to the diameter of the metastatic lymph nodes. The measures included pooled estimates of mean volume reduction, pooled proportions of total disappearance and recurrence, and the pooled proportions of overall complications. RESULTS There were 20 studies with 372 patients and 620 metastatic lymph nodes included. Based on the average maximum diameter of the metastatic lymph nodes, they were divided into three groups: A (≤ 10 mm), B (10 < diameter ≤ 20 mm), and C (> 20 mm). The study results indicated a significant decrease in the average volume only in groups A and B. The ratio of tumor disappearance showed that group A had the highest percentage, followed by group B and then group C. The recurrence rates were comparable between groups A and B, but slightly lower than in group C. Moreover, the overall complication rates for the three groups were ranked as follows: group A > group C > group B. CONCLUSION Overall, thermal ablation is an effective and safe treatment for thyroid cancer metastatic lymph nodes with diameters of 10-20mm.
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Affiliation(s)
- Xiaoyi Xiao
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yun Zhu
- Department of Ultrasound, The First Hospital of Hunan University of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, People's Republic of China
| | - Linzhe Li
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yacong Liao
- The Second Xiangya Hospital of Central South University, Ultrasound Changsha, Hunan, People's Republic of China
| | - Na Li
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
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Zhang S, Liu Y, Zhou B, Xu H. Efficacy and safety of percutaneous ultrasound-guided thermal ablation in the treatment of cervical metastatic lymph nodes from papillary thyroid carcinoma. Clin Hemorheol Microcirc 2024; 87:77-87. [PMID: 38250765 DOI: 10.3233/ch-231998] [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] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of percutaneous ultrasound-guided thermal ablation in the treatment of cervical metastatic lymph nodes (LNs) from papillary thyroid carcinoma (PTC). MATERIALS AND METHODS A total of 77 patients with 79 LNs ablated by microwave ablation (MWA) or radiofrequency ablation (RFA) between September 2018 and October 2022 were enrolled in this study. After treatment, patients were followed up with measurement of diameters of LNs and serum thyroglobulin (s-Tg) at 1, 3, 6, and 12 months and annually thereafter. The paired t-test was used to compare the changes of s-Tg level, diameters of LNs before and after ablation. RESULTS There were no serious complications related to ablation while one case of incomplete ablation in MWA was found during follow-up. The mean longest and shortest diameter of the ablated LNs reduced from 11.6 ± 4.3 mm to 5.0 ± 4.1 mm (p < 0.001), and from 6.1 ± 1.9 mm to 3.0 ± 2.5 mm (p < 0.001) at the last follow-up visit. Besides, the final volume reduction rate (VRR) was 61.8 ± 56.4% (range, -67.0 -100%). The complete disappearance rate was 46.8%, but there were 4 (5.1%) LNs becoming bigger than before. The average s-Tg level was 9.2 ± 26.6 ng/mL, a data significantly decreased to 3.7 ± 7.0 ng/mL at the last follow-up, but no statistical difference was shown. CONCLUSION Thermal ablation is an effective and safe modality for the treatment of metastatic LNs from PTC.
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Affiliation(s)
- Shen Zhang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China
- Department of Medical Ultrasound, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Yunyun Liu
- Department of Medical Ultrasound, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Bangguo Zhou
- Department of Medical Ultrasound, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Huixiong Xu
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai, China
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Kandil E, Issa PP, Randolph GW. Can Thyroid Nodules be Managed with Radiofrequency Ablation? Adv Surg 2023; 57:87-101. [PMID: 37536864 DOI: 10.1016/j.yasu.2023.05.004] [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] [Indexed: 08/05/2023]
Abstract
Radiofrequency ablation (RFA) is an established and growing minimally-invasive technique with an impressive safety profile used to manage thyroid nodules. Beyond shorter operative and recovery times, the main advantages of RFA include the lack of an incisional scar as well as maximizing the potential for maintenance of normal thyroid function. RFA can significantly reduce nodular volume, achieving rates of 60% to 95% in a breadth of thyroid disease, including benign nodules, primary carcinomas, and recurrent malignancies. Thorough patient counselling is imperative for RFA candidates, including a discussant of complications, nodule regrowth, and the potential for a subsequent ablation session.
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Affiliation(s)
- Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Peter P Issa
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
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Schleder S, Jung EM, Schicho A, Schreyer AG, Habicher W, Grassinger J, Dollinger M. Efficacy and safety of ultrasound-guided core needle biopsies (US-CNBs) in cervical lymphadenopathy in patients with suspected head and neck cancer during the COVID-19 pandemic. Clin Hemorheol Microcirc 2023; 83:397-408. [PMID: 36683499 DOI: 10.3233/ch-221680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cervical lymphadenopathy can be benign or malignant. Its accurate diagnosis is necessary to determine appropriate treatment. Ultrasound-guided core needle biopsies (US-CNBs) are frequently used as a percutaneous sampling approach. OBJECTIVES Our aim was to identify the efficacy and safety of US-CNBs in 125 patients with cervical lymphadenopathy and clinically suspected head and neck cancer during the COVID-19 pandemic with limited surgical resources. METHODS US-CNBs of pathological lymph nodes were performed in 146 lymph nodes on 125 patients. Biopsies were performed ultrasound-guided with a reusable gun core biopsy system and a 10-cm-long 16-G needle. Standard of reference for the histological findings were panendoscopy, clinical and sonographic follow-up, surgical biopsy or a repeat US-CNB. RESULTS Adequate material for histologic diagnosis was obtained in 111 patients (89%), of these 83 patients (75%) were diagnosed as malignant, whereas benign lymphadenopathy accounted for 28 patients (25%). Therefore, US-CNB was able to identify malignant or benign lymphadenopathy with an overall accuracy of 88% and 90%, respectively. CONCLUSIONS Percutaneous US-CNB is a safe and effective alternative to surgical biopsy in the management of cervical lymphadenopathy in patients with clinically suspected head and neck cancer in a setting with limited resources.
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Affiliation(s)
- Stephan Schleder
- Department of Diagnostic and Interventional Radiology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Schicho
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas G Schreyer
- Department of Diagnostic and Interventional Radiology, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Werner Habicher
- Department of Othorhinolaryngology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Jochen Grassinger
- Department of Hematology and Oncology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Marco Dollinger
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Zhu Y, Wang Y, Liu F, Liao Y, Wang Q, Xiao X. Thermal ablation for cervical lymph node metastasis from papillary thyroid carcinoma: A meta-analysis. Medicine (Baltimore) 2022; 101:e32193. [PMID: 36595775 PMCID: PMC9794307 DOI: 10.1097/md.0000000000032193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Traditionally, surgery has been the standard treatment for cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC). However, thermal ablation is currently recommended by several guidelines. This study aimed to evaluate the efficacy and safety of thermal ablation for lymph node metastasis in patients with PTC. METHODS We searched PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases until March 2022 to collect studies on thermal ablation (including radiofrequency, microwave, and laser ablations) for cervical lymph node metastasis from PTC. RESULTS A total of 190 patients were included, ranging from 5 to 39 in each study, with a sex ratio (male/female) ranging from 1/4 to 17/20, an average age ranging from 15.6 ± 3.0 to 62.3 ± 13.2 (yr), and a total of 270 cervical lymph nodes, ranging from 8 to 98. The follow-up results showed that thermal ablation significantly reduced the maximum diameter and volume of metastatic lymph nodes in PTC (P < .01). The pooled complete disappearance rate was 86% (95% confidence interval 79% to 93%). Thyroglobulin levels were significantly lower after surgery (P < .01). No major complications occurred, and the combined voice change rate was as low as 1% [CI 0% to 3%]. CONCLUSION Our meta-analysis showed that thermal ablation is an effective and safe method for the treatment of cervical lymph node metastases from PTC. Considering the limitations of this study, more prospective, multicenter, large-sample studies are needed in the future.
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Affiliation(s)
- Yun Zhu
- Department of Ultrasound, The First Hospital of Hunan University of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410021, People’s Republic of China
| | - Yueai Wang
- Department of Ultrasound, The First Hospital of Hunan University of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410021, People’s Republic of China
| | - Fang Liu
- Department of Ultrasound, The First Hospital of Hunan University of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410021, People’s Republic of China
| | - Yacong Liao
- Department of Ultrasound, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, People’s Republic of China
| | - Qun Wang
- Department of Ultrasound, The First Hospital of Hunan University of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410021, People’s Republic of China
| | - Xiaoyi Xiao
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, People’s Republic of China
- * Correspondence: Xiaoyi Xiao, Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Yuelu District, Changsha, Hunan 410013, People’s Republic of China (e-mail: )
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Yan L, Li X, Li Y, Xiao J, Zhang M, Luo Y. Comparison of ultrasound-guided radiofrequency ablation versus thyroid lobectomy for T1bN0M0 papillary thyroid carcinoma. Eur Radiol 2022; 33:730-740. [PMID: 35895122 DOI: 10.1007/s00330-022-08963-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/16/2022] [Accepted: 06/11/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To investigate and compare the clinical outcomes between radiofrequency ablation (RFA) and thyroid lobectomy (TL) for T1bN0M0 papillary thyroid carcinoma (PTC). METHODS This retrospective study evaluated 283 patients with solitary T1bN0M0 PTC treated with RFA (RFA group, 91 patients) or TL (TL group, 192 patients) from May 2014 to November 2018. The patients were regularly followed up after treatment. Local tumor progression, lymph node metastasis (LNM), recurrent tumor, persistent tumor, recurrence-free survival (RFS), treatment variables (hospitalization, procedure time, estimated blood loss, and cost), complication, and delayed surgery were compared. RESULTS During the follow-up (median [interquartile ranges], 50.4 [18.0] months), no significant differences were found in the local tumor progression (4.4% vs 3.6%, p = 1.000), LNM (1.1% vs 2.1%, p = 0.917), recurrent tumor (2.2% vs 1.6%, p = 1.000), persistent tumor (1.1% vs 0%, p = 0.146), and RFS rate (95.6% vs 96.4%, p = 0.816) in the RFA and TL groups. Distant metastasis was not detected. Patients in the RFA group had a shorter hospitalization (0 vs 7.0 [3.0] days, p < 0.001), shorter procedure time (5.6 [2.9] vs 90.0 [38.5] min, p < 0.001), lower estimated blood loss (0 vs 20 [20] mL, p < 0.001), lower cost ($1972.5 [0.1] vs $2362.4 [1009.3], p < 0.001), and lower complication rate (0 vs 12/192 [6.3%], p = 0.015) than those in the TL group. No patients in the RFA group underwent delayed surgery. CONCLUSIONS This study revealed comparable 4-year clinical outcomes between RFA and TL for T1bN0M0 PTC in terms of local tumor progression and RFS. As a minimally invasive modality, RFA may be a promising feasible alternative to surgery for the treatment of T1bN0M0 PTC in selected patients after strict evaluation. KEY POINTS • No significant difference in local tumor progression and RFS was found between RFA and TL for T1bN0M0 PTC during a median follow-up period of 50.4 months. • Compared with TL, RFA led to a shorter hospitalization, lower estimated blood loss, lower cost, and lower complication rate. • RFA may be a promising feasible alternative to surgery for the treatment of T1bN0M0 PTC in selected patients after strict evaluation.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xinyang Li
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jing Xiao
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Mingbo Zhang
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Tang W, Sun W, Niu X, Wang X, Wang X, Zhang M, Wang R, Jiang W, Jiang D, Zhao C. Evaluating the safety and efficacy of microwave ablation in treatment of cervical metastatic lymph nodes of papillary thyroid carcinoma compared to repeat surgery. Int J Hyperthermia 2022; 39:813-821. [PMID: 35719117 DOI: 10.1080/02656736.2022.2086713] [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: 01/27/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of microwave ablation (MWA) versus repeat surgery for treating metastatic lymph nodes (MLNs) in papillary thyroid carcinoma (PTC). METHODS Between July 2017 and October 2020, 67 patients were enrolled in this retrospective study. 19 and 48 patients underwent MWA and repeat surgery, respectively. The primary and secondary endpoints were recurrence-free survival and complication rates, respectively. The largest diameter, volume and volume reduction ratio (VRR) were analyzed before and after MWA. The effects of different ablation powers on the largest diameter, volume and VRR were investigated. Pre and posttreatment variables (e.g., baseline characteristics, serum thyroglobulin [Tg] levels, hospitalization time, treatment costs, recurrence-free survival and complication rates) were compared between groups. RESULTS The largest diameter and volume postablation at each follow-up were smaller than the preablation levels (p < 0.05), except at the 1-month follow-up (p > 0.05). The largest diameter, volume, and VRR among the different ablation powers were not significantly different (p > 0.05). The mean serum Tg levels and biochemical remission rates were not significantly different between the groups (p > 0.05). Compared to reoperation, MWA had a shorter hospitalization time and lower treatment cost (p < 0.001). Total and minor complications were higher in the reoperation group (p < 0.05), but major complications were comparable (p > 0.05). The recurrence-free survival rate between groups was not significantly different (p = 0.401). The 1- and 3-year recurrence-free survival rates were comparable between the groups. CONCLUSIONS MWA may be a safe and effective alternative to repeat surgery for treating MLNs of PTC in select patients.
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Affiliation(s)
- Wanqing Tang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenhai Sun
- Department of Thyroid, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoyan Niu
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xufu Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinya Wang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingzhu Zhang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Rongling Wang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenbin Jiang
- Health Management Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Danni Jiang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Zhao
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
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Ding Z, Chen J, Chen Z, Zeng X, Zheng P, Wang X, Cui X, Sang L. Efficacy and Safety of Thermal Ablation for Treating Lymph Node Metastasis From Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:738299. [PMID: 35433407 PMCID: PMC9010561 DOI: 10.3389/fonc.2022.738299] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/08/2022] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the efficacy and safety of thermal ablation, including radiofrequency ablation (RFA), microwave ablation (MVA), and laser ablation (LA), for treating lymph node metastasis (LNM) from papillary thyroid carcinoma (PTC). Design and Methods PubMed and EMBASE were searched for studies reporting the efficacy and safety of thermal ablation for treating LNM in PTC. After selecting the relevant literature (including 11 papers, 208 patients, 412 lymph nodes), the QUADAS-2 tool was used to evaluate its quality. Then, both the fixed-effects and random-effects models combined with subgroup analysis were used to calculate data on volume changes in metastatic lymph nodes and changes in serum thyroglobulin (Tg) levels. We pooled the proportion of major and overall complication rates and complete disappearance rates and used subgroup forest plots and funnel plots for visual representation. Because of publication bias, we also performed a trim-and-filled model for correction. The rate of recurrence and distant metastasis with ablated details were pooled. Results In the 11 articles (208 patients and 412 diseased lymph nodes), all thermal ablation methods showed effectiveness in reducing lymph node volume (P = 0.02) and serum Tg levels (P < 0.01) which showed no between-group difference. The pooled proportion of major complications was 0%(95% CI: -0.14; 0.15, P = 1) and the overall complication rate was 5% (95% CI: -0.09; 0.20, P = 1), which revealed no significant difference among modalities. The pooled proportion of the complete disappearance rate was 82% (95% CI: 0.43; 0.96, P < 0.01) and the data with statistical significance which contains RFA and LA showed complete disappearance rate was 59% and 81% respectively. Conclusion All thermal ablation methods, including RFA, MWA, and LA, were effective and safe for treating LNM in PTC and were especially suitable for nonsurgical patients. Besides, subgroup analysis showed no significant difference, except for LA is better than RFA in complete disappearance rate.
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Affiliation(s)
- Zheng Ding
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Juan Chen
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiguang Chen
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xiaoke Zeng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Pengchao Zheng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xuemei Wang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xinwu Cui
- Departmant of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xinwu Cui, ; Liang Sang,
| | - Liang Sang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
- *Correspondence: Xinwu Cui, ; Liang Sang,
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Zhang X, Ni T, Zhang W. Ultrasonography-Guided Thermal Ablation for Cervical Lymph Node Metastasis of Recurrent Papillary Thyroid Carcinoma: Is it Superior to Surgical Resection? Front Endocrinol (Lausanne) 2022; 13:907195. [PMID: 35832431 PMCID: PMC9272822 DOI: 10.3389/fendo.2022.907195] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
AIM The study aimed to systematically evaluate the safety and efficacy of ultrasonography-guided percutaneous thermal ablation in the treatment of cervical lymph node metastasis (LNM) of recurrent papillary thyroid carcinoma (PTC). METHODS PubMed, PubMed Central (PMC), Embase, and Cochrane were examined. The inclusion and exclusion criteria were determined and the relevant data were extracted from the library and other databases for LNM thermal ablation of recurrent PTC. The data were analyzed using Stata15.1, Revman5.3 software, and the standard errors of 95% confidence intervals were estimated using fixed or random effects models. Volume reduction rate (VRR), Serum thyroglobulin (Tg) level before and after thermal ablation, the total complications and major complications incidence were analyzed. RESULTS A total of 18 literature articles were included, namely, 10 radiofrequency ablation (RFA), 4 laser ablation (LA), and 4 microwave ablation (MWA). A total of 321 patients had 498 LNM. LNM volume changes before and at the last follow-up of thermal ablation (SMD = 1.04, I2 = 8%, 95% CI 0.86-1.21, P <0.0001). The postoperative lymph node VRR was 88.4% (95% CI 77.8-97.3%, I2 = 34%, P = 0.14). Tg measurements before and after thermal ablation (SMD = 1.15, 95% CI 0.69-1.60, I2 = 84%, P <0.0001). The incidence of total complications was 5.0% (95% CI 3.0-7.0%, I2 = 0.0%, P = 0.915), and the incidence of major complications was 4.0% (95% CI 2.0-6.0%, I2 = 0.0%, P = 0.888). A total of 131 LNM were located in the central region, and the major complication rate was 12.0% (95% CI 6.0-18.0%, I2 = 0.0%, P = 0.653). CONCLUSION Ultrasonography-guided thermal ablation is safe and effective in the treatment of LNM of recurrent PTC. The ablation strategy of central LNM needs to be further explored and improved. It can be used as an alternative to surgery for patients with high surgical risk or who refuse resurgery. SYSTEMATIC REVIEW REGISTRATION 10.37766/inplasy2022.6.0004, identifier INPLASY202260004.
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Tang W, Tang X, Jiang D, Zhang X, Wang R, Niu X, Zang Y, Zhang M, Wang X, Zhao C. Safety and efficacy of thermal ablation for cervical metastatic lymph nodes in papillary thyroid carcinoma: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:967044. [PMID: 36072932 PMCID: PMC9441577 DOI: 10.3389/fendo.2022.967044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/01/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) for the treatment of cervical metastatic lymph nodes (CMLNs) of papillary thyroid carcinoma (PTC). METHODS The Pubmed, EMBASE, Web of Science, and Cochrane Library databases were searched for studies on the safety and efficacy of thermal ablations (RFA, MWA, and LA) for the treatment of CMLNs of PTC until March 30, 2022. A review of 334 potential papers identified 17 eligible papers including 312 patients. Fixed-effects model or random-effects model was used to evaluate the pooled proportions of volume reduction rate (VRR), complete disappearance, and recurrence, and pooled estimates of changes in the largest diameter, volume, and serum Tg after ablation. The pooled proportions of overall and major complications were calculated. Subgroup analysis based on treatment modalities. The heterogeneity among studies was analyzed by using Q statistics and inconsistency index I2 . MINORS scale was used to evaluate the quality of the studies. RESULTS 17 eligible studies were finally identified, including 312 patients and 559 CMLNs. The pooled proportions of VRR, complete disappearance and recurrence of CMLNs were 91.28% [95% confidence interval (CI): 86.60-95.97%], 67.9% [95% CI: 53.1-81.1%] and 7.8% [95%CI: 3.0-14.1%], respectively. The pooled estimates of changes in the largest diameter, volume and serum Tg were 8.12 mm [95%CI: 6.78-9.46 mm], 338.75 mm3 [95%CI: 206.85 -470.65 mm3] and 5.96 ng/ml [95%CI: 3.68-8.24 ng/ml], respectively. The pooled proportions of overall and major complications were 2.9% [95%CI: 0.3-7.1%] and 0.3% [95%CI: 0-1.9%], respectively. Significant between-study heterogeneity was observed for complete disappearance (P<0.01, I2 =88.6%), VRR (P<0.001, I2 =99.9%), recurrence (P=0.02, I2 =47.76%), overall complications (P<0.02, I2 =44.8%), and changes in the largest diameter (P < 0.001, I2 =82.6%), volume (P<0.001, I2 =97.0%), and serum Tg (P < 0.001, I2 =93.7%). Subgroup analysis showed heterogeneity of the VRR among the treatment modality (I2 range: 84.4-100%). The VRR of MWA was the highest (97.97%), followed by RFA (95.57%) and LA (84.46%) (P < 0.001). CONCLUSION All thermal ablations were safe and effective for the treatment of CMLNs of PTC. However, each treatment had significant heterogeneity in VRR. Compared with RFA and MWA, LA was less effective in reducing the volume of CMLNs of PTC.
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Affiliation(s)
- Wanqing Tang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiuyun Tang
- Department of Ultrasound, Zibo Central Hospital, Zibo, China
| | - Danni Jiang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojuan Zhang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Rongling Wang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoyan Niu
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yichen Zang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingzhu Zhang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinya Wang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Zhao
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Cheng Zhao,
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Eilsberger F, Kreissl MC. Nuclear medicine therapy of thyroid cancer metastases. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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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Zhang Y, Wang K, Liu J, Xu S, Sun Y, Xu M, Wang X. Surgical management of parapharyngeal lymph node metastases from thyroid carcinoma with transcervical approach. Surgery 2021; 171:1233-1239. [PMID: 34711428 DOI: 10.1016/j.surg.2021.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/07/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Parapharyngeal lymph node metastasis is very rare in patients with thyroid carcinoma. In this study, we elucidated on the clinical features, diagnosis, surgical treatment, and outcomes for patients with parapharyngeal lymph node metastases from thyroid carcinoma. METHODS Patients with thyroid carcinoma who had been subjected to surgery through the transcervical approach at our institution between April 1999 and January 2019 were retrospectively enrolled in this study. RESULTS Parapharyngeal lymph node metastases were successfully resected through the transcervical approach in all the 97 patients. There were 32 treatment-naïve patients, while 65 patients had a history of treatment before parapharyngeal lymph node metastases. All 97 cases of parapharyngeal lymph node metastases were detected by enhanced CT scans. Lateral neck lymph nodes metastases were confirmed in 96 patients. Unexpected postoperative neurological side effects were reported in 11 (11%) patients, including dysphagia in 5 (5%) patients, Horner's syndrome in 2 (2%) patients, glossal deviation in 3 (3%) patients, and asymmetrical mouth in 1 (1%) patient. During the follow-up period, 6 of the 97 patients exhibited parapharyngeal lymph node recurrence (recurrence rate 6.2%). The incidence of distant metastases was 44.3% (43 out of 97). The 5- and 10-year disease-specific survival was 93.4% and 88.9%, respectively. CONCLUSION Parapharyngeal lymph node metastases should be considered in patients with widespread cervical lymph node metastases. Enhanced CT scan is one of the best methods for diagnosing such metastases. Surgical resection through the transcervical approach is an effective and safe option for patients with parapharyngeal lymph node metastases from thyroid carcinoma. Moreover, parapharyngeal lymph node metastasis is associated with distant metastases that may lead to poor prognosis.
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Affiliation(s)
- Ye Zhang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. https://twitter.com/yezhang1220
| | - Kai Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyuan Xu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Sun
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Xu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaolei Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Ultrasound-guided thermal ablation for cervical lymph node metastasis from thyroid carcinoma: a meta-analysis of clinical efficacy and safety. Lasers Med Sci 2021; 37:1747-1754. [PMID: 34617202 DOI: 10.1007/s10103-021-03428-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/24/2021] [Indexed: 02/05/2023]
Abstract
To evaluate the efficacy and safety of thermal ablation (radiofrequency, microwave, and laser) for treating lymph node metastasis from papillary thyroid carcinoma. A literature search was performed in the Medline, Embase, and Cochrane Library databases. Thirteen studies focusing on the efficacy and safety of thermal ablation for treating lymph node metastasis were eligible. The assessed outcomes were primarily pooled using a random- or fixed-effects model based on the results of the heterogeneity test. A total of 235 patients with 445 metastatic lymph nodes were included. Laser, microwave, and radiofrequency ablation all showed a significant reduction in maximum diameter and volume of metastatic lymph nodes (P < 0.0001). Microwave ablation had a higher volume reduction rate (99%; 95% CI, 98-100%) comparing to the other two techniques (P = 0.0057). For all ablations, the pooled completely disappear rate was 70% (95% CI, 45-87%) and the recurrent rate was 3% (95% CI, 2-5%). Thyroglobulin levels significantly decreased (P < 0.0001). No major complications were encountered; the pooled proportion of voice change was low to 4% (95% CI, 2-7%). Thermal ablation is acceptable treatments to manage lymph nodes metastasis from papillary thyroid carcinoma in terms of efficacy and safety for non-surgical candidates.
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16
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Zhu Y, Che Y, Gao S, Ren S, Tong M, Wang L, Yang F. Long-term follow-up results of PTMC treated by ultrasound-guided radiofrequency ablation: a retrospective study. Int J Hyperthermia 2021; 38:1225-1232. [PMID: 34402363 DOI: 10.1080/02656736.2021.1963850] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To confirm the long-term efficacy and safety of radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC). METHODS We retrospectively reviewed data of 102 primary papillary thyroid carcinoma patients (82 women, 20 men; mean age: 43 [19] years) treated with radiofrequency ablation and thyroid-stimulating hormone (TSH) suppression therapy before December 2018. All patients were at high surgical risk or refused surgery. They were followed up at 1, 3, 6, 9, and 12 months and every 6-12 months thereafter using ultrasound and contrast-enhanced ultrasound. The volume and volume reduction ratio was calculated. Recurrence and lymph node or distant metastasis were evaluated. RESULTS The mean initial tumor diameter was 0.50 (0.29) cm; the mean initial volume was 0.06 (0.09) mL. At 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after RFA, complete resorption rates were 0, 0, 9.8 (10/102), 33.3 (34/102), 91.2 (93/102), 96.1 (98/102), 99 (101/102), 100, and 100%, respectively. Two patients had developed ipsilateral neck lymph node metastasis in regions IV and VI at 30- and 18-month follow-ups, respectively. After RFA, 3/102 patients (2.9%) developed hoarseness-the main side effect. No life-threatening or delayed complications occurred. The TSH value in the initial period was 0.06 (0.02) µIU/mL; the rate of reaching the TSH target was 85.7%. The TSH value at follow-up was 1.47 (0.91) µIU/mL; the compliance rate was 99.3%. CONCLUSIONS Ultrasound-guided RFA for PTMC is highly effective and safe. RFA can serve as a minimally invasive treatment for PTMC patients who refuse surgery or active surveillance.
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Affiliation(s)
- Yalin Zhu
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Che
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuhang Gao
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuangsong Ren
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mengying Tong
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lina Wang
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fang Yang
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Chen W, Luo YK, Zhang Y, Song Q, Tang J. Ultrasound-guided implantation of radioactive 125I seed in radioiodine refractory differentiated thyroid carcinoma. BMC Cancer 2021; 21:834. [PMID: 34284748 PMCID: PMC8290620 DOI: 10.1186/s12885-021-08500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment for radioiodine refractory differentiated thyroid carcinoma (RR-DTC) is challenging. The purpose of this study was to assess the efficacy and safety of ultrasound-guided implantation of radioactive 125I-seed in radioiodine refractory differentiated thyroid carcinoma. METHODS Thirty-six cervical metastatic lymph nodes (CMLNs) diagnosed with RR-DTC from 18 patients were enrolled in this retrospective study. US and contrast-enhanced ultrasound (CEUS) examinations were performed before implantation. Follow-up comprised US, CEUS, thyroglobulin (Tg) level and routine hematology at 1-3, 6, 9 and 12 months and every 6 months thereafter. The volumes of the nodules were compared before implantation and at each follow-up point. The volume reduction rate (VRR) of nodules was also recorded. RESULTS The median volume of the nodules was 523 mm3 (148, 2010mm3) initially, which decreased significantly to 53mm3 (0, 286mm3) (P < 0.01) at the follow-up point of 24 months with a median VRR as 95% (86,100%). During the follow-up period (the range was 24-50 months), 25 (69%) nodules had VRR greater than 90%, of which 12 (33%) nodules had VVR ≈ 100% with unclear structures and only 125I seed images were visible in the US. At the last follow-up visit, the serum Tg level decreased from 57.0 (8.6, 114.8) ng/ml to 4.9 (0.7, 50.3) ng/ml, (P < 0.01). CONCLUSION US-guided 125I seed implantation is safety and efficacy in treating RR- DTC. It could be an effective supplement for the comprehensive treatment of thyroid cancer.
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Affiliation(s)
- Wei Chen
- Department of Ultrasound, The Seventh Medical Center, Medical College of PLA, Chinese PLA General Hospital, Beijing, China
| | - Yu Kun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Ying Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, The Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Shen K, Xue S, Xie Y, Wang H, Li J, Sun Y, Wang K, Xu G, Guo T, Fan B, Zhu L, Ren A. Comparison of thermal ablation and routine surgery for the treatment of papillary thyroid microcarcinoma: a systematic review and Meta-analysis. Int J Hyperthermia 2021; 37:913-924. [PMID: 32722973 DOI: 10.1080/02656736.2020.1777331] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Thermal ablation (TA), as an alternative to surgery, has shown some benefits in the treatment of papillary thyroid microcarcinoma (PTMC) patients, especially for those who are at high risk for surgery or refuse surgery. We performed a systematic review and meta-analysis to evaluate the efficiency, safety, and economy of TA, compared with those of routine surgery (RS), for the treatment of PTMC. METHODS PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases were retrieved from inception to 10 January 2020 to identify relevant original studies on comparison of TA and RS for treatment of PTMC. The recurrence rate, recurrence-free survival (RFS), complication rate, operation time, postoperative length of stay, and cost during the perioperative period were extracted as main indices. The pooled standardized mean difference (SMD) or odds ratio (OR) with 95% confidence intervals (CI) were calculated and analyzed. Chi-square test and I 2 statistic were applied to determine the heterogeneity among studies. The sensitivity analysis was applied to explore the origin of heterogeneity, and the publication bias was evaluated by Egger's test. RESULTS Seven retrospective studies with a total of 867 patients met the eligibility criteria and were included in the final meta-analysis. Our study demonstrated that TA showed significant reduction in complication with a pooled OR 0.24 (95% CI 0.13 to 0.43), postoperative length of stay with a pooled SMD -3.14 (95% CI -4.77 to -1.51) and cost during the perioperative period with a pooled SMD of -1.69 (95% CI -3.18 to -0.20). It also demonstrated that both TA and RS had similar pooled proportion of recurrence of OR 0.93 (95% CI 0.38 to 2.30) and recurrence-free survive (RFS). The sensitivity analysis showed that each included study had no significant effect on the results and the results were stable and reliable. The Egger's test demonstrated publication bias was acceptable. CONCLUSIONS TA may not be oncologically inferior to RS, and it is a relatively safe and economical alternative for the treatment of PTMC.
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Affiliation(s)
- Kangjie Shen
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Shengbai Xue
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Yi Xie
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Hongye Wang
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Jing Li
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yifan Sun
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Kexuan Wang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Guochao Xu
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Tao Guo
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Boqiang Fan
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingjun Zhu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Anjing Ren
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Future Considerations and Directions for Thermal Ablative Technologies. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00344-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Filippiadis D, Charalampopoulos G, Tsochatzis A, Reppas L, Mazioti A, Kelekis A, Kelekis N. Feasibility and safety of percutaneous computed tomography guided radiofrequency ablation of lymph nodes in oligometastatic patients: a single center's experience. Br J Radiol 2021; 94:20200445. [PMID: 33756082 DOI: 10.1259/bjr.20200445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To retrospectively evaluate feasibility and safety of CT-guided percutaneous radiofrequency ablation (RFA) of metastatic lymph nodes (LN) in terms of achieving local tumor control. METHODS Institutional database research identified 16 patients with 24 metastatic LNs who underwent percutaneous CT-guided radiofrequency ablation. Mean patient age was 66.6 ± 15.70 years (range 40-87) and male/female ratio was 8/8. Contrast-enhanced CT or MRI was used for post-ablation follow-up. Patient and tumor characteristics and RFA technique were evaluated. Technical and clinical success on per tumor and per patient basis as well as complication rates were recorded. RESULTS Mean size of the treated nodes was 1.78 ± 0.83 cm. The mean number of tumors per patient was 1.5 ± 0.63. The mean procedure time was 56.29 ± 24.27 min including local anesthesia, electrode(s) placement, ablation and post-procedural CT evaluation. Median length of hospital stay was 1.13 ± 0.34 days. On a per lesion basis, the overall complete response post-ablation according to the mRECIST criteria applied was 75% (18/24) of evaluable tumors. Repeat treatment of an index tumor was performed on two patients (three lesions) with complete response achieved in 87.5% (21/24) of evaluable tumors following a second RFA. On a per patient basis, disease progression was noted in 10/16 patients at a mean of 13.9 ± 6.03 months post the ablation procedure. CONCLUSION CT-guided percutaneous RFA for oligometastatic LNs is a safe and feasible therapy. ADVANCES IN KNOWLEDGE With this percutaneous therapeutic option, metastatic LNs can be eradicated with a very low complication rate.
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Affiliation(s)
- Dimitrios Filippiadis
- Diagnostic and Interventional Radiology 2nd Radiology Dpt, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens 1 Rimini str, 12462, Haidari/Athens, Greece
| | - George Charalampopoulos
- Consultant of Diagnostic Radiology, 2Radiology Dpt, University General Hospital "ATTIKON", 1 Rimini str, 12462, Athens/GR, Greece
| | - Athanasios Tsochatzis
- Residentof Diagnostic Radiology, 2Radiology Dpt, University General Hospital "ATTIKON", 1 Rimini str, 12462, Athens/GR, Greece
| | - Lazaros Reppas
- Consultant of Diagnostic Radiology, 2Radiology Dpt, University General Hospital "ATTIKON", 1 Rimini str, 12462, Athens/GR, Greece
| | - Argyro Mazioti
- Consultant of Diagnostic Radiology, 2Radiology Dpt, University General Hospital "ATTIKON", 1 Rimini str, 12462, Athens/GR, Greece
| | - Alexis Kelekis
- Diagnostic and Interventional Radiology 2nd Radiology Dpt, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens 1 Rimini str, 12462, Haidari/Athens, Greece
| | - Nikolaos Kelekis
- Diagnostic and Interventional Radiology 2nd Radiology Dpt, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens 1 Rimini str, 12462, Haidari/Athens, Greece
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Qin X, Wang B, Li B, Lin C, Liu X, Xie X. Value of contrast-enhanced ultrasonography in radiofrequency ablation of secondary hyperparathyroidism. Ren Fail 2021; 43:445-451. [PMID: 33663332 PMCID: PMC7939554 DOI: 10.1080/0886022x.2021.1889601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The purpose of the current study was to determine the performance of contrast-enhanced ultrasound (CEUS) in the assessment of radiofrequency ablation (RFA) of hyperplastic parathyroid glands due to secondary hyperparathyroidism (SHPT). Methods Thirty-two patients, each with ≥4 hyperplastic parathyroid glands due to SHPT, underwent RFA via hydro-dissection. CEUS was performed in each patient before and during RFA. The patients in whom the intact parathyroid hormone (iPTH) level did not decrease to 300 pg/ml were examined by CEUS. The iPTH, serum calcium, and serum phosphorus levels before and after RFA were compared. Results Ablation was achieved in all patients (131 ablated glands). The volume of the glands was 479.88 ± 549.3mm3. The pre-operative and day 1 post-operative iPTH levels were 2355 ± 1062 and 292.7 ± 306.8 pg/ml, respectively. Three nodules in three patients showed little enhancement on CEUS on post-operative day 1. The iPTH level was <300 pg/mL on post-operative day 1 in 23 patients, which indicated complete ablation; follow-up evaluations were therefore performed. The pre- and post-operative iPTH levels in the 23 patients were 2113 ± 787.2 and 106.2 ± 84.62 pg/ml, respectively (p < 0.05), and the 6- and 12-month post-operative iPTH levels were 111.1 ± 56.57 and 117.6 ± 97.08 pg/ml, respectively (p > 0.05). Conclusions CEUS-guided RFA is effective and feasible for the treatment of ≥4 hyperplastic parathyroid glands. CEUS was shown to assist the surgeon before, during, and after RFA. CEUS on post-operative day 2, but not immediately post-operatively, was shown to accurately reflect gland perfusion.
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Affiliation(s)
- Xiachuan Qin
- Department of Ultrasound, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nan Chong, Peoples Republic of China
| | - Baofu Wang
- Department of Nephrology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nan Chong, Peoples Republic of China
| | - Boliang Li
- Department of Nephrology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nan Chong, Peoples Republic of China
| | - Changwei Lin
- Department of Nephrology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nan Chong, Peoples Republic of China
| | - Xuebin Liu
- Department of Ultrasound, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nan Chong, Peoples Republic of China
| | - Xisheng Xie
- Department of Nephrology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nan Chong, Peoples Republic of China
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22
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Cao XJ, Liu J, Zhu YL, Qi L, Liu G, Wang HL, Wang ZH, Zhou Y, He JF, Guo JQ, Shi LL, Jian M, Shataer A, Yan GZ, Zhao ZL, Wei Y, Peng LL, Li Y, Che Y, Wang SR, Yu MA. Efficacy and Safety of Thermal Ablation for Solitary T1bN0M0 Papillary Thyroid Carcinoma: A Multicenter Study. J Clin Endocrinol Metab 2021; 106:e573-e581. [PMID: 33107573 DOI: 10.1210/clinem/dgaa776] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ultrasound-guided thermal ablation plays an important role in the management of thyroid disease. The objective of this study was to evaluate the feasibility, efficacy, and safety of thermal ablation for patients with solitary T1bN0M0 papillary thyroid carcinoma (PTC) who are ineligible for or unwilling to undergo surgery. MATERIALS AND METHODS Data pertaining to 172 patients (38 males and 134 females) who received thermal ablation therapy at 12 hospitals between April 2015 and March 2020 were retrospectively analyzed. The mean duration of follow-up was 24.9 ± 14.1 months (range, 12-60). The technical feasibility, technical success, efficacy, and safety of treatment were analyzed. Postablation tumor size at various time points was compared with preablation measurement. RESULTS All patients selected for thermal ablation received enlarged ablation, according to contrast-enhanced ultrasound postablation. The maximum diameter and volume of ablation zone at 6, 12, 18, 24, 36, and 48 months postablation were significantly smaller than those recorded preablation (P < 0.05 for all). At the most recent follow-up, 106 (61.6%) tumors had completely disappeared. The rate of lymph node metastasis was 0.6% (1/172) and the incidence of new tumors was 1.2% (2/172). The overall complication rate was 5.2% (9/172) (major complications: 4.6% [8/172]; minor complications: 0.6% [1/172]). All major complications were relieved within 4 months postablation. CONCLUSION Thermal ablation may be a feasible, effective, and safe treatment option for patients with solitary T1bN0M0 PTC who are ineligible for or unwilling to undergo surgery. It may provide a novel treatment option for selected patients.
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Affiliation(s)
- Xiao-Jing Cao
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Juan Liu
- Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China
| | - Ya-Lin Zhu
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lu Qi
- Department of Medical Ultrasound, Yantai Affliated Hospital of Binzhou Medical University, Yantai, China
| | - Geng Liu
- Department of Ultrasound, Wuhai People's Hospital, Wuhai, China
| | - Hong-Ling Wang
- Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Zhong-Hua Wang
- Special Inspection Section, Wendeng District People's Hospital, Weihai, China
| | - Ying Zhou
- First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Jun-Feng He
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China
| | - Jian-Qin Guo
- Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China
| | - Li-Li Shi
- Department of Ultrasound, Laixi Municipal Hospital, Laixi, China
| | - Mei Jian
- Department of Ultrasound, Bayannur Hospital, Bayannur, China
| | - Aini Shataer
- Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Guo-Zhen Yan
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China
| | - Zhen-Long Zhao
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shu-Rong Wang
- Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China
- Department of Medical Ultrasound, Yantai Affliated Hospital of Binzhou Medical University, Yantai, China
| | - Ming-An Yu
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
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23
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Yan L, Zhang Y, Jiang B, Luo Y. Radiofrequency Ablation for Cervical Metastatic Lymph Nodes in Children and Adolescents With Papillary Thyroid Carcinoma: A Preliminary Study. Front Endocrinol (Lausanne) 2021; 12:624054. [PMID: 34084150 PMCID: PMC8167037 DOI: 10.3389/fendo.2021.624054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/05/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of radiofrequency ablation (RFA) for metastatic lymph nodes (LNs) in children and adolescents with papillary Thyroid Carcinoma (PTC). MATERIALS AND METHODS From December 2014 to March 2018, 10 metastatic LNs(mean volume 0.30 ± 0.38 ml, range 0.06-1.23ml) in 5 children and adolescents (3 females, 2 males; mean age 15.60 ± 2.97 years, range 12-19 years) with PTC treated by RFA were evaluated in this study. The mean number of surgical procedures performed before RFA was 1.2 (range 1-2) and the mean number of treated metastatic LNs per patient was 2 (rang 1-3). RFA was performed with an 18-gauge bipolar RF applicator under local anesthesia. Follow-up consisted of US and serum thyroglobulin (Tg) level at 1, 3, 6, 12 months and every 12 months thereafter. RESULTS All the patients were well tolerant to RFA procedure and no procedure-related complications occurred. During a mean follow-up time of 52.00 ± 21.44 months, the initial volume of LNs was 0.30 ± 0.38 ml, which significantly decreased to 0.01 ± 0.03 ml (P = 0.005) with a mean VRR of 99.28 ± 2.27%. A total of 9 metastatic LNs (90.00%) completely disappeared. After RFA, 2 patients developed newly metastases. One patient had additional RFA. The other one with multiple LN metastases underwent total thyroidectomy with central neck dissection. CONCLUSION As a less invasive and effective technique, RFA may provide another alternative to the existing therapeutic modalities for cervical metastatic LNs in children and adolescents with PTC.
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24
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Cao XJ, Wei Y, Zhao ZL, Peng LL, Li Y, Yu MA. Efficacy and safety of microwave ablation for cervical metastatic lymph nodes arising post resection of papillary thyroid carcinoma: a retrospective study. Int J Hyperthermia 2020; 37:450-455. [PMID: 32369712 DOI: 10.1080/02656736.2020.1759829] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: To evaluate the efficacy and safety of microwave ablation (MWA) for cervical metastatic lymph nodes (LNs) post resection of papillary thyroid cancer (PTC).Materials and methods: From November 2015 to November 2018, 14 patients with 38 cervical metastatic LNs treated by MWA were included in this retrospective study. Wilcoxon signed rank test was used to compare the changes of LN and serum thyroglobulin levels pre- and post-ablation.Results: The technical success rate in this study was 100% (38/38). The mean follow-up time was 23.6 ± 9.3 months. On pre-ablation contrast-enhanced ultrasound, 25 LNs showed high-enhancement, 8 LNs showed iso-enhancement, and 5 LNs showed low-enhancement. The median largest diameter of LNs at pre-ablation and 3, 6, 9, 12, 18, 24, and 36 months post-ablation was 11.5 mm and 9.5, 9.0, 8.0, 8.0, 8.0, 7.0, and 6.0 mm, respectively. The median volume of LNs at pre-ablation and 3, 6, 9, 12, 18, 24, and 36 months post-ablation were 251.2 mm3 and 206.7, 167.2, 166.2, 155.7, 153.9, 153.9, and 113.1 mm3, respectively. The largest diameter and the volume of the cervical metastatic LNs at the last post-ablation was significantly smaller than the pre-ablation level (p = .0016; p = .0018). Serum Tg level at the last post-ablation (median 1.25 ng/mL) was significantly lower than the pre-ablation level (median 8.35 ng/mL) (p = .001). There were no complications.Conclusion: MWA is a safe and effective novel treatment option for cervical metastatic LN that emerge post resection of PTC.
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Affiliation(s)
- Xiao-Jing Cao
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
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25
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Wu R, Luo Y, Tang J, Yang M, Li J, Zhang Y, Zhang M. Ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma: a retrospective analysis of 198 patients. Int J Hyperthermia 2020; 37:168-174. [PMID: 32026736 DOI: 10.1080/02656736.2019.1708480] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose: To evaluate the safety and efficacy of ultrasound-guided RFA for the treatment of papillary thyroid microcarcinoma (PTMC).Materials and methods: The data of 204 nodules from 198 PTMC patients who were treated using RFA were retrospectively reviewed in this study. Demographic variables, complication details and CEUS results in different time points were collected. The volumes and volume reduction rate (VRR) of the ablated area under CEUS at different follow-up time points were calculated and compared.Results: All the patients were successfully treated without major complication. Mild complications included cervical discomfort in three cases, postoperative cervical pain in one case, and transient hoarse voice in five cases. The volume of the ablated area in the 1st, 3rd, 6th, 12th, 18th and 24th month postoperatively were 241.7 ± 298.3mm3, 89.8 ± 147.2 mm3, 37.6 ± 87.2 mm3, 13.6 ± 59.8 mm3, 2.4 ± 14.4 mm3, and 0.2 ± 2.0 mm3 respectively, with a statistically significant decrease (F = 138.1, p = .000), and the VRR in those time points were 73.9 ± 13.7%, 90.5 ± 8.2%, 96.1 ± 5.9%, 98.8 ± 3.2%, 99.6 ± 1.9% and 99.8 ± 1.0% respectively, with a statistically significant decrease (F = 695.3, p = .000).Conclusions: US-guided RFA is safe and effective for PTMC, with a good oncological outcome and VRR. Further randomized controlled prospective trials are still needed to compare the value of RFA and surgery.
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Affiliation(s)
- Rong Wu
- Medical School of Chinese PLA, Beijing, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Ultrasound, Ordos Central Hospital, Ordos, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ming Yang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Li
- Department of Pathology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ying Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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26
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Han ZY, Dou JP, Cheng ZG, Liu FY, Yu J, Yu XL, Liang P. Efficacy and safety of percutaneous ultrasound-guided microwave ablation for cervical metastatic lymph nodes from papillary thyroid carcinoma. Int J Hyperthermia 2020; 37:971-975. [PMID: 32781871 DOI: 10.1080/02656736.2020.1805128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Zhi-Yu Han
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, China
| | - Jian-Ping Dou
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasonics, General Hospital of Chinese PLA, Beijing, China
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27
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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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28
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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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29
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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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30
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Ji L, Wu Q, Gu J, Deng X, Zhou W, Fan X, Zhou F. Ultrasound-guided percutaneous laser ablation for papillary thyroid microcarcinoma: a retrospective analysis of 37 patients. Cancer Imaging 2019; 19:16. [PMID: 30894228 PMCID: PMC6425672 DOI: 10.1186/s40644-019-0204-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Over the past ten years, more papillary thyroid microcarcinoma (PTMC) has been diagnosed more frequently due to the development of imaging technology, and the incidence of PTMC has increased significantly. Ultrasound-guided percutaneous laser ablation (PLA) is mainly used for benign thyroid nodules, and few studies have been published on the use of PLA for PTMC. In the present study, a retrospective analysis was performed to explore the efficacy of PLA for PTMC. METHODS A total of 37 patients with PTMC who underwent PLA were included in this study. Measurement of the lesion volume and serum thyroid hormone levels and clinical evaluation were performed at 1, 3, 6, and 12 months and every 6 months thereafter. RESULTS We found that all patients were successfully treated with PLA without serious complications. At the last follow-up visit, 12/37 (32.4%) primary lesions had disappeared, and 24/37 (64.9%) remained as cicatricial hyperplasia. One patient (2.7%) had cervical lymph node metastasis at 24 months post-operatively and underwent open surgery. CONCLUSION Our initial studies suggest that ultrasound-guided PLA is a safe and effective treatment for PTMC.
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Affiliation(s)
- Lili Ji
- Department of Ultrasonography, The Affiliated Infectious Diseases Hospital of Soochow University, 2 Xier Road, Suzhou, 215101, China
| | - Qin Wu
- Department of Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, No. 1 Lijiang Road, Suzhou, 215163, China
| | - Jun Gu
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita Road, Suzhou, 215001, China.
| | - Xuedong Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita Road, Suzhou, 215001, China
| | - Wei Zhou
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2 Road, Shanghai, 200025, China
| | - Xing Fan
- Department of Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, No. 1 Lijiang Road, Suzhou, 215163, China
| | - Feng Zhou
- Department of Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, No. 1 Lijiang Road, Suzhou, 215163, China
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31
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Guang Y, He W, Luo Y, Zhang H, Zhang Y, Ning B, Yu T. Patient satisfaction of radiofrequency ablation for symptomatic benign solid thyroid nodules: our experience for 2-year follow up. BMC Cancer 2019; 19:147. [PMID: 30760229 PMCID: PMC6375217 DOI: 10.1186/s12885-019-5338-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/31/2019] [Indexed: 11/21/2022] Open
Abstract
Background The patient satisfaction of symptoms improvement and disease factors that may affect long-term treatment efficacy of radiofrequency ablation (RFA) for non-functioning solid benign thyroid nodules (TNs) over a 2-year follow up study was investigated. Methods This retrospective study evaluated 194 non-functioning solid benign TNs of 103 patients. The TNs were categorized as small (≤5 ml), medium (5.1 to 13 ml), intermediate (13.1 to 30 ml) and large (over 30 ml) according to the initial volume of TNs before ablation. Clinical evaluation and contrast-enhanced ultrasound (CEUS) were carried out before ablation and the follow up at 1, 3, 6 months and every 6 months after ablation. All patients were asked to assess the cosmetic score (1–4 scores) and symptom score (0–10 scores) before ablation and every follow up after ablation. Results All patients underwent RFA without any major complications. The mean treatment sessions were 1.5 ± 0.6. 98 nodules required a single session (98/194, 50.5%), 87 required two sessions (87/194, 44.9%), 9 required three sessions (9/194, 4.6%). The average follow up months were 16.3 ± 5.6 (range, 6–24 months) and no nodule regrew in our study. After RFA treatment, the TNs volume significantly decreased (P < 0.001). The small group of nodules shrunk larger compared to the medium, intermediate and large groups (P < 0.001). Cosmetic signs and pressure symptoms were significantly improved, particularly in the intermediate and large groups (P < 0.05). Conclusions RFA is effective for treating non-functioning solid benign TNs and controlling clinical symptoms with a low complication rate during 2 years follow up. The reduction rate was related to the initial volume of nodules. Patients were satisfied with cosmetic signs and pressure symptoms improvement, particularly in the intermediate and large groups. However, multiple RFA treatments should be used in larger nodules to achieve the desired clinical outcomes.
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Affiliation(s)
- Yang Guang
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China
| | - Wen He
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China.
| | - Yukun Luo
- Department of Ultrasound, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hongxia Zhang
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China
| | - Yukang Zhang
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China
| | - Bin Ning
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China
| | - Tengfei Yu
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China
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Yang G, Fang J, Yu T, Zhang Y, Zhang W, Zhao D, Xu J, Wang C. Percutaneous ultrasound-guided laser ablation for the treatment of cervical tuberculous lymphadenitis: a pilot study. J Int Med Res 2019; 47:1512-1520. [PMID: 30632441 PMCID: PMC6460608 DOI: 10.1177/0300060518821818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study was performed to assess the feasibility, effectiveness, and safety of percutaneous ultrasound (US)-guided laser ablation (LA) for the treatment of cervical tuberculous lymphadenitis (CTBL). METHODS We retrospectively reviewed 11 patients with CTBL (mean age, 32.0 ± 8.6 years; range, 18-47 years) who underwent percutaneous US-guided LA from June 2014 to December 2016 with a subsequent 12-month follow-up. We assessed the mean volume reduction and contrast-enhanced US (CEUS) changes of the target lymph nodes as well as the tolerability and adverse effects of LA. RESULTS The mean ablation energy was 522 ± 312 J (range, 204-1317 J). All 17 enrolled target lymph nodes were completely non-enhanced after LA treatment as detected by CEUS, indicating complete ablation of all lymph nodes (100%). The target lymph nodes significantly decreased in volume by a mean of 74.0% ± 15.6% from baseline to 12 months after LA. The LA procedure was well tolerated, and none of the 11 patients developed severe complications during the 12-month follow-up. CONCLUSION Percutaneous US-guided LA for the treatment of CTBL exhibits good tolerability, minimal invasiveness, and few adverse effects. Further investigations with larger sample sizes and longer follow-up periods are warranted to confirm these findings.
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Affiliation(s)
- Gaoyi Yang
- 1 Department of Ultrasonography, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, P.R. China
| | - Jianhua Fang
- 2 Department of Ultrasonography, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Tianzhuo Yu
- 1 Department of Ultrasonography, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, P.R. China
| | - Ying Zhang
- 1 Department of Ultrasonography, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, P.R. China
| | - Wenzhi Zhang
- 1 Department of Ultrasonography, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, P.R. China
| | - Dan Zhao
- 1 Department of Ultrasonography, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, P.R. China
| | - Jianping Xu
- 1 Department of Ultrasonography, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, P.R. China
| | - Caifen Wang
- 1 Department of Ultrasonography, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, P.R. 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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Teng D, Ding L, Wang Y, Liu C, Xia Y, Wang H. Safety and efficiency of ultrasound-guided low power microwave ablation in the treatment of cervical metastatic lymph node from papillary thyroid carcinoma: a mean of 32 months follow-up study. Endocrine 2018; 62:648-654. [PMID: 30105431 DOI: 10.1007/s12020-018-1711-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/06/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the safety and efficiency of microwave ablation (MWA) with low power of 20 w, respectively, in the treatment of cervical metastatic lymph node (CMLN) from papillary thyroid carcinoma (PTC) with a mean of 32-month follow-up. METHODS Eleven patients in total with 24 cervical lymph nodes (LNs) diagnosed with CMLN from PTC underwent MWA at a power of 20 w. We recorded images of the LNs under ultrasound first before MWA and 1, 3, 6, 12, months after MWA, and then every 6 months, respectively. The volumes of the LNs were compared before MWA and at each follow-up point after MWA. The thyroglobulin (Tg) test was performed before MWA and 3 months after MWA. RESULTS All patients were successfully treated, and they showed no major complications. Before MWA, the mean volume of the LNs was 364.15 ± 306.89 mm3, which decreased to 234.10 ± 230.34 mm3, 107.51 ± 129.47 mm3, 20.88 ± 39.27 mm3, 3.38 ± 12.74 mm3, and completely disappeared at the follow-up point of 1, 3, 6, 12, and 18 months after MWA, respectively. The mean Tg was 11.81 ± 7.50 ng/ml, a data significantly decreased to 0.43 ± 0.11 ng/ml 3 months after MWA (P = 0.000). In the follow-up period, no recurrent lesions were found. CONCLUSIONS For the treatment of CMLN from PTC, low power MWA showed good safety and efficacy. MWA is likely to be a candidate for patients with high risks or who refuse reoperation.
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Affiliation(s)
- Dengke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Lei Ding
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Yu Wang
- Department of Interventional Ultrasound, the 208th Hospital of PLA, Changchun, Jilin, 130000, China
| | - Caimei Liu
- Department of Interventional Ultrasound, the 208th Hospital of PLA, Changchun, Jilin, 130000, China
| | - Yongxu Xia
- Department of Interventional Ultrasound, the 208th Hospital of PLA, Changchun, Jilin, 130000, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China.
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Percutaneous Laser Ablation of Unifocal Papillary Thyroid Microcarcinoma: Utility of Conventional Ultrasound and Contrast-Enhanced Ultrasound in Assessing Local Therapeutic Response. World J Surg 2018; 42:2476-2484. [PMID: 29488064 DOI: 10.1007/s00268-018-4500-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To investigate the use of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in assessing local therapeutic response of percutaneous laser ablation (PLA) for papillary thyroid microcarcinoma (PTMC). METHODS Sixty-four patients with 64 PTMCs who were referred to our hospital from November 2013 to July 2016 were treated with PLA. The extent of ablation was assessed by CEUS at 10-20 min and 7 days after PLA. The size and volume of the ablation zone were evaluated on conventional ultrasound at 1 h, 1, 3, 6 and 12 months, and every half-year thereafter, and recurrences were also recorded. Ultrasound-guided fine needle aspiration biopsy (FNAB) of the ablated area was performed at 1, 6 and 12 months after PLA. RESULTS Two incomplete ablations were detected by CEUS, and a second ablation was performed. The mean largest diameter and volume of the ablated area on CEUS at 10-20 min and 7 days after PLA were significantly larger than those of pre-treatment on conventional ultrasound (p < 0.05, for both). At the last follow-up, the mean largest diameter was reduced from 4.6 ± 1.5 to 0.6 ± 1.3 mm (p < 0.0.5), and the average volume was 41.0 ± 40.4 mm3, which decreased to 1.8 ± 6.7 mm3 (p < 0.0.5). A cervical metastatic lymph node was detected on ultrasound and confirmed by ultrasound-guided FNAB at 30 months after PLA. CONCLUSIONS CEUS could play a crucial role in assessing the completeness of PLA for treating PTMC, and conventional ultrasound can not only guide the FNAB process but also is important in the follow-up of PTMC after PLA.
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Efficacy of ultrasound-guided core needle biopsy in cervical lymphadenopathy: A retrospective study of 6,695 cases. Eur Radiol 2017; 28:1809-1817. [DOI: 10.1007/s00330-017-5116-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 12/26/2022]
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Image-guided ablations in patients with thyroid tumors. J Cancer Res Clin Oncol 2017; 143:2637-2639. [DOI: 10.1007/s00432-017-2503-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 10/18/2022]
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