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Zhang DL, Chen S, Qiu Y, Yang JC, Hong Z, Li J, Wu SS. Radiofrequency ablation for solitary T1N0M0 papillary thyroid carcinoma in the danger triangle area: a preliminary analysis. Int J Hyperthermia 2024; 41:2305256. [PMID: 38314684 DOI: 10.1080/02656736.2024.2305256] [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: 10/30/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
OBJECTIVES To evaluate the feasibility, efficacy, and safety of radiofrequency ablation (RFA) for solitary T1N0M0 papillary thyroid carcinoma (PTC) in the danger triangle area. METHODS 94 participants (mean age 44.45 ± 13.08; 73 females) with solitary T1N0M0 PTC in the danger triangle area who underwent percutaneous RFA at the hospital from January 2018 to April 2020 were retrospectively analyzed. Key ablation procedures included sufficient paratracheal fluid isolation, low-power, and short active tip (5 mm working electrode). Tumor size changes at different time points after RFA, technical success rates, tumor disappearance, disease progression, and complications were recorded and compared. RESULTS Contrast-enhanced ultrasonography revealed that complete tumor ablation was performed with a 100% success rate in these patients. Post-ablation, the maximum diameter and volume of the ablation zone increased at the first and third month (p < 0.001), followed by a gradual decrease in size, without significant difference by the 6th month. The tumor disappearance rate was 76.59% (72/94), with higher rates in the T1a group compared to the T1b group (80% [64/80] VS57.1% [8/14], p < 0.001). There were no local recurrences. The incidence of new lesions and LNM was 3.2% (3/94), limited to the T1a subgroup. Further ablation was successfully applied to all new lesions and LMN. Mild voice changes were the only complication, with a rate of 3.2% (3/94), resolved within 4 months after RFA. CONCLUSIONS Sufficient paratracheal fluid isolation combined with a low-power, short active tip radiofrequency ablation strategy is a safe and effective method for treating solitary T1N0M0 PTC in the danger triangle area.
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Affiliation(s)
- Dan-Ling Zhang
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian, China
- Department of Ultrasonography, Fuzhou First General Hospital, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian, China
| | - Yuhan Qiu
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian, China
| | - Jian-Chuan Yang
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian, China
| | - Zhiliang Hong
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian, China
| | - Jianwei Li
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian, China
| | - Song-Song Wu
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian, China
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Dong P, Teng DK, Sui GQ, Lin YQ, Luo Q, Wang QM, Li HQ, Wang H. Long-term efficacy of microwave ablation for multifocal papillary thyroid microcarcinoma: a 5-year follow-up study. Eur Radiol 2024; 34:715-723. [PMID: 37581653 DOI: 10.1007/s00330-023-10117-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES Microwave ablation (MWA) has achieved excellent long-term efficacy in treating unifocal papillary thyroid microcarcinoma (UPTMC). The therapeutic effect of this treatment on multifocal papillary thyroid microcarcinoma (MPTMC) is unknown. Therefore, we evaluated the long-term efficacy of MWA for low-risk MPTMC and to provide evidence-based medicine for the revision of clinical guidelines. METHODS This study included 66 MPTMC patients with a total of 158 lesions, all of whom received MWA. We collected and retrospectively analyzed the patients' follow-up data before MWA, at 1, 3, 6, and 12 months posttreatment and every 6 months thereafter until 5 years posttreatment. We evaluated the MWA complication rate, technical success rate (TSR), lesion volume reduction rate (VRR), and complete disappearance rate (CDR) during follow-up and in those patients with tumor progression and delayed surgery. RESULTS After 60 months of follow-up, all 158 lesions disappeared in 66 patients, and the volume was reduced from 43.82 mm3 to 0.00 mm3. The TSR and VRR were both 100%. The CDRs at 1 year, 2 years, and 3 years were 57.59%, 93.67%, and 100%, respectively. The complication rate was 3.03% (2/66), and the incidence of tumor progression was 3.03% (2/66), including one new intrathyroidal lesion and one cervical lymph node metastasis (LNM). These lesions were retreated with MWA, and the lesions disappeared during the follow-up period. CONCLUSIONS Ultrasound-guided MWA for low-risk MPTMC is safe and effective and may serve as an alternative option for patients who refuse surgery or active surveillance (AS). CLINICAL RELEVANCE STATEMENT This study concludes that ultrasound-guided microwave ablation for low-risk multifocal papillary thyroid microcarcinoma is safe and effective and may serve as an alternative option for patients who refuse surgery or active surveillance. KEY POINTS • Ultrasound-guided microwave ablation for low-risk multifocal papillary thyroid microcarcinoma is safe and effective. • During 5 years of follow-up, multifocal papillary thyroid microcarcinoma patients treated with microwave ablation had a favorable prognosis. • To provide evidence-based medicine for the revision of clinical guidelines.
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Affiliation(s)
- Peng Dong
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Guo-Qing Sui
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Yuan-Qiang Lin
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Qiang Luo
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Qi-Meihui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - He-Qun Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, 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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Li L, Wang Z, Guo H, Lin Q. Nanomaterials: a promising multimodal theranostics platform for thyroid cancer. J Mater Chem B 2023; 11:7544-7566. [PMID: 37439780 DOI: 10.1039/d3tb01175e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Thyroid cancer is the most prevalent malignant neoplasm of the cervical region and endocrine system, characterized by a discernible upward trend in incidence over recent years. Ultrasound-guided fine needle aspiration is the current standard for preoperative diagnosis of thyroid cancer, albeit with limitations and a certain degree of false-negative outcomes. Although differentiated thyroid carcinoma generally exhibits a favorable prognosis, dedifferentiation is associated with an unfavorable clinical course. Anaplastic thyroid cancer, characterized by high malignancy and aggressiveness, remains an unmet clinical need with no effective treatments available. The emergence of nanomedicine has opened new avenues for cancer theranostics. The unique features of nanomaterials, including multifunctionality, modifiability, and various detection modes, enable non-invasive and convenient thyroid cancer diagnosis through multimodal imaging. For thyroid cancer treatment, nanomaterial-based photothermal therapy or photodynamic therapy, combined with chemotherapy, radiotherapy, or gene therapy, holds promise in reducing invasiveness and prolonging patient survival or alleviating pain in individuals with anaplastic thyroid carcinoma. Furthermore, nanomaterials enable simultaneous diagnosis and treatment of thyroid cancer. This review aims to provide a comprehensive survey of the latest developments in nanomaterials for thyroid cancer diagnosis and treatment and encourage further research in developing innovative and effective theranostic approaches for thyroid cancer.
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Affiliation(s)
- Lei Li
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, P. R. China.
- Department of Endocrinology, Lequn Branch, The First Hospital of Jilin University, Changchun, 130031, China.
| | - Ze Wang
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, P. R. China.
| | - Hui Guo
- Department of Endocrinology, Lequn Branch, The First Hospital of Jilin University, Changchun, 130031, China.
| | - Quan Lin
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, P. R. China.
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Huang T, Sang Y, Zhang J. Efficacy of Modified Nonpneumatic Transaxillary Approach in the Treatment of Thyroid Cancer and Its Effect on Immune Function and Parathyroid Function. Emerg Med Int 2022; 2022:3336880. [PMID: 36285179 PMCID: PMC9588369 DOI: 10.1155/2022/3336880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/22/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of the study is to investigate the effect of modified nonpneumatic transaxillary approach in the treatment of thyroid cancer and its effect on immune function and parathyroid function. Methods A total of 96 patients with thyroid cancer who were diagnosed and treated in our hospital from January 2018 to December 2020 were selected and randomly divided into the control group of 48 cases and the observation group of 48 cases. The control group was given open surgery, and for the observation group, modified nonpneumatic transaxillary approach was used for treatment. The perioperative related indicators, the incidence of complications, as well as the changes of immune function indicators, parathyroid hormone (PTH), and calcium before and after surgery were compared between the two groups. Results The time of flap separation and cavity construction, operation time, and hospital stay in the observation group were significantly longer than those in the control group (P < 0.05). After operation, CD3+, CD4+, and CD4+/CD8+ in the two groups were lower than those before operation (P < 0.05), but the observation group was significantly higher than that in the control group (P < 0.05). The serum PTH and calcium at 1 h, 1 d, 3 d and 7 d after operation were lower than those before operation in this group (P < 0.05), but the observation group was significantly higher than that in the control group (P < 0.05). Compared with the control group, the incidence of complications in the observation group (4.17% vs. 6.25%) was not statistically significant (P > 0.05). Conclusion Compared with open surgery, the modified nonpneumatic transaxillary approach in the treatment of thyroid cancer is more effective in reducing immune function decline, hypoparathyroidism, and hypocalcemia; although the operation time and recovery time are longer, and it is safe. Sex is also high.
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Affiliation(s)
- Tao Huang
- Department of Breast and Thyroid, Second Hospital of Nanjing, Nanjing, Jiangsu 210000, China
| | - Yiming Sang
- Department of Breast and Thyroid, Second Hospital of Nanjing, Nanjing, Jiangsu 210000, China
| | - Jizong Zhang
- Department of Breast and Thyroid, Second Hospital of Nanjing, Nanjing, Jiangsu 210000, China
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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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