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Papini E, Guglielmi R, Novizio R, Pontecorvi A, Durante C. Management of low-risk papillary thyroid cancer. Minimally-invasive treatments dictate a further paradigm shift? Endocrine 2024:10.1007/s12020-024-03864-7. [PMID: 38767774 DOI: 10.1007/s12020-024-03864-7] [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: 03/25/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Current management options for PTMC include lobo-isthmectomy and active surveillance (AS). Recently, ultrasound-guided minimally invasive procedures (MITs) are offered as a nonsurgical therapy for PTMC because they do not require hospitalization and general anaesthesia, and do not result in loss of thyroid function or cosmetic damage. MITs are reported to consistently provide, mostly in large retrospective series of patients, a rapid, safe, and cost-effective way to eradicate low-risk thyroid malignancies. However, conclusive data from well-conducted prospective studies on the histologically-proven completeness of tumor ablation and the long-term clinical advantages versus AS are still lacking. OBJECTIVES This study aimed to evaluate the efficacy and safety of ultrasound-guided minimally invasive treatments (MITs) for PTMC in comparison to traditional surgical methods and active surveillance, and to assess their role in current clinical practice. METHODS A structured literature review was conducted using keywords related to PTMC, MIT, and comparative techniques. Studies were evaluated based on treatment modality, patient selection, follow-up duration, complication rates, and clinical outcomes. RESULTS MITs have shown promising results in the management of PTMC. These treatments offer several advantages over surgery, such as reduced use of surgical resources, lower costs, minimal work disruption, and fewer major complications. However, there are still limitations, including the need for long-term surveillance and the potential risk of incomplete tumor ablation. CONCLUSIONS MITs represent a promising non-surgical option for managing low-risk PTMC, especially for patients ineligible for or refusing surgery. Despite favorable outcomes, more robust prospective data are needed to confirm their long-term benefits and completeness of tumor ablation. Interdisciplinary discussions and thorough patient education on the advantages and limitations of MITs are crucial for informed decision-making.
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Affiliation(s)
- E Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - R Guglielmi
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - R Novizio
- Department of Endocrinology, Catholic University of The Sacred Heart, Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - A Pontecorvi
- Department of Endocrinology, Catholic University of The Sacred Heart, Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - C Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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Zhao GZ, Zhang MB. Ultrasound-guided radiofrequency ablation for the treatment of papillary thyroid carcinoma: a review of the current state and future perspectives. Ultrasonography 2024; 43:79-87. [PMID: 38310872 PMCID: PMC10915119 DOI: 10.14366/usg.23091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024] Open
Abstract
Papillary thyroid carcinoma (PTC) is a highly prevalent cancer that typically exhibits indolent behavior and is associated with a favorable prognosis. The treatment of choice is surgical intervention; however, this approach carries the risk of complications, including scarring and loss of thyroid function. Although active surveillance can mitigate the risk of PTC overtreatment, the possibility of tumor growth and metastasis can elicit anxiety among patients. Ultrasoundguided thermal ablation has emerged as a safe and effective alternative for individuals who are ineligible for or decline surgery. This article provides a review of the clinical research on radiofrequency ablation as a treatment for PTC, offering a thorough examination of its efficacy, safety, and future perspectives.
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Affiliation(s)
- Guo-zheng Zhao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Ultrasound, Air Force Medical Center, Beijing, China
| | - Ming-bo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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Jing H, Yan L, Xiao J, Li X, Jiang B, Yang Z, Li Y, Sun B, Zhang M, Luo Y. Radiofrequency ablation for papillary thyroid microcarcinoma with a trachea-adjacent versus trachea-distant location. Int J Hyperthermia 2024; 41:2270671. [PMID: 38214143 DOI: 10.1080/02656736.2023.2270671] [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: 07/07/2023] [Accepted: 10/09/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE To evaluate the outcomes of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) adjacent to the trachea and compare them with those of PTMC distant from the trachea. METHODS Patients who received RFA for solitary low-risk PTMC between June 2014 and July 2020 were reviewed and classified into adjacent and distant groups. To balance between-group confounders, the propensity score matching approach was employed. Volume, volume reduction ratio (VRR), tumor disappearance, complications, and disease progression were assessed and compared between the groups. Furthermore, factors affecting disease progression were evaluated. RESULTS A total of 122 and 470 patients were included in the adjacent and distant groups, respectively. Overall VRR was 99.5% ± 3.1 and cumulative tumor disappearance rate was 99.4% after a mean follow-up time of 40.1 months ± 16.2. Overall disease progression and complications incidence were 3.7% and 1.0%, respectively. No substantial differences were observed between the two groups in the latest volume (0.8 mm3 ± 4.1 vs. 0.9 mm3 ± 4.2, p = .77), VRR (99.7% ± 1.6 vs. 99.5% ± 2.7, p = .75), cumulative tumor disappearance rate (92.6% vs. 94.2%, p = .58), and incidence of disease progression (4.1% vs. 4.5%, p = .70) and complication (1.7% vs. 0.8%, p = .86) after 1:2 matching. Additionally, tracheal adjacency exhibited no association with disease progression in multivariate Cox regression analysis (p = .73). CONCLUSION For eligible patients with PTMC located adjacent to or distant from the trachea, RFA may offer a safe and effective alternative treatment method.
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Affiliation(s)
- Haoyu Jing
- Chinese PLA Medical School, Beijing, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xinyang Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Jiang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhen Yang
- Chinese PLA Medical School, Beijing, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yingying Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bin Sun
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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4
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Guo MH, Dou JP, Zheng L, Liu FY, Yu J, Cheng ZG, Yu XL, Che Y, Wang SR, Cong ZB, Bai N, Liu C, Hao Y, Yu MA, Xu ZF, Han ZY, Liang P, Chen L. Ultrasound-guided microwave ablation versus surgery for solitary T1bN0M0 papillary thyroid carcinoma: a prospective multicenter study. Eur Radiol 2024; 34:569-578. [PMID: 37548692 DOI: 10.1007/s00330-023-09908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/24/2023] [Accepted: 05/02/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Microwave ablation (MWA) has emerged as a minimally invasive technology for papillary thyroid microcarcinoma (PTMC), but it has not been widely applied to treat T1bN0M0 PTC with high-level evidence. This study was designed to compare the real-world efficacy and safety of MWA or surgery for treating T1bN0M0 PTC. METHODS From December 2019 to April 2021, 123 continuous unifocal T1bN0M0 PTC patients without lymph node metastasis (LNM) or distant metastasis (DM) were included from 10 hospitals. Patients were allocated into the MWA or surgery group based on their willingness. The main outcomes were local tumour progression (LTP), new thyroid cancer, LNM, and DM. The secondary outcomes included changes in tumour size and volume, complications, and cosmetic results. Subgroup analyses were conducted to identify influencing factors. RESULTS Fifty-two patients chose MWA, and 71 patients chose surgery. Patients had similar demographic information and tumour characteristics in the two groups. The follow-up durations after MWA and surgery were 10.6 ± 4.2 and 10.4 ± 3.4 months, respectively. The LNM rate was 5.8% in the MWA group and 1.4% in the surgery group (p = 0.177). No LTP, new thyroid cancer, or distant metastasis (DM) occurred in either group. Five (9.6%) of the 52 patients in the MWA group and 8 (11.3%) of the 71 patients in the surgery group had complications (p = 0.27). Better cosmetic results were found in the MWA group (p < 0.01). CONCLUSION MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further. CLINICAL RELEVANCE STATEMENT MWA achieved comparable short-time treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC. KEY POINTS • MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further. • The complication rate in the surgery group was higher than that in the MWA group without a significant difference. • There was no statistically significant difference in the LNM rate between the MWA and surgery groups.
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Affiliation(s)
- Mo-Han Guo
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jian-Ping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Lin Zheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Zhi-Bin Cong
- Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Nan Bai
- Department of Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Cun Liu
- Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Ying Hao
- Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China
| | - Ming-An Yu
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhi-Feng Xu
- First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
| | - Lei Chen
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.
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Carlisle KM, Brown JP, Kim J, Turner DJ, Slejko JF, Kuo JH, Mullins CD, Hu Y. Age-stratified comparison of active surveillance versus radiofrequency ablation for papillary thyroid microcarcinoma using decision analysis. Surgery 2024; 175:153-160. [PMID: 37872047 PMCID: PMC10845124 DOI: 10.1016/j.surg.2023.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/09/2023] [Accepted: 06/20/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Papillary thyroid microcarcinomas may be treated with radiofrequency ablation, active surveillance, or surgery. The objective of this study was to use mathematical modeling to compare treatment alternatives for papillary thyroid microcarcinomas among those who decline surgery. We hypothesized that radiofrequency ablation would outperform active surveillance in avoiding progression and surgery but that the effect size would be small for older patients. METHODS We engaged stakeholders to identify meaningful long-term endpoints for papillary thyroid microcarcinoma treatment-(1) cancer progression/surgery, (2) need for thyroid replacement therapy, and (3) permanent treatment complication. A Markov decision analysis model was created to compare the probability of these endpoints after radiofrequency ablation or active surveillance for papillary thyroid microcarcinomas and overall cost. Transition probabilities were extracted from published literature. Model outcomes were estimated to have a 10-year time horizon. RESULTS The primary outcome yielded a number needed to treat of 18.1 for the avoidance of progression and 27.4 for the avoidance of lifelong thyroid replacement therapy for radiofrequency ablation compared to active surveillance. However, as patient age increased, the number needed to treat to avoid progression increased from 5.2 (age 20-29) to 39.1 (age 60+). The number needed to treat to avoid lifelong thyroid replacement therapy increased with age from 7.8 (age 20-29) to 59.3 (age 60+). The average 10-year cost/treatment for active surveillance and radiofrequency ablation were $6,400 and $11,700, respectively, translating to a cost per progression-avoided of $106,500. CONCLUSION As an alternative to active surveillance, radiofrequency ablation may have a greater therapeutic impact in younger patients. However, routine implementation may be cost-prohibitive for most patients with papillary thyroid microcarcinomas.
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Affiliation(s)
- Kendyl M Carlisle
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD
| | - Jessica P Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Justin Kim
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD
| | - Douglas J Turner
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD
| | - Julia F Slejko
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Jennifer H Kuo
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - C Daniel Mullins
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Yinin Hu
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD.
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Zhao ZL, Dong G, Wang SR, Liu Y, He JF, Shi LL, Guo JQ, Wang ZH, Cong ZB, Liu LH, Yang BB, Qu CP, Wei Y, Peng LL, Li Y, Lu NC, Wu J, Yu MA. Efficacy and safety of microwave ablation for the treatment of multifocal versus unifocal T1N0M0 papillary thyroid carcinoma: a propensity-matched multicentre retrospective study. Eur Radiol 2023; 33:8727-8735. [PMID: 37466709 DOI: 10.1007/s00330-023-09932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/07/2023] [Accepted: 05/15/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Microwave ablation (MWA) has been widely used for unifocal papillary thyroid carcinoma (U-PTC) and has recently been preliminarily used in multifocal papillary thyroid carcinoma (M-PTC). However, the efficacy and safety of MWA for M-PTC have not been investigated in large samples. The aim of the present study was to evaluate the efficacy and safety of MWA for M-PTC and compare them with MWA for U-PTC. MATERIALS AND METHODS This retrospective multicentre study enrolled 504 patients (376 females) who underwent MWA for U-PTC (340 cases) or M-PTC (164 cases) from Jan 2015 to Dec 2020. The median age of the patients was 43 years (age range, 20-80 years). Propensity score matching (PSM) was used to balance the baseline characteristics between M-PTC group and U-PTC group. The tumour progression, tumour disappearance, and complication rates were compared between the two groups. RESULTS The complete ablation was achieved in all enrolled cases in one session. According to the statistical results, no significant differences were shown in tumour progression-free survival (p = 0.29) or cumulative tumour progression rate (6.7% vs. 4.3%, p = 0.33) between the M-PTC and U-PTC groups during the follow-up time. However, the tumour disappearance rate in the M-PTC group was lower in the U-PTC group (40.9% vs. 62.8%, p < 0.001), and tumour disappearance was slower in the M-PTC group (p < 0.001). The complication rate showed no significant difference (3.0% vs. 4.9%, p = 0.571). CONCLUSIONS MWA is an effective and safe treatment for selected patients with M-PTC, and the prognosis is similar to that of U-PTC. CLINICAL RELEVANCE STATEMENT The present study provided evidence that compared with unifocal papillary thyroid cancer, microwave ablation could also treat multifocal T1N0M0 papillary thyroid cancer safely with similar clinical outcome, which could promote the application of minimally invasive treatment for papillary thyroid cancer. KEY RESULTS • Microwave ablation for multifocal and unifocal T1N0M0 papillary thyroid carcinoma had similar tumour progression rates after propensity score matching (6.7% vs. 4.3%, p = 0.33). • The tumour disappearance rate in the multifocal group was lower than that in the unifocal group (40.9% vs. 62.8%, p < 0.001), and tumour disappearance was slower in the multifocal group (p < 0.001). • Tumour size, number, and location were not risk factors for tumour progression in the multifocal papillary thyroid cancer group.
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Affiliation(s)
- Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Gang Dong
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shu-Rong Wang
- Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, Shandong, China
| | - Ying Liu
- Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, Shandong, China
| | - Jun-Feng He
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China
| | - Li-Li Shi
- Department of Ultrasound, Laixi Municipal Hospital, Laixi, Shandong, China
| | - Jian-Qin Guo
- Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical Univeristy, Haikou, Hainan, China
| | - Zhong-Hua Wang
- Department of Special Inspection, Wendeng District People's Hospital, Weihai, Shandong, China
| | - Zhi-Bin Cong
- Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Li-Hong Liu
- Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Bei-Bei Yang
- Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Chun-Ping Qu
- Department of Special Inspection, Muping Zhongyi Hospital, Yantai, Shandong, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Nai-Cong Lu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China.
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Ren Y, Lu C, Xu S. Ultrasound-guided thermal ablation for papillary thyroid microcarcinoma: the devil is in the details. Int J Hyperthermia 2023; 40:2278823. [PMID: 37940134 DOI: 10.1080/02656736.2023.2278823] [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: 07/28/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023] Open
Abstract
Thermal ablation (TA) has harvested favorable outcomes in treating low-risk papillary thyroid microcarcinoma (PTMC). Preoperative assessment, intraoperative procedures and postoperative follow-up are all closely linked with the success and safety of TA on PTMC. However, many details in these aspects have not been systematically reviewed. This review firstly described the influence of preoperative assessment, especially for the risk of lymph node metastasis (LNM), as well as the molecular testing on the selection of TA for PTMC. Besides, we also summarized the experiences in treating special PTMC cases by TA, like multifocal lesions, PTMC located in the isthmus or adjacent to the dorsal capsule. At last, we discussed the follow-up strategies, the influence of the thyroid-stimulating hormone (TSH) level on the prognosis of PTMCs, and the management for recurrent cases. In conclusion, the procedures during the entire perioperative period should be standardized to improve the outcomes of TA in treating PTMC patients.
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Affiliation(s)
- Yujie Ren
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Chenya Lu
- Department of Endocrinology, Dongyang Hospital of Chinese Medicine, Dangyang, China
| | - Shuhang Xu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
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8
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Han ZY, Dou JP, Zheng L, Che Y, Yu MA, Wang SR, Wang H, Cong ZB, He JF, Qian TG, Hu QH, He GZ, Liu G, Yu SY, Guo JQ, Jiang TA, Feng RF, Li QY, Chen XJ, Zhu YL, Wei Y, Liu LH, Wang X, Qi LN, Liang P. Safety and efficacy of microwave ablation for the treatment of low-risk papillary thyroid microcarcinoma: a prospective multicenter study. Eur Radiol 2023; 33:7942-7951. [PMID: 37294329 DOI: 10.1007/s00330-023-09802-x] [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: 07/16/2022] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To assess the safety and efficacy of ultrasound-guided thermal ablation for low-risk papillary thyroid microcarcinoma (PTMC) via a prospective multicenter study. METHODS From January 2017 through June 2021, low-risk PTMC patients were screened. The management details of active surveillance (AS), surgery, and thermal ablation were discussed. Among patients who accepted thermal ablation, microwave ablation (MWA) was performed. The main outcome was disease-free survival (DFS). The secondary outcomes were tumor size and volume changes, local tumor progression (LTP), lymph node metastasis (LNM), and complication rate. RESULTS A total of 1278 patients were included in the study. The operation time of ablation was 30.21 ± 5.14 min with local anesthesia. The mean follow-up time was 34.57 ± 28.98 months. Six patients exhibited LTP at 36 months, of whom 5 patients underwent a second ablation, and 1 patient received surgery. The central LNM rate was 0.39% at 6 months, 0.63% at 12 months, and 0.78% at 36 months. Of the 10 patients with central LNM at 36 months, 5 patients chose ablation, 3 patients chose surgery and the other 2 patients chose AS. The overall complication rate was 1.41%, and 1.10% of patients developed hoarseness of the voice. All of the patients recovered within 6 months. CONCLUSIONS Thermal ablation of low-risk PTMC was observed to be safe and efficacious with few minor complications. This technique may help to bridge the gap between surgery and AS as treatment options for patients wishing to have their PTMC managed in a minimally invasive manner. CLINICAL RELEVANCE STATEMENT This study proved that microwave ablation is a safe and effective treatment method for papillary thyroid microcarcinoma. KEY POINTS Percutaneous US-guided microwave ablation of papillary thyroid microcarcinoma is a very minimally invasive treatment under local anesthesia during a short time period. The local tumor progression and complication rate of microwave ablation in the treatment of papillary thyroid microcarcinoma are very low.
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Affiliation(s)
- Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China
| | - Jian-Pin Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China
| | - Lin Zheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ming-An Yu
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Beijing, Chaoyang District, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, China
| | - Zhi-Bin Cong
- Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Jun-Feng He
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, 41 Linyin Road, Kunqu District, Baotou City, Inner Mongolia Autonomous Region, China
| | - Tong-Gang Qian
- Department of Ultrasound, Zunhua People's Hospital, Hebei Province, Huaming Road, Zunhua, Hebei Province, China
| | - Qiao-Hong Hu
- Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, 158 Shangtang Road, Xiacheng District, Hangzhou City, Zhejiang, China
| | - Guang-Zhi He
- Department of Ultrasound, Shenzhen Hospital of University of Chinese Academy of Sciences, Shenzhen, China
| | - Geng Liu
- Department of Ultrasound, Wuhai People's Hospital, No. 29, Huanghe East Street, Haibowan District, Wuhai City, Inner Mongolia Autonomous Region, China
| | - Song-Yuan Yu
- Department of Medical Ultrasound, the First Center of Minimally Invasive Treatment for, TumorShanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jian-Qin Guo
- Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Gonghe Road, Chengdong District, Xining City, Qinghai Province, China
| | - Tian-An Jiang
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Zhejiang, Hangzhou, China
| | - Rui-Fa Feng
- Department of Ultrasound, breast and thyroid surgery, the Second Affiliated Hospital of Guilin Medical University, No.212, Renmin Road, Lingui District, Guilin City, Guangxi Province, China
| | - Qin-Ying Li
- Department of Interventional Ultrasound, Puyang Traditional Chinese medicine hospital, No.135 Shengli Road, Hualong District, Puyang City, Henan, China
| | - Xiao-Jun Chen
- Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou City, Zhejiang Province, China
| | - Ya-Lin Zhu
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Wei
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Beijing, Chaoyang District, China
| | - Li-Hong Liu
- Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Xue Wang
- Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Li-Na Qi
- Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Gonghe Road, Chengdong District, Xining City, Qinghai Province, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, China.
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Hu C, Liang S, Liu H, Yang J, Kang H, Guan S, Yan R, Xu E. Prediction of ablation zone disappearance after microwave ablation for the patients with papillary thyroid microcarcinoma using nomograph. Front Endocrinol (Lausanne) 2023; 14:1145958. [PMID: 37600691 PMCID: PMC10433776 DOI: 10.3389/fendo.2023.1145958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives To construct a prognostic nomogram to predict the ablation zone disappearance for patients with papillary thyroid microcarcinoma (PTMC) after microwave ablation (MWA). Materials and methods From April 2020 to April 2022, patients with PTMC who underwent MWA treatment were collected retrospectively. Ultrasound (US) or contrast-enhanced ultrasound (CEUS) was performed at 1 day, 1, 3, 6, 12, 18 and 24 months after MWA to observe the curative effect after ablation. The volume, volume reduction rate (VRR) and complete disappearance rate of the ablation zone at each time point were calculated. Univariate and multivariate logistic regression analysis were used to determine the prognostic factors associated with the disappearance of the ablation zone after MWA, and the nomogram was established and validated. Results 72 patients with PTMCs underwent MWA were enrolled into this study. After MWA, no tumor progression (residual, recurrence or lymph node metastasis) and major postoperative complications occurred. The ablation zone in 28 (38.89%) patients did not completely disappear after MWA in the follow-up period. Three variables, including age (odds ratio [OR]: 1.216), calcification type (OR: 12.283), initial maximum diameter (OR: 2.051) were found to be independent prognostic factors predicting ablation zone status after MWA by multivariate analysis. The above variables and outcomes were visualized by nomogram (C-index=0.847). Conclusions MWA was a safe and effective treatment for PTMC. Older patients with macrocalcification and larger size PTMCs were more unlikely to obtain complete disappearance of ablation zones. Incomplete disappearance of ablation zone was not related to recurrence.
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Affiliation(s)
- Cai Hu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Shuang Liang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Huahui Liu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Jing Yang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Haiyu Kang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Sainan Guan
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Ronghua Yan
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzen, China
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
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Zheng L, Dou JP, Han ZY, Liu FY, Yu J, Cheng ZG, Yu XL, Wang H, Cong ZB, Wang SR, Yu MA, Xu ZF, Che Y, Nan B, Liu C, Hao Y, Wang X, Liu Y, Zhou Y, Liang P. Microwave Ablation for Papillary Thyroid Microcarcinoma with and without US-detected Capsule Invasion: A Multicenter Prospective Cohort Study. Radiology 2023; 307:e220661. [PMID: 36880949 DOI: 10.1148/radiol.220661] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Background Microwave ablation (MWA) has achieved favorable results in the treatment of papillary thyroid microcarcinoma (PTMC) confined in glandular parenchyma. However, studies on the outcome of MWA for PTMC with US-detected capsular invasion remain unclarified in the literature. Purpose To compare the feasibility, effectiveness, and safety of MWA in the treatment of PTMC with and without US-detected capsular invasion. Materials and Methods Participants from 12 hospitals with a PTMC maximal diameter of 1 cm or less without US- or CT-detected lymph node metastasis (LNM) who planned to undergo MWA were enrolled in this prospective study between December 2019 and April 2021. All tumors were evaluated with preoperative US and were divided into those with and those without capsular invasion. The participants were observed until July 1, 2022. The primary end points, including technical success and disease progression, and the secondary end points, including treatment parameters, complications, and tumor shrinkage during follow-up, were compared between the two groups, and multivariable regression was performed. Results After exclusion, 461 participants (mean age, 43 years ± 11 [SD]; 337 women) were included: 83 with and 378 without capsular invasion. After one participant with capsular invasion aborted MWA because of technical failure, 82 participants with and 378 participants without capsular invasion (mean tumor volume, 0.1 mL ± 0.1 vs 0.1 mL ± 0.1; P = .07) were analyzed with a mean follow-up period of 20 months ± 4 (range, 12-25 months) and 21 months ± 4 (range, 11-26 months), respectively. In those with and those without capsular invasion, comparable technical success rates were achieved (99% [82 of 83] vs 100% [378 of 378], P = .18), with one and 11 complications, respectively (1% [one of 82] vs 3% [11 of 378], P = .38). There was no evidence of differences in disease progression (2% [one of 82] vs 1% [four of 378]; P = .82) or tumor shrinkage (mean, 97% ± 8 [SD] vs 96% ± 13; P = .58). Conclusion Microwave ablation was feasible in the treatment of papillary thyroid microcarcinoma with US-detected capsular invasion and showed comparable short-term efficacy with or without the presence of capsular invasion. © RSNA, 2023 Clinical trial registration no. NCT04197960 Supplemental material is available for this article.
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Affiliation(s)
- Lin Zheng
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Jian-Ping Dou
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Zhi-Yu Han
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Fang-Yi Liu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Jie Yu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Zhi-Gang Cheng
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Xiao-Ling Yu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Hui Wang
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Zhi-Bin Cong
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Shu-Rong Wang
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ming-An Yu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Zhi-Feng Xu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ying Che
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Bai Nan
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Cun Liu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ying Hao
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Xue Wang
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ying Liu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ying Zhou
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ping Liang
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
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11
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Zeng F, Zou B, Chen H, Luo M, Liu W. Analysis of Therapeutic Effect and Influencing Factors of Ultrasound-Guided Radiofrequency Ablation in the Treatment of Papillary Thyroid Microcarcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36880705 DOI: 10.1002/jum.16197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The current study sought to explore the effects of ultrasound (US)-guided radiofrequency ablation (RFA) on papillary thyroid microcarcinoma (PTMC) and influencing factors. METHODS PTMC patients were assigned to observation (US-guided RFA) and control (surgical operation) groups. A series of operation-related indexes (operation time, intraoperative bleeding, wound closure time, hospital stay, and expenses), visual analogue scale score, lesion size, and thyroid function-related indexes (thyroid-stimulating hormone [TSH], free triiodothyronine*** [FT3], free thyroxine [FT4]), inflammatory factors, and thyroglobulin antibody (TgAb) were assessed and compared. After a 6-month follow-up period, the complications and recurrence were recorded, in addition to analyses of postoperative recurrence cumulative incidence and evaluation of recurrence risk factors. RESULTS Operation-related indexes of the observation group were relatively decreased compared with the control group. In addition, the lesion volume in the observation group was lower compared to that in the control group at the 6th month after operation, whereas the volume reduction rate was higher. There were no significant differences in regard to thyroid function-related indexes in the observation group before/after operation. After operation, serum TSH levels and inflammatory factors, and TgAb levels were all diminished, while the FT3 and FT4 levels were both elevated in the observation group relative to the control group, and postoperative recurrence cumulative incidence was lower in the observation group. TSH and TgAb were established as the independent risk factors for recurrence after RFA in PTMC patients. CONCLUSIONS Our findings highlighted that US-guided RFA exhibits better efficacy, safety, and postoperative recovery and lower recurrence risk for PTMC.
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Affiliation(s)
- Fuqiang Zeng
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Bin Zou
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Huabin Chen
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Ming Luo
- Department of Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Wenmin Liu
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
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12
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Li Y, Huo SN, Lu NC, Peng LL, Wei Y, Zhao ZL, Yu MA. A comparative study of quality of life in patients with papillary thyroid carcinoma undergoing microwave ablation vs. Total thyroidectomy. Int J Hyperthermia 2023; 40:2250935. [PMID: 37699584 DOI: 10.1080/02656736.2023.2250935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE To compare the health-related quality of life (HRQoL) of patients with T1N0M0 papillary thyroid carcinoma (PTC) who underwent microwave ablation (MWA) and those who underwent total thyroidectomy (TT). MATERIALS AND METHODS From February 2018 to February 2022, 180 T1N0M0 PTC patients were enrolled in present study, including 90 in the MWA group and 90 in the TT group, respectively. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QoL) were completed by patients to evaluate their HRQoL scores. RESULTS According to the results of the EORTC-QLQ-C30, there was a significant difference in the scores of global health, physical, emotional, etc. between the two groups, which indicated that the quality of life in these items in the MWA group was better than those in the TT group (all p < 0.05). According to the results of the THYCA-QoL, all items had significant differences between the two groups except for headache, which demonstrated the thyroid-specific quality of life was higher in the MWA group than in the TT group (all p < 0.05). CONCLUSION Ultrasound (US)-guided MWA offers a significant advantage in HRQoL over TT in T1N0M0 PTC patients, which provides an important reference for MWA as an alternative strategy to TT.
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Affiliation(s)
- Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Sheng-Nan Huo
- Department of Thyroid, Handan Hangang Hospital, Handan City, Hebei Province, P.R. China
| | - Nai-Cong Lu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
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13
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Wei Y, Niu WQ, Zhao ZL, Wu J, Peng LL, Li Y, Yu MA. Microwave Ablation versus Surgical Resection for Solitary T1N0M0 Papillary Thyroid Carcinoma. Radiology 2022; 304:704-713. [PMID: 35536133 DOI: 10.1148/radiol.212313] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Microwave ablation (MWA) has attracted interest as a minimally invasive treatment for papillary thyroid carcinoma (PTC). However, comparisons between MWA and surgical resection (SR) in the management of T1N0M0 PTC are rare. Purpose To compare the technical effectiveness, disease progression, and complications of MWA and SR for solitary T1N0M0 PTC. Materials and Methods This retrospective study was conducted in a single center. A total of 1029 patients with T1N0M0 PTC treated with either MWA or SR from January 2015 to May 2021 were studied and divided into two groups according to treatment modality. Propensity score matching and inverse probability of treatment weighting were used to control for confounding factors. Disease progression was analyzed in T1N0M0 PTCs as well as T1a and T1b subgroups by using Kaplan-Meier curves and Cox proportional hazards regression models. Results A total of 404 patients (mean age, 43 years ± 12 [SD]; 289 women; 337 with T1a PTC) underwent MWA, and 625 (mean age, 46 years ± 12; 495 women; 521 with T1a PTC) underwent SR. During the follow-up (median, 25 months; IQR, 7-61 months), there was no evidence of differences regarding disease progression in T1N0M0 (4.0% vs 4.0%; P = .97), T1a (3.4% vs 3.8%; P = .89), or T1b PTCs (6.8% vs 5.0%; P = .72). Compared with SR, MWA resulted in less blood loss (2 mL vs 10 mL) and a shorter procedure time (23 minutes vs 72 minutes) (both P < .001). The rate of major complications was 5.4% (19 of 350 patients) in the MWA group and 6.3% (22 of 350 patients) in the SR group (P = .75). Permanent hoarseness only occurred in the SR group (1.7%; P = .03). Conclusion For T1a and T1b solitary T1N0M0 papillary thyroid carcinomas, there was no evidence of differences regarding disease progression and major complications between microwave ablation and surgical resection. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by vanSonnenberg and Simeone in this issue.
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Affiliation(s)
- Ying Wei
- From the Department of Interventional Medicine (Y.W., Z.Z., J.W., L.P., Y.L., M.Y.) and Institute of Clinical Medical Services (W.N.), China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East St, Chao-yang District, Beijing 100029, China
| | - Wen-Quan Niu
- From the Department of Interventional Medicine (Y.W., Z.Z., J.W., L.P., Y.L., M.Y.) and Institute of Clinical Medical Services (W.N.), China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East St, Chao-yang District, Beijing 100029, China
| | - Zhen-Long Zhao
- From the Department of Interventional Medicine (Y.W., Z.Z., J.W., L.P., Y.L., M.Y.) and Institute of Clinical Medical Services (W.N.), China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East St, Chao-yang District, Beijing 100029, China
| | - Jie Wu
- From the Department of Interventional Medicine (Y.W., Z.Z., J.W., L.P., Y.L., M.Y.) and Institute of Clinical Medical Services (W.N.), China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East St, Chao-yang District, Beijing 100029, China
| | - Li-Li Peng
- From the Department of Interventional Medicine (Y.W., Z.Z., J.W., L.P., Y.L., M.Y.) and Institute of Clinical Medical Services (W.N.), China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East St, Chao-yang District, Beijing 100029, China
| | - Yan Li
- From the Department of Interventional Medicine (Y.W., Z.Z., J.W., L.P., Y.L., M.Y.) and Institute of Clinical Medical Services (W.N.), China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East St, Chao-yang District, Beijing 100029, China
| | - Ming-An Yu
- From the Department of Interventional Medicine (Y.W., Z.Z., J.W., L.P., Y.L., M.Y.) and Institute of Clinical Medical Services (W.N.), China-Japan Friendship Hospital, No. 2 Ying-hua-yuan East St, Chao-yang District, Beijing 100029, China
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14
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Ou D, Chen C, Jiang T, Xu D. Research Review of Thermal Ablation in the Treatment of Papillary Thyroid Carcinoma. Front Oncol 2022; 12:859396. [PMID: 35847945 PMCID: PMC9283792 DOI: 10.3389/fonc.2022.859396] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022] Open
Abstract
Background Minimally invasive treatment of thyroid tumors has become increasingly common, but has mainly focused on benign thyroid tumors, whereas thermal ablation of thyroid cancer remains controversial. Clinical studies analyzing the efficacy of thermal ablation of papillary thyroid carcinoma (PTC) have been conducted in several countries to verify its safety. Here, we screened and reviewed recent studies on the efficacy and safety of thermal ablation of PTC as well as psychological assessment, patient prognosis, recurrence, and factors affecting ablation. Summary The most significant controversy surrounding ablative treatment of PTC centers on its effectiveness and safety, and >40 studies have been conducted to address this issue. The studies include papillary thyroid microcarcinoma (PTMC) and non-PTMC, single PTC and multiple PTC, and controlled studies of ablative therapy and surgical treatment. In general, ablation techniques can be carefully performed and promoted under certain conditions and with active follow-up of postoperative patients. Ablation is a promising alternative treatment especially in patients who are inoperable. Conclusions Clinical studies on PTC ablation have provided new perspectives on local treatment. However, because PTC grows very slowly, it is an indolent tumor; therefore, studies with larger sample sizes and extended post-procedure follow-ups are necessary to confirm the investigators’ hypotheses.
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Affiliation(s)
- Di Ou
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Chen Chen
- Graduate School, Wannan Medical College, Wuhu, China
| | - Tian Jiang
- The Postgraduate Training Base, Wen Zhou Medical University, Hangzhou, China
| | - Dong Xu
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
- *Correspondence: Dong Xu,
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15
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Zhao ZL, Wei Y, Peng LL, Li Y, Lu NC, Yu MA. Recurrent Laryngeal Nerve Injury in Thermal Ablation of Thyroid Nodules-Risk Factors and Cause Analysis. J Clin Endocrinol Metab 2022; 107:e2930-e2937. [PMID: 35311971 DOI: 10.1210/clinem/dgac177] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 12/19/2022]
Abstract
CONTEXT Recurrent laryngeal nerve (RLN) injury is a complication of thermal thyroid nodule treatment. OBJECTIVE We investigated the influencing factors of RLN injury in patients who underwent thermal ablation of thyroid nodules. METHODS The data of 1004 patients (252 male, 752 female; median age 44 years) who underwent thermal thyroid nodule ablation were retrospectively reviewed. Patients were divided into benign cystic, benign solid, and papillary thyroid cancer (PTC) groups. The parameters related to RLN injury were analyzed, including the largest diameter, location of the nodules, and shortest distance of the nodule to thyroid capsule and tracheoesophageal groove (TEG). Univariate and multivariate analyses were performed to select risk factors for RLN injury. RESULTS The RLN injury rate was higher in PTC (6.3%) than in benign cystic (1.2%, P = 0.019) and solid nodules (2.9%, P = 0.018). PTC subgroup analysis showed that the RLN injury rate was higher in T1b (10.7%) and T2 (28.6%) PTC than in T1a PTC (5.0%, P < 0.05). In the PTC group, TEG distance, anterior capsule distance, median capsule distance, posterior capsule distance, and maximum nodule diameter were risk factors for RLN injury. The logistic regression fitting of the nomogram showed high prediction efficiency (C-Index 0.876). The main cause of RLN injury was insufficient medial isolating fluid (MIF). The safety thicknesses of MIF for benign cystic, benign solid, and PTC nodules were 3.1 mm, 3.7 mm, and 3.9 mm, respectively. CONCLUSION Several risk factors for RLN injury should be considered before thermal ablation of thyroid nodules. The RLN injury rate could be predicted with the nomogram.
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Affiliation(s)
- Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Nai-Cong Lu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
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16
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Chen S, Mao Y, Chen G. Economic effect between surgery and thermal ablation for patients with papillary thyroid microcarcinoma: a systemic review and meta-analysis. Endocrine 2022; 76:9-17. [PMID: 35122627 PMCID: PMC8817154 DOI: 10.1007/s12020-022-02991-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/19/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND At present, there are still many controversies regarding the treatment of papillary thyroid microcarcinoma (PTMC). It is worth noting that thermal ablation has become a viable alternative for patients at high risk of surgery or those who wish to receive more active treatment than active surveillance. OBJECTIVE To investigate the economic benefits, efficacy, and safety of thermal ablation for patients with PTMC. METHODS We searched PubMed, Cochrane Library, Web of Science, and Embase for articles published from the database establishment to August 2021. All of the studies included were retrospective cohort analyses. In addition, meta-analysis was performed using the Stata15.1 versions and Review Manager5.3. Data were extracted according to the PRISMA guidelines by two professional doctors. RESULTS A total of 7 articles (1582 patients) were included in our systematic review and meta-analysis. We discovered that thermal ablation could shorten the hospitalization time (SMD, -3.82[95%CI, -5.25 to -2.40]), operation time (SMD, -5.67[95%CI, -6.65 to -4.68]), cost (SMD, -3.40 [95%CI, -5.06 to -1.75]) and reduce postoperative complications (OR, 0.07 [95%CI, 0.01 to 0.44]) than surgical treatment. In addition, our study also found that compared with surgery, there was no significant difference in the recurrence rate (OR, 1.53 [95% CI, 0.63 to 3.73]) and metastasis rate (OR, 0.47 [95% CI, 0.12 to 1.86]). CONCLUSION On the premise of being safe and effective, thermal ablation has better economic benefits than surgical treatment for patients with PTMC.
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Affiliation(s)
- Shuqian Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Yaqian Mao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Gang Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China.
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Wu J, Wei Y, Zhao ZL, Peng LL, Li Y, Lu NC, Yu MA. A preliminary study of microwave ablation for solitary T1N0M0 papillary thyroid carcinoma with capsular invasion. Int J Hyperthermia 2022; 39:372-378. [PMID: 35184656 DOI: 10.1080/02656736.2022.2040607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Affiliation(s)
- Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Nai-Cong Lu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
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18
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Zhao ZL, Wei Y, Liu CH, Peng LL, Li Y, Lu NC, Wu J, Yu MA. Changes in Thyroid Antibodies after Microwave Ablation of Thyroid Nodules. Int J Endocrinol 2022; 2022:7916327. [PMID: 36147726 PMCID: PMC9489371 DOI: 10.1155/2022/7916327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/24/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Microwave ablation (MWA) is a minimally invasive method for the thermal ablation of benign thyroid nodules and papillary thyroid cancer (PTC) and has shown promising results. The aim of this study was to investigate the impact of MWA on thyroid antibodies and associated influencing factors. MATERIALS AND METHODS A total of 119 patients, including 69 with benign thyroid nodules and 50 with PTC, underwent MWA between June 2019 and June 2021. The serum levels of (free) triiodothyronine, (free) thyroxine, thyrotropin, and antibodies against Tg (TGAb), thyrotropin receptors (TRAb), and thyroid peroxidase (TPOAb) were measured during the follow up. RESULTS One month after ablation, three patients (4.3%) in the benign group had hypothyroidism, and one (1.4%) had hyperthyroidism. Four patients (5.8%) had subclinical hypothyroidism, and two (2.9%) had subclinical hyperthyroidism. Among the PTC patients, two (4%) had hypothyroidism, and one (2%) had hyperthyroidism. Two patients (4%) had subclinical hypothyroidism, and one (2%) had subclinical hyperthyroidism. In the benign group, among patients with normal preablation antibodies, the postablation TGAb abnormal rate was 12.7%, the TPOAb level was 4.8%, and the TRAb level was 0%. Among PTC patients, the postablation TGAb abnormal rate was 11.4%, the TPOAb level was 8.7%, and the TRAb level was 4.0%. The cutoff value of preablation TGAb for predicting postoperative antibody abnormalities was 19.0 IU/mL, while that of TPOAb was 11.4 IU/mL. CONCLUSIONS MWA of thyroid nodules had little influence on thyroid function and antibodies. Elevations in TGAb, TPOAb, and TRAb beyond the normal ranges after MWA may be related to high preablation levels of TGAb and TPOAb.
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Affiliation(s)
- Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Cai-Hong Liu
- Department of Ultrasound, Tumor Hospital of Mudanjiang City, Mudanjiang, Heilongjiang, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Nai-Cong Lu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
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Xue J, Teng D, Wang H. Over than three-year follow-up results of thermal ablation for papillary thyroid carcinoma: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:971038. [PMID: 36353232 PMCID: PMC9637737 DOI: 10.3389/fendo.2022.971038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study is a meta-analysis based on evidence-based medicine to explore the long-term (≥3 years) efficacy of thermal ablation in the treatment of papillary thyroid carcinoma (PTC). METHODS We searched the PubMed, Embase, and Cochrane Library databases for studies published during the time between the establishment of the databases through June 2022. We included 13 non-randomized-controlled trials (non-RCTs) that reported the application of ultrasound-guided thermal ablation in PTC. We excluded studies that were repeated publications, research without full text, contained incomplete information, lacked data extraction, involved animal experiments, reviews, and systematic reviews. STATA 15.1 software was used to analyze the data. RESULTS Tumor volume after thermal ablation at 3-year follow-up was significantly lower than pre-ablation (standardized mean difference [SMD] = -1.06, 95% CI: -1.32~-0.80). The pooled results indicated that the maximum diameter after thermal ablation at 3-year follow-up was significantly lower than pre-ablation (SMD = -1.93, 95% CI: -12.13~-1.73). The pooled results indicated that volume reduction rate (VRR) after thermal ablation at 3-year follow-up was 98.91% (95% CI: 97.98-99.83%), and complete disappearance rate (CDR) after thermal ablation at 3-year follow-up was 83% (95% CI: 67-94%). In addition, the incidence of newly discovered mPTC and lymph node metastases after thermal ablation was 0.3% (95% CI: 0.0-1.0%) and 0.0% (95% CI: 0.0-0.0%), respectively. CONCLUSION Overall, the long-term (≥3 years) efficacy of ultrasound-guided thermal ablation in the treatment of PTC was significant, with favorable disease progression. Ultrasound-guided thermal ablation can be considered an alternative approach for patients with PTC who refuse surgery or are unable to undergo surgery.
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Affiliation(s)
| | | | - Hui Wang
- *Correspondence: DengKe Teng, ; Hui Wang,
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20
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Wu J, Zhao ZL, Cao XJ, Wei Y, Peng LL, Li Y, Yu MA. A feasibility study of microwave ablation for papillary thyroid cancer close to the thyroid capsule. Int J Hyperthermia 2021; 38:1217-1224. [PMID: 34384314 DOI: 10.1080/02656736.2021.1962549] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To evaluate the feasibility, efficiency, and safety of microwave ablation (MWA) for papillary thyroid carcinoma (PTC) close to the thyroid capsule. METHODS The data of 106 cases who underwent thermal ablation from June 2014 to September 2020 were retrospectively analyzed. The mean follow-up time was 25 ± 11 months (range, 9-48 months). The strategy of fluid isolation was successfully applied in all cases, and all PTC nodules underwent extended ablation. The technical feasibility, technical success rate, and safety were analyzed. Changes in tumor size at different time points after MWA were evaluated. RESULTS According to the contrast-enhanced ultrasound results after ablation, MWA has been successfully applied in all enrolled cases. The capsular ablation has also been achieved for all cases. Nodules in 71 cases (70.0%) completely disappeared in the follow-up period. No local recurrence was detected. The incidence of lymph node metastasis and new tumors was 1.9% (2/106) respectively. Light voice changes were the only complication, with a rate of 5.7% (6/106), which were relieved within 6 months after MWA. The size of the ablation zone increased firstly in 6 months after MWA compared with the pretreatment tumor size (p < 0.05). At 12, 18, 24, 30, 36 and 42 months after MWA, the ablation zone shrank and the sizes were smaller than the tumor size before MWA (p < 0.05 for all). CONCLUSIONS MWA is an effective, safe, and feasible method in treating PTC close to the thyroid capsule.
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Affiliation(s)
- Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xiao-Jing Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| |
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