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Lund S, Schmitz JJ, Foster T, Dy B, McKenzie T, Castro MR, Lyden ML. Ethanol ablation of papillary thyroid carcinoma nodal metastases: Long-term outcomes. Surgery 2024; 175:1034-1039. [PMID: 38195302 DOI: 10.1016/j.surg.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Percutaneous ethanol ablation has emerged as a treatment for recurrent papillary thyroid carcinoma in the lateral neck after compartment-oriented therapeutic lymphadenectomy. However, the safety and utility of percutaneous ethanol ablation as a primary treatment modality for lateral neck metastases remains undefined. We aimed to investigate long-term outcomes of percutaneous ethanol ablation of lateral neck papillary thyroid carcinoma recurrence both with and without prior lymphadenectomy. METHODS We conducted a retrospective study of patients with lateral neck papillary thyroid carcinoma treated with percutaneous ethanol ablation from 2013 to 2018. Patient characteristics, disease volume, morbidity, and recurrence (development of new lymphadenopathy within a percutaneous ethanol ablation-treated nodal compartment) were assessed. RESULTS We identified 117 patients who underwent percutaneous ethanol ablation for papillary thyroid carcinoma lateral neck metastases-67 (57%) had a prior lateral neck dissection. Median follow-up after percutaneous ethanol ablation was 5.5 years (interquartile range 3.1-7.5). On average, 1.4 lymph nodes (range: 1-6) were treated. Three patients (3%) developed transient nerve-related complications after percutaneous ethanol ablation. Of 15 patients who underwent lateral neck dissection after percutaneous ethanol ablation (including patients undergoing repeat lateral neck dissection), dissection was "difficult" in 8 (53%) (7 of whom had previously undergone lateral neck dissection), and 4 (27%) developed complications (transient nerve dysfunction = 3, lymphatic leak = 1). Thirty-three patients (28%) developed recurrent papillary thyroid carcinoma. No difference in recurrence was seen between patients who did or did not undergo pre-percutaneous ethanol ablation lateral neck dissection (no pre-percutaneous ethanol ablation lateral neck dissection: 24%, pre-percutaneous ethanol ablation lateral neck dissection, 31%; hazard ratio = 1.27, 95% confidence interval 0.62-2.58; P = .514). CONCLUSION Percutaneous ethanol ablation may be a safe primary treatment modality for papillary thyroid carcinoma lateral neck nodal recurrence in selected patients with low-volume nodal disease.
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Affiliation(s)
- Sarah Lund
- Mayo Clinic Department of Surgery, Rochester, MN.
| | - John J Schmitz
- Mayo Clinic Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Rochester, MN
| | - Trenton Foster
- Mayo Clinic Division of Endocrine and Metabolic Surgery, Rochester, MN
| | - Benzon Dy
- Mayo Clinic Division of Endocrine and Metabolic Surgery, Rochester, MN
| | - Travis McKenzie
- Mayo Clinic Division of Endocrine and Metabolic Surgery, Rochester, MN
| | - M Regina Castro
- Mayo Clinic Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Rochester, MN
| | - Melanie L Lyden
- Mayo Clinic Division of Endocrine and Metabolic Surgery, Rochester, MN
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Hay ID, Lee RA, Reading CC, Charboneau JW. Can Ethanol Ablation Achieve Durable Control of Neck Nodal Recurrences in Adults With Stage I Papillary Thyroid Cancer? J Endocr Soc 2024; 8:bvae037. [PMID: 38505561 PMCID: PMC10949354 DOI: 10.1210/jendso/bvae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Indexed: 03/21/2024] Open
Abstract
Objective Results of ethanol ablation (EA) for controlling neck nodal metastases (NNM) in adult patients with papillary thyroid carcinoma (APTC) beyond 6 months have rarely been reported. We now describe outcome results in controlling 71 NNM in 40 node-positive stage I APTC patients followed for 66 to 269 months. Methods All 40 patients were managed with bilateral thyroidectomy and radioiodine therapy and followed with neck ultrasound (US) for >48 months after EA. Cumulative radioiodine doses ranged from 30 to 550 mCi; pre-EA 27 patients (67%) had 36 additional neck surgeries. Cytologic diagnosis of PTC in 71 NNM selected for EA was confirmed by US-guided biopsy. EA technique and follow-up protocol were as previously described. Results The 40 patients had 1 to 4 NNM; 67/71 NNM (94%) received 2 to 4 ethanol injections (total median volume 0.8 cc). All ablated 71 NNM shrank (mean volume reduction of 93%); nodal hypervascularity was eliminated. Thirty-eight NNM (54%) with initial volumes of 12-1404 mm3 (median 164) disappeared on neck sonography. Thirty-three hypovascular foci from ablated NNM (pre-EA volume range 31-636 mm3; median 147) were still identifiable with volume reductions of 45% to 97% observed (median 81%). There were no complications and no postprocedure hoarseness. Final results were considered to be ideal or near ideal in 55% and satisfactory in 45%. There was no evidence of tumor regrowth after EA. Conclusion Our results demonstrate that for patients with American Joint Committee on Cancer stage I APTC, who do not wish further surgery or radioiodine, and are uncomfortable with active surveillance, EA can achieve durable control of recurrent NNM.
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Affiliation(s)
- Ian D Hay
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert A Lee
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Carl C Reading
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
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Tofé S, Argüelles I, Álvarez C, Tofé Á, Repetto A, Barceló A, Pereg V. Ultrasound-Guided Ethanol Percutaneous Ablation Versus Rescue Surgery in Patients With Locoregional Recurrence of Papillary Thyroid Cancer. Clin Exp Otorhinolaryngol 2023; 16:380-387. [PMID: 37641858 DOI: 10.21053/ceo.2023.00689] [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: 05/12/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Neck recurrence of papillary thyroid cancer (PTC) is frequently detected after initial surgery. The management of these lesions may include rescue surgery (RS) or minimally invasive techniques in selected patients, but comparative studies evaluating the effectiveness and safety of these techniques are lacking. In this paper, we compared ultrasound-guided ethanol ablation (EA) in selected patients to RS in a matched cohort. METHODS We retrospectively compared 41 patients and 41 matched PTC patients without known distant metastases, who underwent ultrasound-guided EA or RS (matched reference group), who had 63 and 75 thyroid bed and/or lymph node confirmed PTC recurrences during a median follow-up of 72.8 and 89.6 months, respectively. The primary outcome was time until structural recurrence, compared using Kaplan-Meier survival curves. The secondary outcomes included time until biochemical recurrence, plasma thyroglobulin (Tg) levels, American Thyroid Association (ATA) response-to-therapy categories by the last available observation, and treatment-derived complications in each group. RESULTS No significant differences were found between the EA and RS groups for time until structural recurrence (log-rank test, P=0.94). The time until biochemical recurrence was also similar (P=0.51); and the plasma Tg concentration reduction and proportions of patients in the ATA reclassification categories were also similar. A significantly higher proportion of patients in the RS group presented treatment-derived complications (29.27% vs. 9.75%, P<0.05). CONCLUSION In this retrospective analysis, the treatment of PTC neck recurrence with EA in selected patients was comparable to RS in a matched reference group for the long-term risk of structural or biochemical relapse, but with a lower risk of treatment-derived complications. These. RESULTS support the effectiveness and safety of this minimally invasive technique in the management of selected patients with recurrent PTC.
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Affiliation(s)
- Santiago Tofé
- Department of Endocrinology, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Iñaki Argüelles
- Department of Endocrinology, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Cristina Álvarez
- Department of Surgery, Section of Endocrine Surgery, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Álvaro Tofé
- Department of Maxillo-Facial Surgery, University Hospital Puerta del Mar, Cádiz, Spain
| | - Alessandra Repetto
- Department of Nuclear Medicine, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Antonia Barceló
- Laboratory of Clinical Analysis, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Vicente Pereg
- Department of Endocrinology, University Hospital Son Espases, Palma de Mallorca, Spain
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Bhattacharya K, Mahajan A, Vaish R, Rane S, Shukla S, D'Cruz AK. Imaging of Neck Nodes in Head and Neck Cancers - a Comprehensive Update. Clin Oncol (R Coll Radiol) 2023; 35:429-445. [PMID: 37061456 DOI: 10.1016/j.clon.2023.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Cervical lymph node metastases from head and neck squamous cell cancers significantly reduce disease-free survival and worsen overall prognosis and, hence, deserve more aggressive management and follow-up. As per the eighth edition of the American Joint Committee on Cancer staging manual, extranodal extension, especially in human papillomavirus-negative cancers, has been incorporated in staging as it is important in deciding management and significantly impacts the outcome of head and neck squamous cell cancer. Lymph node imaging with various radiological modalities, including ultrasound, computed tomography and magnetic resonance imaging, has been widely used, not only to demonstrate nodal involvement but also for guided histopathological evaluation and therapeutic intervention. Computed tomography and magnetic resonance imaging, together with positron emission tomography, are used widely for the follow-up of treated patients. Finally, there is an emerging role for artificial intelligence in neck node imaging that has shown promising results, increasing the accuracy of detection of nodal involvement, especially normal-appearing nodes. The aim of this review is to provide a comprehensive overview of the diagnosis and management of involved neck nodes with a focus on sentinel node anatomy, pathogenesis, imaging correlates (including radiogenomics and artificial intelligence) and the role of image-guided interventions.
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Affiliation(s)
- K Bhattacharya
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - A Mahajan
- The Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK.
| | - R Vaish
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Rane
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Shukla
- Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - A K D'Cruz
- Apollo Hospitals, India; Union International Cancer Control (UICC), Geneva, Switzerland; Foundation of Head Neck Oncology, India
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Hay ID, Lee RA, Reading CC, Pittock ST, Sharma A, Thompson GB, William Charboneau J. Long-term Effectiveness of Ethanol Ablation in Controlling Neck Nodal Metastases in Childhood Papillary Thyroid Cancer. J Endocr Soc 2023; 7:bvad065. [PMID: 37388573 PMCID: PMC10306272 DOI: 10.1210/jendso/bvad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Indexed: 07/01/2023] Open
Abstract
Context Childhood papillary thyroid carcinoma (CPTC), despite bilateral thyroidectomy, nodal dissection and radioiodine remnant ablation (RRA), recurs within neck nodal metastases (NNM) in 33% within 20 postoperative years. These NNM are usually treated with reoperation or further radioiodine. Ethanol ablation (EA) may be considered when numbers of NNM are limited. Objective We studied the long-term results of EA in 14 patients presenting with CPTC during 1978 to 2013 and having EA for NNM during 2000 to 2018. Methods Cytologic diagnoses of 20 NNM (median diameter 9 mm; median volume 203 mm3) were biopsy proven. EA was performed during 2 outpatient sessions under local anesthesia; total volume injected ranged from 0.1 to 2.8 cc (median 0.7). All were followed regularly by sonography and underwent volume recalculation and intranodal Doppler flow measurements. Successful ablation required reduction both in NNM volume and vascularity. Results Post EA, patients were followed for 5 to 20 years (median 16). There were no complications, including postprocedure hoarseness. All 20 NNM shrank (mean by 87%) and Doppler flow eliminated in 19 of 20. After EA, 11 NNM (55%) disappeared on sonography; 8 of 11 before 20 months. Nine ablated foci were still identifiable after a median of 147 months; only one identifiable 5-mm NNM retained flow. Median serum Tg post EA was 0.6 ng/mL. Only one patient had an increase in Tg attributed to lung metastases. Conclusion EA of NNM in CPTC is effective and safe. Our results suggest that for CPTC patients who do not wish further surgery and are uncomfortable with active surveillance of NNM, EA represents a minimally invasive outpatient management option.
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Affiliation(s)
- Ian D Hay
- Correspondence: Ian D. Hay, MD, PhD, FRSE, Division of Endocrinology, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Robert A Lee
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Carl C Reading
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Animesh Sharma
- Department of Pediatric Endocrinology, Children’s Hospital, Aurora, CO 80045, USA
| | - Geoffrey B Thompson
- Department of Surgery, Sheikh Shakhbout Medical City, PO Box 11001, Abu Dhabi, United Arab Emirates
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Young S, Chen T, Golzarian J, Sanghvi T. Ablation of Cervical Lymph Nodes in Patients with Thyroid Cancer: A Comparison between Cryoablation and Percutaneous Ethanol Injection. J Vasc Interv Radiol 2022; 34:777-781.e1. [PMID: 36521788 DOI: 10.1016/j.jvir.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
The purpose of this brief report was to retrospectively evaluate the safety and efficacy of cryoablation and compare the outcomes with those of percutaneous ethanol injection (PEI) for the treatment of metastatic cervical lymph nodes (CLNs) in patients with thyroid cancer at a single center. The study included 24 patients with 47 CLNs treated with PEI and 7 patients with 11 CLNs treated with cryoablation. Three of 7 (42.9%) patients did not respond to PEI and progressed to cryoablation. There were more local recurrences in CLNs treated with PEI (7/47, 14.9%) compared with cryoablation (0/11, 0%), but this did not reach significance (P = .33). There was no difference in mild/moderate (3/24, 12.5% vs 2/7, 28.6%; P = .31) or severe (1/24, 4.2% vs 0/7, 0%; P = 1) adverse events in the PEI and cryoablation cohorts. The number of treatments required for CLNs treated with PEI (2 ± 1.1) was significantly greater than those for CLNs treated with cryoablation (1 ± 0) (P = .002). These limited data suggest that the treatment of metastatic CLNs with cryoablation or PEI may be safe and effective; however, further data are needed.
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Affiliation(s)
- Shamar Young
- Department of Medical Imaging, Division of Interventional Radiology, University of Arizona, Tucson, Arizona.
| | - Ting Chen
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, Minnesota
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Berciano‐Guerrero M. Use of multikinase inhibitors/lenvatinib concomitant with locoregional therapies for the treatment of radioiodine-refractory differentiated thyroid cancer. Cancer Med 2022; 11 Suppl 1:40-46. [PMID: 36202609 PMCID: PMC9537059 DOI: 10.1002/cam4.5108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 11/16/2022] Open
Abstract
Locoregional recurrence of differentiated thyroid cancer (DTC) occurs in 20% of thyroid cancer patients. Currently, there are many strategies for management of locoregional recurrence of DTC that lead to local control of the disease. The introduction of lenvatinib into the therapeutic armamentarium provides a new option for the treatment of radioiodine-refractory DTC (RR-DTC). However, results for simultaneous treatment with lenvatinib and locoregional therapies are unknown in patients with RR-DTC. This paper reviews the current status of this approach and gives recommendations on the management of lenvatinib during concomitant locoregional procedures.
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Frich PS, Sigstad E, Berstad AE, Fagerlid KH, Paulsen TH, Bjøro T, Flinder LI. Long-Term Efficacy of Ethanol Ablation as Treatment of Metastatic Lymph Nodes From Papillary Thyroid Carcinoma. J Clin Endocrinol Metab 2022; 107:e2141-e2147. [PMID: 34922379 PMCID: PMC9016442 DOI: 10.1210/clinem/dgab907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Indexed: 11/25/2022]
Abstract
CONTEXT Ethanol ablation (EA) is considered an alternative to surgery for metastatic lymph nodes from papillary thyroid carcinoma (PTC) in selected patients. OBJECTIVE The aim of this study was to evaluate the long-term efficacy and safety of this treatment. DESIGN AND SETTING Adult patients with PTC who had received EA in lymph node metastasis at a tertiary referral center, and were included in a published study from 2011, were invited to participate in this follow-up study. METHODS Radiologic and medical history were reviewed. Ultrasound examination of the neck was performed by radiologists, and clinical examination was performed by an endocrine surgeon. Response was reported according to predefined criteria for satisfactory EA treatment. Adverse events associated with EA were evaluated. Cause of death was reported for deceased patients. RESULTS From the 2011 study, 51 of 63 patients were included. Forty-four patients were reexamined (67/109 lesions) and 7 patients were deceased. Median follow-up time from primary surgery was 14.5 years. Median follow-up from the latest performed EA in the 2011 study was 11.3 years. Local control was permanently achieved in most patients (80%). Recurrence within an ablated node was registered in 13 metastases in 10 patients. Seven of these patients also had recurrent disease elsewhere in the neck. No major side effects were reported. CONCLUSION EA is a minimally invasive procedure with a low risk of complications. Our data suggest that EA is a safe and efficient treatment, providing excellent results for a large group of patients in the long term.
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Affiliation(s)
- Pål Stefan Frich
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Correspondence: Pål Stefan Frich, MD, Department of Radiology, The Norwegian Radium Hospital, Oslo University Hospital, P.O. Box 4953, Nydalen N-0424 Oslo, Norway. E-mail:
| | - Eva Sigstad
- Division of Laboratory Medicine, Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Audun Elnæs Berstad
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Kristin Holgersen Fagerlid
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Trond Harder Paulsen
- Division of Cancer Medicine, Department of Breast and Endocrine Surgery, Oslo University Hospital, Oslo, Norway
| | - Trine Bjøro
- Division of Laboratory Medicine, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Liv Ingrid Flinder
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Oslo, Norway
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Stan MN, Papaleontiou M, Schmitz JJ, Castro MR. Nonsurgical Management of Thyroid Nodules: The Role of Ablative Therapies. J Clin Endocrinol Metab 2022; 107:1417-1430. [PMID: 34953163 PMCID: PMC9016471 DOI: 10.1210/clinem/dgab917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 12/02/2022]
Abstract
CONTEXT After a thorough evaluation most thyroid nodules are deemed of no clinical consequence and can be observed. However, when they are compressive, toxic, or involved by papillary thyroid carcinoma surgery or radioactive iodine (RAI) (if toxic) are the treatments of choice. Both interventions can lead to hypothyroidism and other adverse outcomes (eg, scar, dysphonia, logistical limitation with RAI). Active surveillance might be used for papillary thyroid microcarcinoma (PTMC) initially, but anxiety leads many cases to surgery later. Several ablative therapies have thus evolved over the last few years aimed at treating these nodules while avoiding described risks. CASES We present 4 cases of thyroid lesions causing concern (compressive symptoms, thyrotoxicosis, anxiety with active surveillance of PTMC). The common denominator is patients' attempt to preserve thyroid function, bringing into focus percutaneous ethanol injection (PEI) and thermal ablation techniques (radiofrequency ablation [RFA] being the most common). We discuss the evidence supporting these approaches and compare them with standard therapy, where evidence exists. We discuss additional considerations for the utilization of these therapies, their side-effects, and conclude with a simplified description of how these procedures are performed. CONCLUSION Thermal ablation, particularly RFA, is becoming an attractive option for managing a subgroup of solid thyroid nodules, while PEI has a role in managing thyroid cysts and a select group of PTMC. Their role in the algorithm of thyroid nodule management is still being refined and technical expertise will be essential to reproduce the reported results into everyday practice.
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Affiliation(s)
- Marius N Stan
- Correspondence: Marius N. Stan, Division of Endocrinology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Jasim S, Patel KN, Randolph G, Adams S, Cesareo R, Condon E, Henrichsen T, Itani M, Papaleontiou M, Rangel L, Schmitz J, Stan MN. American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions. Endocr Pract 2022; 28:433-448. [PMID: 35396078 DOI: 10.1016/j.eprac.2022.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE The objective of this disease state clinical review is to provide clinicians with a summary of the nonsurgical, minimally invasive approaches to managing thyroid nodules/malignancy, including their indications, efficacy, side effects, and outcomes. METHODS A literature search was conducted using PubMed and appropriate key words. Relevant publications on minimally invasive thyroid techniques were used to create this clinical review. RESULTS Minimally invasive thyroid techniques are effective and safe when performed by experienced centers. To date, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Both ultrasound-guided laser and radiofrequency ablation can be safely used for symptomatic solid nodules, both toxic and nontoxic. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. Despite limited data, encouraging results suggest that minimally invasive techniques can also be used in small-size primary and locally recurrent thyroid cancer. CONCLUSION Surgery and radioiodine treatment remain the conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective alternatives when used appropriately and by trained professionals to treat symptomatic or enlarging thyroid masses.
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Affiliation(s)
- Sina Jasim
- Division of Endocrinology, Metabolism and Lipid Research, School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
| | | | - Gregory Randolph
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Adams
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, Florida
| | - Roberto Cesareo
- Unit of Metabolic Diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leonardo Rangel
- Head and Neck Surgery Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - John Schmitz
- Mayo Clinic Department of Radiology, Rochester, Minnesota
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
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Eilsberger F, Kreissl MC. Nuclear medicine therapy of thyroid cancer metastases. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Orloff LA, Noel JE, Stack BC, Russell MD, Angelos P, Baek JH, Brumund KT, Chiang FY, Cunnane MB, Davies L, Frasoldati A, Feng AY, Hegedüs L, Iwata AJ, Kandil E, Kuo J, Lombardi C, Lupo M, Maia AL, McIver B, Na DG, Novizio R, Papini E, Patel KN, Rangel L, Russell JO, Shin J, Shindo M, Shonka DC, Karcioglu AS, Sinclair C, Singer M, Spiezia S, Steck JH, Steward D, Tae K, Tolley N, Valcavi R, Tufano RP, Tuttle RM, Volpi E, Wu CW, Abdelhamid Ahmed AH, Randolph GW. Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association. Head Neck 2021; 44:633-660. [PMID: 34939714 DOI: 10.1002/hed.26960] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The use of ultrasound-guided ablation procedures to treat both benign and malignant thyroid conditions is gaining increasing interest. This document has been developed as an international interdisciplinary evidence-based statement with a primary focus on radiofrequency ablation and is intended to serve as a manual for best practice application of ablation technologies. METHODS A comprehensive literature review was conducted to guide statement development and generation of best practice recommendations. Modified Delphi method was applied to assess whether statements met consensus among the entire author panel. RESULTS A review of the current state of ultrasound-guided ablation procedures for the treatment of benign and malignant thyroid conditions is presented. Eighteen best practice recommendations in topic areas of preprocedural evaluation, technique, postprocedural management, efficacy, potential complications, and implementation are provided. CONCLUSIONS As ultrasound-guided ablation procedures are increasingly utilized in benign and malignant thyroid disease, evidence-based and thoughtful application of best practices is warranted.
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Affiliation(s)
- Lisa A Orloff
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Julia E Noel
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Brendan C Stack
- Department of Otolaryngology - Head & Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Marika D Russell
- Department of Otolaryngology - Head & Neck Surgery, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Jung Hwan Baek
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kevin T Brumund
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA
| | - Feng-Yu Chiang
- Department of Otolaryngology - Head and Neck Surgery, E-Da Hospital, School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Mary Beth Cunnane
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Louise Davies
- The Section of Otolaryngology, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Andrea Frasoldati
- Department of Endocrinology and Metabolism, Arcispedale Santa Maria Nuova IRCCS-ASL, Reggio Emilia, Italy
| | - Anne Y Feng
- Department of Otolaryngology - Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Ayaka J Iwata
- Department of Otolaryngology - Head & Neck Surgery, Kaiser Permanente, Santa Clara, California, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jennifer Kuo
- Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Celestino Lombardi
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mark Lupo
- Thyroid & Endocrine Center of Florida, Sarasota, Florida, USA
| | - Ana Luiza Maia
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center, Research Institute, Tampa, Florida, USA
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | | | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Kepal N Patel
- Department of Surgery, New York University, New York, New York, USA
| | - Leonardo Rangel
- Division of Otorhinolaryngology - Head and Neck Surgery, State University of Rio de Janeiro, Rio de Janiero, Brazil
| | - Jonathon O Russell
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Shin
- Department of Otolaryngology - Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maisie Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - David C Shonka
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Amanda S Karcioglu
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA.,Clinician Educator, Pritzker School of Medicine, Chicago, Illinois, USA
| | - Catherine Sinclair
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai West Hospital, New York, New York, USA
| | - Michael Singer
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Stefano Spiezia
- Endocrine Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Jose Higino Steck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Campinas, Campinas, Brazil
| | - David Steward
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kyung Tae
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Neil Tolley
- Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK
| | | | - Ralph P Tufano
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Michael Tuttle
- Endocrine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erivelto Volpi
- Oncology Center, Oswaldo Cruz German Hospital, Sao Paulo, Brazil
| | - Che Wei Wu
- Department of Otolaryngology - Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Amr H Abdelhamid Ahmed
- Department of Otolaryngology - Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology - Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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13
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Mauri G, Hegedüs L, Bandula S, Cazzato RL, Czarniecka A, Dudeck O, Fugazzola L, Netea-Maier R, Russ G, Wallin G, Papini E. European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical Practice Guideline for the Use of Minimally Invasive Treatments in Malignant Thyroid Lesions. Eur Thyroid J 2021; 10:185-197. [PMID: 34178704 PMCID: PMC8215982 DOI: 10.1159/000516469] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/10/2021] [Indexed: 12/15/2022] Open
Abstract
The growing detection of papillary thyroid microcarcinomas (PTMCs) is paralleled by an increase in surgical procedures. Due to the frequent indolent nature, cost, and risk of surgery, active surveillance (AS) and ultrasound-guided minimally invasive treatments (MITs) are in suitable cases of incidental PTMC proposed as alternatives to thyroidectomy. Surgery and radioiodine are the established treatments for relapsing cervical differentiated thyroid carcinoma (DTC) metastases. But radioiodine refractoriness, risk of surgical complications, adverse influence on quality of life, or declining repeat surgery have led to AS and MIT being considered as alternatives for slow-growing DTC nodal metastases. Also, for distant radioiodine-refractory metastases not amenable to surgery, MIT is proposed as part of a multimodality therapeutic approach. The European Thyroid Association and the Cardiovascular and Interventional Radiological Society of Europe commissioned these guidelines for the appropriate use of MIT. Based on a systematic PubMed search, an evidence-based approach was applied, and both knowledge and practical experience of the panelists were incorporated to develop the manuscript and the specific recommendations. We recommend that when weighing between surgery, radioiodine, AS, or MIT for DTC, a multidisciplinary team including members with expertise in interventional radiology assess the demographic, clinical, histological, and imaging characteristics for appropriate selection of patients eligible for MIT. Consider TA in low-risk PTMC patients who are at surgical risk, have short life expectancy, relevant comorbidities, or are unwilling to undergo surgery or AS. As laser ablation, radiofrequency ablation, and microwave ablation are similarly safe and effective thermal ablation (TA) techniques, the choice should be based on the specific competences and resources of the centers. Use of ethanol ablation and high-intensity focused ultrasound is not recommended for PTMC treatment. Consider MIT as an alternative to surgical neck dissection in patients with radioiodine refractory cervical recurrences who are at surgical risk or decline further surgery. Factors that favor MIT are previous neck dissection, presence of surgical complications, small size metastases, and <4 involved latero-cervical lymph nodes. Consider TA among treatment options in patients with unresectable oligometastatic or oligoprogressive distant metastases to achieve local tumor control or pain palliation. Consider TA, in combination with bone consolidation and external beam radiation therapy, as a treatment option for painful bone metastases not amenable to other established treatments.
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Affiliation(s)
- Giovanni Mauri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- *Laszlo Hegedüs,
| | - Steven Bandula
- Interventional Oncology Service, University College Hospital, London, United Kingdom
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Oliver Dudeck
- Center for Microtherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Laura Fugazzola
- Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Romana Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gilles Russ
- Thyroid and Endocrine Tumors Unit, La Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Göran Wallin
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Enrico Papini
- Department of Endocrinology & Metabolism, Ospedale Regina Apostolorum, Albano, Italy
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14
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Lorusso L, Cappagli V, Valerio L, Giani C, Viola D, Puleo L, Gambale C, Minaldi E, Campopiano MC, Matrone A, Bottici V, Agate L, Molinaro E, Elisei R. Thyroid Cancers: From Surgery to Current and Future Systemic Therapies through Their Molecular Identities. Int J Mol Sci 2021; 22:3117. [PMID: 33803747 PMCID: PMC8003273 DOI: 10.3390/ijms22063117] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/16/2022] Open
Abstract
Differentiated thyroid cancers (DTC) are commonly and successfully treated with total thyroidectomy plus/minus radioiodine therapy (RAI). Medullary thyroid cancer (MTC) is only treated with surgery but only intrathyroidal tumors are cured. The worst prognosis is for anaplastic (ATC) and poorly differentiated thyroid cancer (PDTC). Whenever a local or metastatic advanced disease is present, other treatments are required, varying from local to systemic therapies. In the last decade, the efficacy of the targeted therapies and, in particular, tyrosine kinase inhibitors (TKIs) has been demonstrated. They can prolong the disease progression-free survival and represent the most important therapeutic option for the treatment of advanced and progressive thyroid cancer. Currently, lenvatinib and sorafenib are the approved drugs for the treatment of RAI-refractory DTC and PDTC while advanced MTC can be treated with either cabozantinib or vandetanib. Dabrafenib plus trametinib is the only approved treatment by FDA for BRAFV600E mutated ATC. A new generation of TKIs, specifically for single altered oncogenes, is under evaluation in phase 2 and 3 clinical trials. The aim of this review was to provide an overview of the current and future treatments of thyroid cancer with regards to the advanced and progressive cases that require systemic therapies that are becoming more and more targeted on the molecular identity of the tumor.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Rossella Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.L.); (V.C.); (L.V.); (C.G.); (D.V.); (L.P.); (C.G.); (E.M.); (M.C.C.); (A.M.); (V.B.); (L.A.); (E.M.)
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15
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Current Practice of Percutaneous Ablation Technologies for Thyroid Nodules 2020. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00323-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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16
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Asimakopoulos P, Shaha AR, Nixon IJ, Shah JP, Randolph GW, Angelos P, Zafereo ME, Kowalski LP, Hartl DM, Olsen KD, Rodrigo JP, Vander Poorten V, Mäkitie AA, Sanabria A, Suárez C, Quer M, Civantos FJ, Robbins KT, Guntinas-Lichius O, Hamoir M, Rinaldo A, Ferlito A. Management of the Neck in Well-Differentiated Thyroid Cancer. Curr Oncol Rep 2020; 23:1. [PMID: 33190176 DOI: 10.1007/s11912-020-00997-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer. RECENT FINDINGS Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant.
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Affiliation(s)
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Jatin P Shah
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Mark E Zafereo
- Head and Neck Endocrine Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, Leuven, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain
| | - Miquel Quer
- Department of Otolaryngology-Head and Neck Surgery, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Surgery Department, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Francisco J Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - K Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, IL, USA
| | | | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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17
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Hay ID, Lee RA, Kaggal S, Morris JC, Stan MN, Castro MR, Fatourechi V, Thompson GB, Charboneau JW, Reading CC. Long-Term Results of Treating With Ethanol Ablation 15 Adult Patients With cT1aN0 Papillary Thyroid Microcarcinoma. J Endocr Soc 2020; 4:bvaa135. [PMID: 33073159 PMCID: PMC7543935 DOI: 10.1210/jendso/bvaa135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Currently acceptable management options for patients with adult papillary thyroid microcarcinoma (APTM) range from immediate surgery, either unilateral lobectomy or bilateral lobar resection, to active surveillance (AS). An alternative minimally invasive approach, originally employed for eliminating neck nodal metastases, may be ultrasound-guided percutaneous ethanol ablation (EA). Here we present our experience of definitively treating with EA 15 patients with APTM. Patients and Methods During 2010 through 2017, the 15 cT1aN0M0 patients selected for EA were aged 36 to 86 years (median, 45 years). Tumor volumes (n = 17), assessed by sonography, ranged from 25 to 375 mm3 (median, 109 mm3). Fourteen of 15 patients had 2 ethanol injections on successive days; total volume injected ranged from 0.45 to 1.80 cc (median, 1.1 cc). All ablated patients were followed with sonography and underwent recalculation of tumor volume and reassessment of tumor perfusion at each follow-up visit. Results The ablated patients have now been followed for 10 to 100 months (median, 64 months). There were no complications and no ablated patient developed postprocedure recurrent laryngeal nerve dysfunction. All 17 ablated tumors shrank (median 93%) and Doppler flow eliminated. Median tumor volume reduction in 9 identifiable avascular foci was 82% (range, 26%-93%). After EA, 8 tumors (47%) disappeared on sonography after a median of 10 months. During follow-up no new PTM foci and no nodal metastases have been identified. Conclusions Definitive treatment of APTM by EA is effective, safe, and inexpensive. Our results suggest that, for APTM patients who do not wish neck surgery and are uncomfortable with AS, EA represents a well-tolerated and minimally invasive outpatient management option.
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Affiliation(s)
- Ian D Hay
- Departments of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Robert A Lee
- Departments of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Suneetha Kaggal
- Departments of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John C Morris
- Departments of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Marius N Stan
- Departments of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - M Regina Castro
- Departments of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Vahab Fatourechi
- Departments of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Geoffrey B Thompson
- Departments of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - J William Charboneau
- Departments of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Carl C Reading
- Departments of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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18
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Iñiguez-Ariza NM, Lee RA, Brewer JD, Hay ID. Elimination of Locoregional Recurrences and Skin Metastases in Papillary Thyroid Cancer by Ethanol Ablation and Mohs Surgery. J Endocr Soc 2020; 4:bvaa095. [PMID: 32803095 PMCID: PMC7417876 DOI: 10.1210/jendso/bvaa095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/04/2020] [Indexed: 12/19/2022] Open
Abstract
Ultrasound-guided percutaneous ethanol ablation procedures for locoregional recurrences in papillary thyroid carcinoma (PTC) can be repeatedly performed over years. Skin metastases (SM) from PTC generally portend a lethal prognosis. Our patient case report demonstrates the innovative use in low-risk PTC (LRPTC) of treatment modalities designed to prevent neck re-explorations and capable of eliminating both locoregional recurrences and SM. In 2004, a 48-year-old man presented with neck nodal metastases due to PTC. He underwent a near-total thyroidectomy and nodal dissection, confirming an 8-mm PTC involving 2 ipsilateral node metastases. Postoperatively, he received 2 doses of radioactive iodine (RAI) for remnant uptake (cumulative dose 338 mCi); posttherapy scanning was unrevealing. In 2007, he underwent right neck dissection for further node metastases. In 2008, a guided biopsy confirmed a level IV node metastasis. He was referred to our institution for ethanol ablation. Two node metastases were ablated and subsequently disappeared. During 2010-2016, he developed an additional 6 node metastases, which were treated with ethanol ablation; all disappeared on high-resolution sonography. FDG-PET-CT scans in 2009 and 2016 were negative for distant spread. In 2016, a SM in his right neck was removed by dermatologic surgery. In 2017-2018, 2 further SM were excised with negative margins, one after Mohs surgery. He has now been disease-free for 20 months. In conclusion, despite 3 neck surgeries and 2 RAI therapies, our patient repeatedly developed both locoregional recurrences and SM. All 11 disease foci were eliminated with minimally invasive procedures which should more often be considered as effective treatment options in LRPTC.
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Affiliation(s)
- Nicole M Iñiguez-Ariza
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Robert A Lee
- Department of Radiology, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Ian D Hay
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, Minnesota
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19
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Hahn SY, Shin JH, Na DG, Ha EJ, Ahn HS, Lim HK, Lee JH, Park JS, Kim JH, Sung JY, Lee JH, Baek JH, Yoon JH, Sim JS, Lee KH, Baek SM, Jung SL, Kim YK, Choi YJ. Ethanol Ablation of the Thyroid Nodules: 2018 Consensus Statement by the Korean Society of Thyroid Radiology. Korean J Radiol 2020; 20:609-620. [PMID: 30887743 PMCID: PMC6424836 DOI: 10.3348/kjr.2018.0696] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/05/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, Gangneung, Korea.,Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea
| | - Eun Joo Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Hye Shin Ahn
- Department of Radiology and Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Ji Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Yong Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Joon Hyung Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University School of Medicine, Busan, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Kwang Hwi Lee
- Department of Radiology, Sheikh Khalifa Specialty Hospital, Ras Al Khaima, UAE
| | - Seon Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea
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20
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Paz-Fumagalli R, Li X, Smallridge RC. Ethanol Ablation of Neck Metastases from Differentiated Thyroid Carcinoma. Semin Intervent Radiol 2019; 36:381-385. [PMID: 31798211 DOI: 10.1055/s-0039-1696651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Differentiated thyroid cancer often metastasizes to cervical lymph nodes, characteristically with slow growth rate and low-level aggressiveness. Cervical lymph node resection is the treatment of choice, but ethanol ablation offers a therapeutic option for patients with few nodes unresponsive to radioiodine therapy and who are poor surgical candidates. The ethanol ablation procedure is minimally invasive, guided sonographically, easily and safely repeated, and easily implemented with minimal technology and cost. Transient nerve injury is infrequent and virtually the only important complication. Current experience indicates that ethanol ablation has the safest therapeutic profile compared to surgery and thermal ablation, and the effectiveness is comparable to thermal ablation and approaches that of surgery. Well-designed clinical trials are lacking.
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Affiliation(s)
| | - Xi Li
- Division of Interventional Radiology, Mayo Clinic, Jacksonville, Florida.,Interventional Radiology Department, Changzheng Hospital, Shanghai, China
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21
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Nishio N, Fujimoto Y, Hiramatsu M, Maruo T, Tsuzuki H, Mukoyama N, Yokoi S, Wada A, Kaneko Furukawa M, Furukawa M, Sone M. Diagnosis of cervical lymph node metastases in head and neck cancer with ultrasonic measurement of lymph node volume. Auris Nasus Larynx 2019; 46:889-895. [PMID: 30857763 DOI: 10.1016/j.anl.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/16/2019] [Accepted: 02/05/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness of ultrasound (US) volume measurement of the cervical lymph nodes for diagnosing nodal metastasis in patients with head and neck cancer using a node-by-node comparison. METHODS Thirty-four consecutive patients with head and neck cancer from one tertiary university hospital were prospectively enrolled from 2012 to 2017. Patients with histologically proven squamous cell primary tumors in the head and neck region scheduled to undergo a therapeutic neck dissection were eligible. For each patient, 1-4 target lymph nodes were selected from the planned neck dissection levels. Lymph nodes with thickness >20 mm or in a cluster were excluded. Node-by-node comparisons between the pre-operative US assessment, the post-operative actual measurements and histopathological results were performed for all target lymph nodes. Quantitative measurements, such as three diameters, ratios of the three diameters and volume were analyzed in this study. Lymph node volume was calculated using the ellipsoid formula. RESULTS Patients comprised 28 men and 6 women with a mean age of 60.0 years (range, 29-80 years) at the time of surgery. In total, 67 target lymph nodes were analyzed in this study and the thickness ranged from 3.9 to 20.0 mm (mean 8.0 mm). There was a strong correlation between the US volume and post-operative actual volume (ρ = 0.87, p < 0.01). The US volume measured 2156 ± 2156 mm3 for the tumor positive nodes, which was significantly greater than the US volume of 512 ± 315 mm3 for tumor negative nodes (p < 0.01). Significant differences between tumor positive and tumor negative nodes were found in five variables (volume, thickness, major axis, minor axis and ratio of minor axis to thickness) for total lymph nodes. To identify predictors of lymph node metastasis, ROC curves of the US variables of target lymph nodes were compared, of which 4 variables were considered acceptable for predicting the lymph node metastasis: volume (AUC 0.86), thickness (AUC 0.86), major axis (AUC 0.79), and minor axis (AUC 0.79) for total lymph nodes. The optimal cut-off level for US volume in total lymph nodes was found to be 1242 mm3, whereby a 62% sensitivity and 98% specificity was reached (likelihood ratio: 25.2). CONCLUSION Pre-operative ultrasonic volume measurement of the cervical lymph nodes was useful for early detection of cervical nodal metastasis in head and neck cancer.
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Affiliation(s)
- Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Otolaryngology, Stanford University, Stanford, CA, USA.
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Maruo
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidenori Tsuzuki
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sayaka Yokoi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihisa Wada
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Masaki Furukawa
- Department of Otorhinolaryngology, Hiro-Yama Clinic, Tokyo, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Hong YP, Kim CS. Intraoperative CT Image-Guided Navigation System-Assisted Endoscopic Enucleation of a Mandibular Odontogenic Keratocyst. EAR, NOSE & THROAT JOURNAL 2019; 98:NP144-NP146. [PMID: 30832502 DOI: 10.1177/0145561319833320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yu-Pyo Hong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Choung-Soo Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
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Abstract
The worldwide incidence of thyroid cancer is increasing. A third of new thyroid cancer cases are papillary thyroid microcarcinoma (PTM), which are 1 cm or less. These tumors are mostly indolent with excellent prognosis. Although thyroid surgery is the most common management option for patients with PTM, new management options demand that treatment decisions must be individualized and based on patient's preference, context, and biology. This article describes management options for PTM patients and shared decision-making as a novel method for individualizing care.
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Affiliation(s)
- Juan P Brito
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Ian D Hay
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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24
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Luster M, Aktolun C, Amendoeira I, Barczyński M, Bible KC, Duntas LH, Elisei R, Handkiewicz-Junak D, Hoffmann M, Jarząb B, Leenhardt L, Musholt TJ, Newbold K, Nixon IJ, Smit J, Sobrinho-Simões M, Sosa JA, Tuttle RM, Verburg FA, Wartofsky L, Führer D. European Perspective on 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: Proceedings of an Interactive International Symposium. Thyroid 2019; 29:7-26. [PMID: 30484394 DOI: 10.1089/thy.2017.0129] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The American Thyroid Association (ATA) management guidelines for patients with thyroid nodules and differentiated thyroid cancer (DTC) are highly influential practice recommendations. The latest revision appeared in 2015 ("ATA 2015"). These guidelines were developed predominantly by North American experts. European experts frequently have different perspectives, given epidemiological, technological/methodological, practice organization, and medicolegal differences between the respective regions. SUMMARY Divergent viewpoints were the focus of an invited symposium organized by the European Association of Nuclear Medicine involving 17 European thyroidologists, four ATA Guidelines Taskforce members, and an audience of 200 international experts. The group discussed the preoperative assessment of thyroid nodules, surgery and the role of pathology, radioiodine (RAI) therapy (RAIT), the assessment of initial therapy and dynamic risk stratification, and the treatment of persistent disease, recurrences, and advanced thyroid cancer. The dialogue resulted in this position paper contrasting European and ATA 2015 perspectives on key issues. One difference pertains to the permissiveness of ATA 2015 regarding lobectomy for primary tumors ≤4 cm. European panelists cited preclusion of RAIT, potential need for completion thyroidectomy, frequent inability to avoid chronic thyroid hormone replacement, and limitations of supportive evidence as arguments against widely applying lobectomy. Significant divergence involved ATA 2015's guidance regarding RAIT. European panelists favored wider use of postoperative RAIT than does ATA 2015. Rationales included the modality's association with favorable patient outcomes and generally limited toxicity, and lack of high-quality evidence supporting withholding RAIT. Additionally, European panelists favored recombinant human thyrotropin (rhTSH) in more settings than does ATA 2015, citing avoidance of hypothyroid morbidity and quality-of-life impairment, without apparent sacrifice in oncologic outcomes. Based on clinical evidence plus theoretical advantages, European experts advocated dosimetric versus fixed-activity RAIT approaches for advanced DTC. European panelists noted that the ATA 2015 risk-stratification system requires information sometimes unavailable in everyday practice. ATA 2015 recommendations regarding RAI-refractory DTC should consider potential palliative benefits of RAIT in patients who also have RAI-susceptible lesions. CONCLUSIONS European panelists suggested modifications to approximately one-third of ATA 2015 recommendations. Varying European and ATA 2015 perspectives can stimulate analysis and discussion of the literature and performance of primary research to resolve discrepant recommendations and potentially improve patient outcomes.
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Affiliation(s)
- Markus Luster
- 1 Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Cumali Aktolun
- 2 Department of Nuclear Medicine, School of Medicine, Izmir Ekonomi Universitesi, Izmir, Turkey
| | - Isabel Amendoeira
- 3 University Hospital of São João, Medical Faculty and Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Marcin Barczyński
- 4 Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Keith C Bible
- 5 Division of Medical Oncology, Department of Oncology, The Mayo Clinic, Rochester, Minnesota
| | - Leonidas H Duntas
- 6 Endocrine Unit, Evgenidion Hospital, University of Athens, Athens, Greece
| | - Rossella Elisei
- 7 Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daria Handkiewicz-Junak
- 8 Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute and Centre of Oncology, Gliwice Branch, Gliwice, Poland
| | - Martha Hoffmann
- 9 Departments of Nuclear Medicine and Positron Emission Tomography/Computed Tomography, Radiology Center, Vienna, Austria
| | - Barbara Jarząb
- 8 Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute and Centre of Oncology, Gliwice Branch, Gliwice, Poland
| | - Laurence Leenhardt
- 10 Thyroid and Endocrine Tumor Unit, Pitié-Salpêtrière Sorbonne University Hospital, Paris, France
| | - Thomas J Musholt
- 11 Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kate Newbold
- 12 Thyroid Therapy Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Iain J Nixon
- 13 Department of Ear, Nose, and Throat Surgery, NHS Lothian and University of Edinburgh, Edinburgh, United Kingdom
| | - Johannes Smit
- 14 Department of Medicine, Division of Endocrinology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Manuel Sobrinho-Simões
- 3 University Hospital of São João, Medical Faculty and Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Julie Ann Sosa
- 15 Department of Surgery, University of California at San Francisco-UCSF, San Francisco, California
| | - R Michael Tuttle
- 16 Department of Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Frederik A Verburg
- 1 Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Leonard Wartofsky
- 17 Department of Medicine, Washington Hospital Center, Washington, DC
| | - Dagmar Führer
- 18 Department of Endocrinology and Metabolism, Endocrine Tumor Center at WTZ, Essen University Hospital, Essen, Germany
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25
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Teng D, Ding L, Wang Y, Liu C, Xia Y, Wang H. Safety and efficiency of ultrasound-guided low power microwave ablation in the treatment of cervical metastatic lymph node from papillary thyroid carcinoma: a mean of 32 months follow-up study. Endocrine 2018; 62:648-654. [PMID: 30105431 DOI: 10.1007/s12020-018-1711-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/06/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the safety and efficiency of microwave ablation (MWA) with low power of 20 w, respectively, in the treatment of cervical metastatic lymph node (CMLN) from papillary thyroid carcinoma (PTC) with a mean of 32-month follow-up. METHODS Eleven patients in total with 24 cervical lymph nodes (LNs) diagnosed with CMLN from PTC underwent MWA at a power of 20 w. We recorded images of the LNs under ultrasound first before MWA and 1, 3, 6, 12, months after MWA, and then every 6 months, respectively. The volumes of the LNs were compared before MWA and at each follow-up point after MWA. The thyroglobulin (Tg) test was performed before MWA and 3 months after MWA. RESULTS All patients were successfully treated, and they showed no major complications. Before MWA, the mean volume of the LNs was 364.15 ± 306.89 mm3, which decreased to 234.10 ± 230.34 mm3, 107.51 ± 129.47 mm3, 20.88 ± 39.27 mm3, 3.38 ± 12.74 mm3, and completely disappeared at the follow-up point of 1, 3, 6, 12, and 18 months after MWA, respectively. The mean Tg was 11.81 ± 7.50 ng/ml, a data significantly decreased to 0.43 ± 0.11 ng/ml 3 months after MWA (P = 0.000). In the follow-up period, no recurrent lesions were found. CONCLUSIONS For the treatment of CMLN from PTC, low power MWA showed good safety and efficacy. MWA is likely to be a candidate for patients with high risks or who refuse reoperation.
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Affiliation(s)
- Dengke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Lei Ding
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Yu Wang
- Department of Interventional Ultrasound, the 208th Hospital of PLA, Changchun, Jilin, 130000, China
| | - Caimei Liu
- Department of Interventional Ultrasound, the 208th Hospital of PLA, Changchun, Jilin, 130000, China
| | - Yongxu Xia
- Department of Interventional Ultrasound, the 208th Hospital of PLA, Changchun, Jilin, 130000, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China.
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26
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Liu Z, Zhao Q, Liu C, Zeng W, Ming J, Chen C, Wang S, Xiong Y, Zhang C, Chen T, Huang T, Guo L. Is biopsy enough for papillary thyroid microcarcinoma?: An analysis of the SEER database 2004 to 2013 with propensity score matching. Medicine (Baltimore) 2018; 97:e11791. [PMID: 30075609 PMCID: PMC6081083 DOI: 10.1097/md.0000000000011791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/16/2018] [Indexed: 11/30/2022] Open
Abstract
The treatment of papillary thyroid microcarcinoma (PTMC) remains deeply controversial. In this study, we investigated the prognosis of patients who underwent biopsy alone, as compared with other forms of thyroidectomy approaches. We sought to provide reference information for treatment selection in cases of PTMC.The analysis included a large cohort of 34,972 PTMC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2013. Survival was examined by Kaplan-Meier analyses with log-rank tests, Cox proportional-hazards regression analyses, and propensity score matching analyses.In the study cohort, the rate of cancer-specific mortality per 1000 person-years was higher for patients who underwent biopsy alone than for those who underwent other surgical approaches. According to multivariate Cox regression analyses, patients undergoing biopsy had similar cancer-specific survival rates and higher all-cause survival rates in comparison with patients undergoing other surgical approaches. After matching for influential factors using propensity scores, Kaplan-Meier analyses also showed that patients undergoing biopsy had similar cancer-specific survival rates and lower all-cause survival rates in comparison with patients undergoing other surgical approaches.Our results provided helpful implications for the treatment of patients with PTMC.
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Affiliation(s)
- Zeming Liu
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Qiuyang Zhao
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Chunping Liu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Wen Zeng
- Department of Ophthalmology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei
| | - Jie Ming
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Chen Chen
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Shuntao Wang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Yiquan Xiong
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Chao Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Tianwen Chen
- Department of Breast and Thyroid Surgery, Affiliated Nanshan Hospital, Guangdong Medical University, Shenzhen, People's Republic of China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Liang Guo
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan
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27
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Nixon IJ, Angelos P, Shaha AR, Rinaldo A, Williams MD, Ferlito A. Image-guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications. Head Neck 2018; 40:2103-2115. [PMID: 29684251 DOI: 10.1002/hed.25181] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/03/2018] [Accepted: 02/20/2018] [Indexed: 01/03/2023] Open
Abstract
Image-guided ablation of thyroid disease is increasingly being commonly reported. Techniques including ethanol injection and thermal ablation using radio-frequency, laser, and microwave devices have been described. Minimally invasive approaches to the management of benign cystic, solid, and functional thyroid nodules as well as both primary and recurrent thyroid malignancy have been reported. The purpose of this article is to review the current evidence relating to image-guided ablation of thyroid disease with a focus on clinical outcomes and complication rates for patients treated with this minimally invasive approach.
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Affiliation(s)
- Iain J Nixon
- Ear, Nose, and Throat Department, NHS Lothian, Edinburgh, UK
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Ethics, The University of Chicago Medicine, Chicago, Illinois
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Michelle D Williams
- Department of Pathology, Division of Pathology/Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alfio Ferlito
- Coordinator of The International Head and Neck Scientific Group
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28
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Yoo RE, Kim JH, Paeng JC, Park YJ. Radiofrequency ablation for treatment of locally recurrent thyroid cancer presenting as a metastatic lymph node with dense macrocalcification: A case report and literature review. Medicine (Baltimore) 2018; 97:e0003. [PMID: 29489641 PMCID: PMC5851762 DOI: 10.1097/md.0000000000010003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Long-term recurrence rate of differentiated thyroid carcinoma has been reported to be as high as 30%. Repeat surgery may be challenging due to normal tissue plane distortion secondary to postoperative fibrosis, especially for small-sized recurrences. Recently, radiofrequency ablation (RFA) has been suggested to be a safe and effective alternative for high-risk patients or those who refuse surgery. Nonetheless, the efficacy of RFA remains questionable for densely calcified lymph nodes, which would have an increased likelihood of leaving residues after RFA. PATIENT CONCERNS We present a case of a successful combined treatment of a metastatic lymph node with dense macrocalcification with the use of a single RFA session and radioactive iodine (RAI) ablation in a patient with a previous history of total thyroidectomy and neck node dissection for papillary thyroid carcinoma. DIAGNOSES A 71-year-old man with papillary thyroid carcinoma underwent total thyroidectomy and neck node dissection followed by RAI ablation. The stimulated serum thyroglobulin level was 4.74 ng/mL at the time of RAI ablation, and the follow-up ultrasonography 3 months later revealed a 15-mm lymph node with dense macrocalcification at the right cervical level III. INTERVENTIONS After confirming metastasis on cytology, the lesion was treated with ultrasound-guided RFA. OUTCOMES The single RFA session combined with RAI ablation led to biochemical remission at 5 months after RFA, and complete resolution of structural recurrence including macrocalcification was observed 7 months after the second RAI (1 year after RFA). The patient remained free of recurrence at the 5-year follow-up. LESSONS RFA may offer a safe and effective alternative to 'berry picking' surgery in cases of surgical ineligibility or patient refusal of surgery even when the target lesions contain dense macrocalcification.
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Affiliation(s)
- Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | | | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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29
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Jeong SY, Baek JH, Choi YJ, Lee JH. Ethanol and thermal ablation for malignant thyroid tumours. Int J Hyperthermia 2017; 33:938-945. [PMID: 28797186 DOI: 10.1080/02656736.2017.1361048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid malignancy and has a good prognosis and low mortality rate. Surgery is the standard treatment for patients with primary and recurrent thyroid cancer. Although patients with PTC usually exhibit excellent treatment outcome, the incidence of recurrence in the neck ranges from 20% to 59%. When a patient with thyroid cancer is contraindicated for surgery, ultrasound (US)-guided ablation techniques, including ethanol ablation (EA) and thermal ablations, are suggested alternatives. In this review, we evaluated the indications, devices, techniques, clinical outcomes, and complications associated with US-guided EA and thermal ablations based on available scientific evidence and expert opinions regarding the use of ablation for primary and recurrent thyroid cancers.
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Affiliation(s)
- So Yeong Jeong
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
| | - Jung Hwan Baek
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
| | - Young Jun Choi
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
| | - Jeong Hyun Lee
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
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30
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Rodríguez-Lomba E, Molina-López I, Parra-Blanco V, Suárez-Fernández R, Ciudad-Blanco C. Cutaneous implantation of papillary thyroid carcinoma secondary to percutaneous ethanol injection into nodal metastasis. J Eur Acad Dermatol Venereol 2017; 32:e11-e13. [PMID: 28653452 DOI: 10.1111/jdv.14440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- E Rodríguez-Lomba
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Molina-López
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - V Parra-Blanco
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Suárez-Fernández
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C Ciudad-Blanco
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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31
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Kim SY, Kim SM, Chang H, Kim BW, Lim CY, Lee YS, Chang HS, Park CS. Long-term outcomes of ethanol injection therapy for locally recurrent papillary thyroid cancer. Eur Arch Otorhinolaryngol 2017; 274:3497-3501. [PMID: 28664330 DOI: 10.1007/s00405-017-4660-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/26/2017] [Indexed: 01/29/2023]
Abstract
The standard treatment regimen for locally recurrent lesions is total thyroidectomy, or complete removal of the recurrent thyroid lesion within the thyroid bed. However, reoperation increases the risk of complications and patients have to undergo general anesthesia. Percutaneous ethanol injection therapy represents a far less invasive procedure without general anesthesia and with lower risk of complications. Thirty-four patients who received PEIT at Yonsei University Medical Center between October 2002 and August 2009 for recurrent cervical nodal metastases of differentiated papillary thyroid cancer were included in this retrospective study. During a minimum follow-up of 60 months, treatment outcomes were determined by measuring the lesion size prior to the first injection and 3 months after the last injection. A total of 46 recurrent lesions were detected in 34 patients. Five patients underwent surgery and PEIT was administered to the remaining 19 and 22 lesions in the central compartment and lateral neck lymph nodes, respectively. Size increases were observed in seven (17.1%) lesions, whereas no changes in size and decreases were detected in 10 (24.4%) and 24 (58.5%) lesions. Patients with increased lymph nodes were significantly older (65.3 ± 14.4 vs. 48.2 ± 16.3 years; p = 0.02) and had smaller sizes (9.3 ± 1.0 vs. 12.3 ± 6.4 mm; p = 0.012). Although reoperation remains the first-line treatment for recurrent thyroid cancer, PEIT may be considered as a treatment option in selected patients with lesions larger than 1 cm who are ineligible for surgery or have refused reoperation.
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Affiliation(s)
- Soo Young Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea
| | - Hojin Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea
| | - Bup-Woo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea
| | - Chi Young Lim
- National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea.
| | - Cheong Soo Park
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea
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32
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McCarthy CJ, Gervais DA. Decision Making: Thermal Ablation Options for Small Renal Masses. Semin Intervent Radiol 2017; 34:167-175. [PMID: 28579684 DOI: 10.1055/s-0037-1602708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Renal cell carcinoma is a relatively common tumor, with an estimated 63,000 new cases being diagnosed in the United States in 2016. Surgery, be it with partial or total nephrectomy, is considered the mainstay of treatment for many patients. However, those patients with small renal masses, typically less than 3 to 4 cm in size who are deemed unsuitable for surgery, may be suitable for percutaneous thermal ablation. We review the various treatment modalities, including radiofrequency ablation, microwave ablation, and cryoablation; discuss the advantages and disadvantages of each method; and review the latest data concerning the performance of the various ablative modalities compared with each other, and compared with surgery.
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Affiliation(s)
- Colin J McCarthy
- Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts
| | - Debra A Gervais
- Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts
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Matrone A, Valerio L, Pieruzzi L, Giani C, Cappagli V, Lorusso L, Agate L, Puleo L, Viola D, Bottici V, Del Re M, Molinaro E, Danesi R, Elisei R. Protein kinase inhibitors for the treatment of advanced and progressive radiorefractory thyroid tumors: From the clinical trials to the real life. Best Pract Res Clin Endocrinol Metab 2017; 31:319-334. [PMID: 28911728 DOI: 10.1016/j.beem.2017.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The last ten years have been characterized by the introduction in the clinical practice of new drugs named tyrosine kinase inhibitors for the treatment of several human tumors. After the positive conclusion of two international multicentric, randomized phase III clinical trials, two of these drugs, sorafenib and lenvatinib, have been recently approved and they are now available for the treatment of advanced and progressive radioiodine refractory thyroid tumors. We have been involved in most clinical trials performed with different tyrosine kinase inhibitors in different histotypes of thyroid cancer thus acquiring a lot of experience in the management of both drugs and their adverse events. Aim of this review is to give an overview of both the rationale for the use of these inhibitors in thyroid cancer and the major results of the clinical trials. Some suggestions for the management of treated patients in the real life are also provided.
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Affiliation(s)
- Antonio Matrone
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Laura Valerio
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Letizia Pieruzzi
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Carlotta Giani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Virginia Cappagli
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Loredana Lorusso
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Laura Agate
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Luciana Puleo
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - David Viola
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Valeria Bottici
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Marzia Del Re
- Unit of Pharmacology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Eleonora Molinaro
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Romano Danesi
- Unit of Pharmacology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Rossella Elisei
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
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Nabhan F, Ringel MD. Thyroid nodules and cancer management guidelines: comparisons and controversies. Endocr Relat Cancer 2017; 24:R13-R26. [PMID: 27965276 PMCID: PMC5241202 DOI: 10.1530/erc-16-0432] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/13/2016] [Indexed: 12/23/2022]
Abstract
Thyroid cancer is an increasingly prevalent malignancy throughout the world. Management guidelines for both thyroid nodules and thyroid cancer have been published and updated by a number of societies internationally. All of these guidelines recognize this increasing incidence, particularly of small papillary thyroid cancers, due in part to improved technology enabling early or even 'over' diagnosis. Recent advances in molecular imaging and molecular methods have been developed to better characterize thyroid nodules, and a number of studies that have clarified risk stratification systems that can be modified over time allow for individualization of diagnosis, initial treatment, and subsequent follow-up strategies. Advances in surgical approaches and new treatments for patients with the most aggressive forms of thyroid cancer have all influenced management guidelines. Despite substantial similarities, there also are important differences between recent guidelines for some of the common clinical scenarios encountered by physicians in clinical practice. In the present manuscript, we will highlight similarities and differences between several of the most recently published guidelines focused on key areas of importance to clinical care and controversy. These are key areas for future research to strengthen the data to support future guideline recommendations.
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Affiliation(s)
- Fadi Nabhan
- Division of EndocrinologyDiabetes and Metabolism, The Ohio State University College of Medicine, Wexner Medical Center, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Matthew D Ringel
- Division of EndocrinologyDiabetes and Metabolism, The Ohio State University College of Medicine, Wexner Medical Center, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
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Al-Hilli Z, Strajina V, McKenzie TJ, Thompson GB, Farley DR, Richards ML. The role of lateral neck ultrasound in detecting single or multiple lymph nodes in papillary thyroid cancer. Am J Surg 2016; 212:1147-1153. [DOI: 10.1016/j.amjsurg.2016.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/02/2016] [Accepted: 09/04/2016] [Indexed: 10/20/2022]
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Leboulleux S, Tuttle RM, Pacini F, Schlumberger M. Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance? Lancet Diabetes Endocrinol 2016; 4:933-942. [PMID: 27550849 DOI: 10.1016/s2213-8587(16)30180-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 02/08/2023]
Abstract
The incidence of differentiated thyroid cancer is increasing greatly in high-income countries. Roughly 50% of this increase is attributable to the identification of intrathyroidal papillary thyroid microcarcinomas. Since mortality associated with these tumours remains low and stable, the increasing diagnosis has led to concerns about overdiagnosis and overtreatment. Management of papillary thyroid microcarcinomas should take into account the reported absence of mortality when diagnosed in the absence of lymph node metastases and distant metastases, as shown even in recent studies promoting active surveillance; a low recurrence rate of 1-5%; and the risk of permanent complications from surgery that cannot be decreased to less than 1-3%, even in high-volume tertiary care centres with experienced surgeons. On the basis of these data, active surveillance with curative intent, in which active treatment is delayed until the cancer shows signs of significant progression to avoid side-effects of treatment, should be considered in properly selected patients.
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Affiliation(s)
- Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France.
| | - R Michael Tuttle
- Endocrinology Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Furio Pacini
- Section of Endocrinology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France
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Consensus on the management of advanced radioactive iodine-refractory differentiated thyroid cancer on behalf of the Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and Spanish Rare Cancer Working Group (GETHI). Clin Transl Oncol 2016; 19:279-287. [DOI: 10.1007/s12094-016-1554-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/20/2016] [Indexed: 01/15/2023]
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Scharpf J, Tuttle M, Wong R, Ridge D, Smith R, Hartl D, Levine R, Randolph G. Comprehensive management of recurrent thyroid cancer: An American Head and Neck Society consensus statement: AHNS consensus statement. Head Neck 2016; 38:1862-1869. [PMID: 27717219 DOI: 10.1002/hed.24513] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/04/2016] [Indexed: 01/12/2023] Open
Abstract
This American Head and Neck Society (AHNS) consensus statement focuses on the detection and management of recurrent thyroid cancer. This document describes the radiologic approach to defining structural recurrent disease and the operative and nonoperative rationale in addressing identified structural disease to create equipoise in the personalized treatment strategy for the patient. The recommendations of this AHNS multidisciplinary consensus panel of the American Head and Neck Society are intended to help guide all multidisciplinary clinicians who diagnose or manage adult patients with thyroid cancer. The consensus panel is comprised of members of the American Head and Neck Society and its Endocrine Surgical Committee, and there is representation from medical endocrinology and both national and international surgical representation drawn from general/endocrine surgery and otolaryngology/head and neck surgery. Authors provided expertise for their respective sections, and consensus recommendations were made regarding the evaluation and treatment of recurrent thyroid cancer. Evidence-based literature support is drawn from thyroid cancer studies, recurrent thyroid cancer studies, and American Thyroid Association (ATA) guidelines. The manuscript was then distributed to members of the American Head and Neck Society Endocrine Committee and governing counsel for further feedback. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1862-1869, 2016.
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Affiliation(s)
| | - Michael Tuttle
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard Wong
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Drew Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Russell Smith
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Dana Hartl
- Institut de Cancerologie Gustave Roussy, Villejuif, France
| | - Robert Levine
- Thyroid Center of New Hampshire, Nashua, New Hampshire
| | - Gregory Randolph
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
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Zhou W, Zhang L, Zhan W, Jiang S, Zhu Y, Xu S. Percutaneous laser ablation for treatment of locally recurrent papillary thyroid carcinoma <15 mm. Clin Radiol 2016; 71:1233-1239. [PMID: 27554615 DOI: 10.1016/j.crad.2016.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 01/06/2023]
Abstract
AIM To evaluate the efficacy and safety of ultrasound-guided percutaneous laser ablation (PLA) for recurrent papillary thyroid carcinomas (PTC) <15 mm in the neck. MATERIALS AND METHODS A retrospective study was conducted in 21 patients with 27 recurrent PTC lesions who underwent PLA. The extent of ablation was assessed by contrast-enhanced ultrasonography (CEUS) after PLA. Measurement of the volume of tumour and serum thyroglobulin, and clinical evaluation were performed at 7 days, and 1, 3, 6, and 12 months, and every 6 months thereafter. RESULTS The procedure was well tolerated. Of 21 patients, 18 were successfully treated in a single session. Incomplete ablation was detected by CEUS in three patients, and a second ablation was performed. The mean largest diameter and the average baseline volume were reduced from 7.5±2.8 mm and 105.4±114 mm3 to 0.4±1 mm and 0.8±2.4 mm3 at the final follow-up. CONCLUSIONS Ultrasound-guided PLA is effective for the treatment of recurrent PTCs with a comparable success rate to radio-iodine therapy, and it may become a primary choice of treatment for recurrent PTCs in selected patients who are ineligible for surgery and/or prefer not to have further surgery.
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Affiliation(s)
- W Zhou
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - L Zhang
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - W Zhan
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - S Jiang
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Y Zhu
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - S Xu
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Suh CH, Baek JH, Choi YJ, Lee JH. Efficacy and Safety of Radiofrequency and Ethanol Ablation for Treating Locally Recurrent Thyroid Cancer: A Systematic Review and Meta-Analysis. Thyroid 2016; 26:420-8. [PMID: 26782174 DOI: 10.1089/thy.2015.0545] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) and ethanol ablation (EA) for treating locally recurrent thyroid cancer. MATERIALS AND METHODS Ovid-MEDLINE and EMBASE databases were searched for studies on the efficacy and safety of RFA and EA for treating locally recurrent thyroid cancer. The pooled proportions of the volume reduction ratio (VRR) ≥50%, complete disappearance, changes in serum level of thyroglobulin (Tg), recurrence, and complications were assessed using random-effects modeling. Heterogeneity among studies was determined using the chi-square statistic for the pooled estimates and the inconsistency index I(2). To overcome heterogeneity, sensitivity analysis was performed. RESULTS Ten eligible studies were included, with a total sample size of 270 patients and 415 thyroid nodules. The pooled proportion of VRR ≥50% after RFA (100%, recalculated 100%; I(2) = 100%, recalculated I(2) = 55.3%) was higher than that after EA (89.5%; I(2) = 82.4%; p = 0.2764); the pooled proportion of complete disappearance after RFA (68.8%) was higher than that after EA (53.4%; p = 0.3384); and the pooled proportion of recurrence after RFA (0.0%) was lower than that after EA (2.4%, adjusted 1.6%; p = 0.9766). However, these differences were not statistically significant. In addition, the pooled proportion of reduction in serum level of Tg after RFA was 71.6% and after EA was 93.8% (p < 0.0001). The pooled proportion of complications of both RFA (5.8%, adjusted 1.6%) and EA (1.6%) were low (p = 0.8479). The mean number of RFA sessions was <1.3 in five of six RFA studies, and the number of EA sessions was more than two in three of four EA studies. CONCLUSION Both RFA and EA are acceptable treatment modalities to manage locally recurrent thyroid cancer in terms of efficacy and safety for poor surgical candidates or those who refuse surgery.
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Affiliation(s)
- Chong Hyun Suh
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
- 2 Department of Radiology, Namwon Medical Center , Namwon, Korea
| | - Jung Hwan Baek
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
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Mauri G, Cova L, Ierace T, Baroli A, Di Mauro E, Pacella CM, Goldberg SN, Solbiati L. Treatment of Metastatic Lymph Nodes in the Neck from Papillary Thyroid Carcinoma with Percutaneous Laser Ablation. Cardiovasc Intervent Radiol 2016; 39:1023-30. [PMID: 26911732 DOI: 10.1007/s00270-016-1313-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/15/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the effectiveness of percutaneous laser ablation (PLA) of cervical lymph node metastases from papillary thyroid carcinoma. MATERIALS AND METHODS 24 patients (62.3 ± 13.2 year; range 32-80) previously treated with thyroidectomy, neck dissection, and radioiodine ablation underwent ultrasound-guided PLA of 46 (18)FDG-PET/CT-positive metachronous nodal metastases. All patients were at high surgical risk or refused surgery and were unsuitable for additional radioiodine ablation. A 300 µm quartz fiber and a continuous-wave Nd-YAG laser operating at 1.064 mm were used. Technical success, rate of complications, rate of serological conversion, and local control at follow-up were derived. Fisher's exact test and Mann-Whitney U test were used and Kaplan-Meier curve calculated. RESULTS Technical success was obtained in all 46 lymph nodes (100 %). There were no major complications. Thyroglobulin levels decreased from 8.40 ± 9.25 ng/ml before treatment to 2.73 ± 4.0 ng/ml after treatment (p = 0.011), with serological conversion in 11/24 (45.8 %) patients. Overall, local control was obtained in 40/46 (86.9 %) lymph nodes over 30 ± 11 month follow-up, with no residual disease seen at imaging in 19/24 (79.1 %) patients. Local control was achieved in 40/46 (86.9 %) lymph nodes at 1 year and in all of the 25 nodes (100 %) followed for 3 years. Estimated mean time to progression was 38.6 ± 2.7 m. CONCLUSION Ultrasound-guided PLA is a feasible, safe, and effective therapy for the treatment of cervical lymph node metastases from papillary thyroid carcinoma.
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Affiliation(s)
- Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, Milan, Italy. .,Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 2, 20097, San Donato Milanese, Milano, Italy.
| | - Luca Cova
- Unit of Interventional Oncology, General Hospital of Busto Arsizio, Busto Arsizio, Italy
| | - Tiziana Ierace
- Unit of Interventional Radiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Alberto Baroli
- Department of Nuclear Medicine, General Hospital of Busto Arsizio, Busto Arsizio, Italy
| | - Enzo Di Mauro
- Department of Nuclear Medicine, General Hospital of Busto Arsizio, Busto Arsizio, Italy
| | | | - Shraga Nahum Goldberg
- Image-guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Luigi Solbiati
- Unit of Interventional Radiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy.,Humanitas Research Hospital, Humanitas University, Milan, Italy
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8384] [Impact Index Per Article: 1048.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Riesco-Eizaguirre G, Galofré JC, Grande E, Zafón Llopis C, Ramón y Cajal Asensio T, Navarro González E, Jiménez-Fonseca P, Santamaría Sandi J, Gómez Sáez JM, Capdevila J. Spanish consensus for the management of patients with advanced radioactive iodine refractory differentiated thyroid cancer. ACTA ACUST UNITED AC 2015; 63:e17-24. [PMID: 26601805 DOI: 10.1016/j.endonu.2015.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/02/2015] [Accepted: 08/26/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Approximately one third of the patients with differentiated thyroid cancer (DTC) who develop structurally-evident metastatic disease are refractory to radioactive iodine (RAI). Most deaths from thyroid cancer occur in these patients. The main objective of this consensus is to address the most controversial aspects of management of these patients. METHODS On behalf of the Spanish Society of Endocrinology & Nutrition (SEEN) and the Spanish Group for Orphan and Infrequent Tumors (GETHI), the Spanish Task Force for Thyroid Cancer, consisting of endocrinologists and oncologists, reviewed the relevant literature and prepared a series of clinically relevant questions related to management of advanced RAI-refractory DTC. RESULTS Ten clinically relevant questions were identified by the task force. In answering to these 10 questions, the task force included recommendations regarding the best definition of refractoriness; the best therapeutic options including watchful waiting, local therapies, and systemic therapy (e.g. kinase inhibitors), when sodium iodide symporter (NIS) restoration may be expected; and how recent advances in molecular biology have increased our understanding of the disease. CONCLUSIONS In response to our appointment as a task force by the SEEN and GHETI, we developed a consensus to help in clinical management of patients with advanced RAI-refractory DTC. We think that this consensus will provide helpful and current recommendations that will help patients with this disorder to get optimal medical care.
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Affiliation(s)
| | - Juan Carlos Galofré
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Enrique Grande
- Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Carles Zafón Llopis
- Department of Endocrinology and Nutrition, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Elena Navarro González
- Department of Endocrinology and Nutrition, Vírgen del Rocío University Hospital, Sevilla, Spain
| | - Paula Jiménez-Fonseca
- Medical Oncology Department, Central de Asturias University Hospital, Oviedo, Asturias, Spain
| | - Javier Santamaría Sandi
- Department of Endocrinology and Nutrition, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain
| | - José Manuel Gómez Sáez
- CIBERDEM Service of Endocrinology and Nutrition, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Jaume Capdevila
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
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Kim JH, Yoo WS, Park YJ, Park DJ, Yun TJ, Choi SH, Sohn CH, Lee KE, Sung MW, Youn YK, Kim KH, Cho BY. Efficacy and Safety of Radiofrequency Ablation for Treatment of Locally Recurrent Thyroid Cancers Smaller than 2 cm. Radiology 2015; 276:909-18. [DOI: 10.1148/radiol.15140079] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Yue W, Chen L, Wang S, Yu S. Locoregional control of recurrent papillary thyroid carcinoma by ultrasound-guided percutaneous microwave ablation: A prospective study. Int J Hyperthermia 2015; 31:403-8. [DOI: 10.3109/02656736.2015.1014433] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Yue W, Wang S, Yu S, Wang B. Ultrasound-guided percutaneous microwave ablation of solitary T1N0M0 papillary thyroid microcarcinoma: initial experience. Int J Hyperthermia 2015; 30:150-7. [PMID: 24571178 DOI: 10.3109/02656736.2014.885590] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the feasibility, safety and efficacy of ultrasound-guided percutaneous microwave (MW) ablation for solitary T1N0M0 papillary thyroid microcarcinoma. MATERIALS AND METHODS A total of 21 patients (six men and 15 women; age range, 29-81 years; mean, 52.1 ± 13.6 years) with 21 nodules of pathologically proven solitary papillary carcinoma 3.7 to 10.0 mm in diameter without clinically apparent lymph node, or distant metastasis at diagnosis (T1N0M0) were treated with MW ablation in our department. Microwaves were emitted at 40 W for 400 s and prolonged as necessary to attain confluent ablation zones. All patients were treated with levothyroxine after MW ablation to maintain thyroid stimulating hormone (TSH) levels below 0.1 mU/L. Follow-up consisted of ultrasound in 21 patients, biopsy in five patients, and surgical treatment in three patients. RESULTS Four patients complained of hoarseness immediately after the MW ablation procedure, and all of them recovered within 3 months spontaneously. All tumours were completely ablated at a single session and no serious or permanent complications occurred. No recurrence at the treatment site and no distant metastases were detected, with a mean follow-up of 11 months. Histological examination showed no evidence of a tumour in the treated lesions in eight patients. Follow-up ultrasound examinations showed disappearance of previously detected colour Doppler flow, as well as mass shrinkage, or both. CONCLUSION During the short-term follow-up period, ultrasound-guided percutaneous MW ablation appears to be a safe and effective technique for solitary T1N0M0 papillary thyroid microcarcinoma.
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Affiliation(s)
- Wenwen Yue
- Department of Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University , Yantai , China and
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Lee SJ, Jung SL, Kim BS, Ahn KJ, Choi HS, Lim DJ, Kim MH, Bae JS, Kim MS, Jung CK, Chong SM. Radiofrequency ablation to treat loco-regional recurrence of well-differentiated thyroid carcinoma. Korean J Radiol 2014; 15:817-26. [PMID: 25469095 PMCID: PMC4248639 DOI: 10.3348/kjr.2014.15.6.817] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 08/12/2014] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the efficacy of radiofrequency ablation (RFA) in the treatment of loco-regional, recurrent, and well-differentiated thyroid carcinoma. Materials and Methods Thirty-five recurrent well-differentiated thyroid carcinomas (RTC) in 32 patients were treated with RFA, between March 2008 and October 2011. RTCs were detected by regular follow-up ultrasound and confirmed by biopsy. All patients had fewer than 3 RTCs in the neck and were at high surgical risk or refused to undergo repeated surgery. Average number of RFA sessions were 1.3 (range 1-3). Post-RFA biopsy and ultrasound were performed. The mean follow-up period was 30 months. Pre- and post-RFA serum thyroglobulin values were evaluated. Results Thirty-one patients with 33 RTCs were treated with RFA only, whereas 1 patient with 2 RTCs was treated with RFA followed by surgery. At the last follow-up ultrasound, 31 (94%) of the 33 RTCs treated with RFA alone completely disappeared and the remaining 2 (6%) RTCs showed decreased volume. The largest diameter and volume of the 33 RTCs were markedly decreased by 93.2% (from 8.1 ± 3.4 mm to 0.6 ± 1.8 mm, p < 0.001) and 96.4% (from 173.9 ± 198.7 mm3 to 6.2 ± 27.9 mm3, p < 0.001), respectively. Twenty of the 21 RTCs evaluated with post-RFA biopsies (95%) were negative for malignancy. One (5%) showed remaining tumor that was removed surgically. The serum thyroglobulin was decreased in 19 of 26 patients (73%). Voice change developed immediately after RFA in 6 patients (19%) and was spontaneously recovered in 5 patients (83%). Conclusion Radiofrequency ablation can be effective in treating loco-regional, recurrent, and well-differentiated thyroid carcinoma in patients at high surgical risk.
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Affiliation(s)
- Sun Jin Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul 156-755, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Bum Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Kook Jin Ahn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Hyun Seok Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Dong Jun Lim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Min Hee Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Ja Seong Bae
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Min Sik Kim
- Department of Otolaryngology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Chan Kwon Jung
- Department of Clinical Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Se Min Chong
- Department of Radiology, Chung-Ang University Hospital, Seoul 156-755, Korea
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Vannucchi G, Covelli D, Perrino M, De Leo S, Fugazzola L. Ultrasound-guided percutaneous ethanol injection in papillary thyroid cancer metastatic lymph-nodes. Endocrine 2014; 47:648-51. [PMID: 24610207 DOI: 10.1007/s12020-014-0215-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Post-operative neck nodal metastases are detected in 9-20 % of papillary thyroid cancer (PTC). Ultrasound-guided ethanol injection (UPEI) has been used with promising results in the treatment of PTC patients with limited number of lymph-node metastases. CLINICAL CASE We report the imaging and biochemical documentation of UPEI results in four metastatic neck lymph-nodes of papillary thyroid-cancer. A significant reduction both in the diameter of the lymph-nodes and in the serum thyroglobulin levels were observed in all cases and have been reported in a step-by-step sequence. CONCLUSION the UPEI treatment is a simple and suitable tool for the treatment of PTC cervical lymph-node metastases.
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Affiliation(s)
- Guia Vannucchi
- Endocrine Unit, Fondazione IRCCS Cà Granda, Milan and Department of Clinical Sciences and Community Health, University of Milan, Via Sforza, 35, 20122, Milan, Italy,
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Lim HK, Baek JH, Lee JH, Kim WB, Kim TY, Shong YK, Hong SJ. Efficacy and safety of radiofrequency ablation for treating locoregional recurrence from papillary thyroid cancer. Eur Radiol 2014; 25:163-70. [DOI: 10.1007/s00330-014-3405-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 07/26/2014] [Accepted: 08/20/2014] [Indexed: 01/19/2023]
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