Ultrasound-guided thermal ablation for cervical lymph node metastasis from thyroid carcinoma: a meta-analysis of clinical efficacy and safety

Landmark Studies in Differentiated Thyroid Cancer

Surgical resection remains the mainstay of curative intent therapy for patients with differentiated thyroid cancer, with radioactive iodine ablation and/or TSH suppression commonly employed in the adjuvant setting. Alternative strategies such as active surveillance and ablation are potentially available for patients with very low risk disease, although data regarding long term oncologic outcomes are limited. While only a small subset of patients with DTC will require systemic therapy, an increased understanding of tumor mutation profiles and available targeted therapies may facilitate multidisciplinary treatment of patients with locally advanced and/or unresectable DTC. This landmark series will summarize key studies that shape current guidelines in the surgical management of DTC and its adjuncts, with particular attention to current controversies and novel therapeutics that impact surgical management.

Ultrasound‑guided Percutaneous Radiofrequency and Microwave Ablation for Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma: A Systematic Review and Meta‑analysis of Clinical Efficacy and Safety

AIM

To evaluate the efficacy and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) for treating cervical lymph node metastasis (CLNM) from papillary thyroid carcinoma (PTC).

METHODS

Medline, EMBASE, Web of Science, and Cochrane Library were searched for studies on the efficacy and safety of thermal ablations for treating CLNM from PTC until July 2024. Among 544 papers, 11 articles were reviewed involving 233 patients and 432 CLNM cases. Random- or fixed-effects models assessed pooled proportions of volume reduction rate (VRR), complete disappearance, recurrence, major and minor or other complications. Similarly, pooled estimates of changes in the largest diameter, volume, and serum thyroglobulin (Tg) were evaluated post-ablation. Subgroup analysis by treatment modality was performed. Study heterogeneity was analyzed using Q statistics and inconsistency index (I2). The quality of the studies was assessed using the MINORS scale.

RESULTS

Eleven studies with 233 patients and 432 CLNM were analyzed. The pooled VRR was 95.24% [95% Confidence Interval (CI): 91.97- 98.51%], complete disappearance was 63.1%, and recurrence was 1.6%. Changes in largest diameter, volume, and serum Tg were 8.36 mm (95%CI: 6.46-10.26mm), 216.09mm³, and 6.12ng/ml, respectively. Major complications occurred at 3.0%, while minor complications were 25.6%. Significant heterogeneity was found for diameter, volume, VRR, Tg, and minor complications. Subgroup analysis showed that MWA had a higher VRR (97.18%) than RFA (93.84%) (P < 0.001).

CONCLUSION

Both RFA and MWA were effective and safe for treating CLNM from PTC. However, RFA showed lower volume reduction than MWA with significant heterogeneity in VRR.

DATA AVAILABILITY STATEMENT

The original contributions revealed in the study are included in the article/Supplemental Material. Further inquiries can be made to the corresponding author.

Ultrasound imaging of the perithyroid fascial space: a comparative analysis with anatomical correlations

This study aims to examine the ultrasonic characteristics of perithyroid fascial spaces following in vivo hydrodissection, validating their visualization through a comparative analysis with anatomical references. A retrospective review was conducted on data from 2390 patients (631 males and 1759 females, median age 46 years, 25-75% interquartile range 26-69 years) who underwent microwave ablation for thyroid tumors, including 1436 benign nodules and 954 papillary thyroid carcinomas. Detailed descriptions of perithyroid fascial spaces and the hydrodissection strategy were provided. Ultrasonic characteristics of fascial spaces during hydrodissection were documented and systematically compared with anatomical references. Hydrodissection was successfully performed in all cases according to the protocol. Isolating fluid was injected into classic anatomical spaces: anterior cervical (58.5%), pretracheal (71.8%, including Berry's ligament in 196 cases), retropharyngeal (43.7%), and carotid (1.2%). Additionally, US revealed two new spaces-perilymphatic (4.1%) and tracheoesophageal groove (3.7%)-with corresponding anatomical structures. The US-identified fascial structures aligned with their anatomical positions and distribution. US-guided hydrodissection facilitates the visualization of the fascial space, making it possible to study the microenvironment physiology and pathology of fascia in vivo.

Value of radiofrequency ablation for treating locally recurrent thyroid cancer: a systematic review and meta-analysis for 2-year follow-up

PURPOSE

To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating locoregional recurrent thyroid cancer (LRTC) after a 2-year follow-up time.

METHODS

PubMed, Embase and Cochrane Library were searched from inception until 20 September 2022 to find studies reporting the safety and efficacy of RFA in LRTC patients after a 2-year follow-up. Two radiologists performed the data extraction and methodological quality assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

We analyzed 6 studies, 229 LRTC patients with 319 locally recurrent tumors were treated with RFA. The mean follow-up time of each study was ≥24 months. The pooled changes in the largest diameter and volume were 7.22 mm (95% confidence interval (CI), 6.35-8.09 mm) and 164.28 mm3 (95% CI, 87.78-240.77 mm3), respectively; the pooled volume reduction rate was 95.03% (95% CI, 87.56-102.49%). The total complete disappearance rate after treatment was 92% (95% CI, 83-100%). The pooled decrease of serum thyroglobulin levels was 0.02 ng/ml (95% CI, -0.00-0.04 ng/ml). The pooled proportion of recurrence rate was 6% (95% CI, 0-13%). The pooled complication rate was 5% (95% CI, 0-10%). The major complications were voice change and hoarseness, only one patient developed permanent vocal cord paralysis; minor complications were cough and pain.

CONCLUSIONS

Ultrasound-guided RFA is an effective and safe treatment for LRTC based on 2-year follow-up results.

The effectiveness and safety of thermal ablation for thyroid carcinoma lymph node metastasis are affected by the diameter of metastatic lymph nodes: A meta-analysis

BACKGROUND

To explore the diameter of lymph nodes with metastatic thyroid carcinoma and the effectiveness and safety of thermal ablation.

METHODS

Several databases were searched for literature on the treatment of thyroid carcinoma metastatic lymph nodes by thermal ablation. A subgroup analysis was performed according to the diameter of the metastatic lymph nodes. The measures included pooled estimates of mean volume reduction, pooled proportions of total disappearance and recurrence, and the pooled proportions of overall complications.

RESULTS

There were 20 studies with 372 patients and 620 metastatic lymph nodes included. Based on the average maximum diameter of the metastatic lymph nodes, they were divided into three groups: A (≤ 10 mm), B (10 < diameter ≤ 20 mm), and C (> 20 mm). The study results indicated a significant decrease in the average volume only in groups A and B. The ratio of tumor disappearance showed that group A had the highest percentage, followed by group B and then group C. The recurrence rates were comparable between groups A and B, but slightly lower than in group C. Moreover, the overall complication rates for the three groups were ranked as follows: group A > group C > group B.

CONCLUSION

Overall, thermal ablation is an effective and safe treatment for thyroid cancer metastatic lymph nodes with diameters of 10-20mm.

Ultrasound-guided microwave ablation versus surgery for solitary T1bN0M0 papillary thyroid carcinoma: a prospective multicenter study

OBJECTIVE

Microwave ablation (MWA) has emerged as a minimally invasive technology for papillary thyroid microcarcinoma (PTMC), but it has not been widely applied to treat T1bN0M0 PTC with high-level evidence. This study was designed to compare the real-world efficacy and safety of MWA or surgery for treating T1bN0M0 PTC.

METHODS

From December 2019 to April 2021, 123 continuous unifocal T1bN0M0 PTC patients without lymph node metastasis (LNM) or distant metastasis (DM) were included from 10 hospitals. Patients were allocated into the MWA or surgery group based on their willingness. The main outcomes were local tumour progression (LTP), new thyroid cancer, LNM, and DM. The secondary outcomes included changes in tumour size and volume, complications, and cosmetic results. Subgroup analyses were conducted to identify influencing factors.

RESULTS

Fifty-two patients chose MWA, and 71 patients chose surgery. Patients had similar demographic information and tumour characteristics in the two groups. The follow-up durations after MWA and surgery were 10.6 ± 4.2 and 10.4 ± 3.4 months, respectively. The LNM rate was 5.8% in the MWA group and 1.4% in the surgery group (p = 0.177). No LTP, new thyroid cancer, or distant metastasis (DM) occurred in either group. Five (9.6%) of the 52 patients in the MWA group and 8 (11.3%) of the 71 patients in the surgery group had complications (p = 0.27). Better cosmetic results were found in the MWA group (p < 0.01).

CONCLUSION

MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further.

CLINICAL RELEVANCE STATEMENT

MWA achieved comparable short-time treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC.

KEY POINTS

• MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further. • The complication rate in the surgery group was higher than that in the MWA group without a significant difference. • There was no statistically significant difference in the LNM rate between the MWA and surgery groups.

Percutaneous Ablation of Metastatic Lymph Nodes: An Insight from the Comparison of Efficacy and Safety Between Cryoablation and Radiofrequency Ablation

PURPOSE

To retrospectively compare efficacy and safety of computed tomography (CT)-guided percutaneous ablation of metastatic lymph nodes (LN) between cryoablation (CA) and radiofrequency ablation (RFA).

MATERIALS AND METHODS

A bi-central institutional database research identified 28 patients (42 metastatic LNs) who underwent percutaneous CT-guided ablation. RFA group included 18 patients/26 tumors; CA group included 10 patients/16 tumors. Contrast-enhanced CT or MRI was used for post-ablation follow-up. Patient and tumor characteristics, technical and clinical success on a per tumor and a per patient basis and complication rates were recorded, evaluated and compared between the 2 groups.

RESULTS

Both RFA and CA groups had the same median tumor size (2.00 vs. 2.20 cm, p = 0.257), the same median follow-up time (20.50 vs. 20.00 months, p = 0.923) and the same median length of hospital stay (1.00 vs. 1.00 days, p = 0.283). CA group had a higher median procedure time (110.50 vs. 52.00 min, p = 0.001). On a per lesion basis, the overall complete response post-ablation was 88.46% (23/26 lesions) in the RFA and 93.75% (15/16 lesions) in the CA group; no association was revealed between local tumor control and ablation technique (p = 0.709). No complications were recorded in both Groups. On a per patient basis, CA had a longer disease-free interval (24.00 vs. 14.50, p = 0.012) which, however, did not affect the overall survival between the two techniques (26.0 vs. 22.0, p = 0.099 for CA and RFA respectively).

CONCLUSION

Our limited data suggest that CT-guided RFA and CA are equally effective on terms of efficacy and safety for the treatment of metastatic lymph nodes.

Efficacy and Safety of Thermal Ablation for Treating Lymph Node Metastasis From Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis

Objective

To evaluate the efficacy and safety of thermal ablation, including radiofrequency ablation (RFA), microwave ablation (MVA), and laser ablation (LA), for treating lymph node metastasis (LNM) from papillary thyroid carcinoma (PTC).

Design and Methods

PubMed and EMBASE were searched for studies reporting the efficacy and safety of thermal ablation for treating LNM in PTC. After selecting the relevant literature (including 11 papers, 208 patients, 412 lymph nodes), the QUADAS-2 tool was used to evaluate its quality. Then, both the fixed-effects and random-effects models combined with subgroup analysis were used to calculate data on volume changes in metastatic lymph nodes and changes in serum thyroglobulin (Tg) levels. We pooled the proportion of major and overall complication rates and complete disappearance rates and used subgroup forest plots and funnel plots for visual representation. Because of publication bias, we also performed a trim-and-filled model for correction. The rate of recurrence and distant metastasis with ablated details were pooled.

Results

In the 11 articles (208 patients and 412 diseased lymph nodes), all thermal ablation methods showed effectiveness in reducing lymph node volume (P = 0.02) and serum Tg levels (P < 0.01) which showed no between-group difference. The pooled proportion of major complications was 0%(95% CI: -0.14; 0.15, P = 1) and the overall complication rate was 5% (95% CI: -0.09; 0.20, P = 1), which revealed no significant difference among modalities. The pooled proportion of the complete disappearance rate was 82% (95% CI: 0.43; 0.96, P < 0.01) and the data with statistical significance which contains RFA and LA showed complete disappearance rate was 59% and 81% respectively.

Conclusion

All thermal ablation methods, including RFA, MWA, and LA, were effective and safe for treating LNM in PTC and were especially suitable for nonsurgical patients. Besides, subgroup analysis showed no significant difference, except for LA is better than RFA in complete disappearance rate.

Upregulated miR-9-5p inhibits osteogenic differentiation of bone marrow mesenchymal stem cells under high glucose treatment

INTRODUCTION

Diabetic osteoporosis (DOP) is a chronic diabetic complication, which is attributed to high glucose (HG)-induced dysfunction of bone marrow mesenchymal stem cells (BMSCs). Studies have revealed that microRNAs (miRNAs) play critical roles in osteogenic differentiation of BMSCs in DOP. Here, the role of miR-9-5p in DOP progression was explored.

MATERIALS AND METHODS

The rat model of DOP was established by intraperitoneal injection of streptozotocin (STZ). BMSCs were treated with high glucose (HG) to establish in vitro models. Gene expression in BMSCs and bone tissues of rats was tested by RT-qPCR. The degree of osteogenic differentiation of BMSCs was examined by Alizarin Red staining and ALP activity analysis. The protein levels of collagen-I (COL1), osteocalcin (OCN), osteopontin (OPN), runt-related transcription factor-2 (RUNX2), and DEAD-Box Helicase 17 (DDX17) in BMSCs were evaluated by western blotting. The interaction between miR-9-5p and DDX17 was identified by luciferase reporter assay. H&E staining was used to test morphological structure of femurs of rats with STZ treatment.

RESULTS

MiR-9-5p was overexpressed in HG-treated BMSCs, while DDX17 was downregulated. Functionally, miR-9-5p knockdown promoted BMSCs osteogenic differentiation under HG condition. Mechanically, miR-9-5p targeted DDX17. DDX17 knockdown reversed the effect of miR-9-5p silencing on osteogenic differentiation of HG-treated BMSCs. In in vivo studies, miR-9-5p downregulation ameliorated the DOP condition of rats and miR-9-5p expression was negatively correlated with DDX17 expression in bone tissues of rats with STZ treatment.

CONCLUSION

MiR-9-5p knockdown promotes HG-induced osteogenic differentiation BMSCs in vitro and mitigates the DOP condition of rats in vivo by targeting DDX17.

Safety and efficacy of thermal ablation for cervical metastatic lymph nodes in papillary thyroid carcinoma: A systematic review and meta-analysis

BACKGROUND

To evaluate the safety and efficacy of radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) for the treatment of cervical metastatic lymph nodes (CMLNs) of papillary thyroid carcinoma (PTC).

METHODS

The Pubmed, EMBASE, Web of Science, and Cochrane Library databases were searched for studies on the safety and efficacy of thermal ablations (RFA, MWA, and LA) for the treatment of CMLNs of PTC until March 30, 2022. A review of 334 potential papers identified 17 eligible papers including 312 patients. Fixed-effects model or random-effects model was used to evaluate the pooled proportions of volume reduction rate (VRR), complete disappearance, and recurrence, and pooled estimates of changes in the largest diameter, volume, and serum Tg after ablation. The pooled proportions of overall and major complications were calculated. Subgroup analysis based on treatment modalities. The heterogeneity among studies was analyzed by using Q statistics and inconsistency index I² . MINORS scale was used to evaluate the quality of the studies.

RESULTS

17 eligible studies were finally identified, including 312 patients and 559 CMLNs. The pooled proportions of VRR, complete disappearance and recurrence of CMLNs were 91.28% [95% confidence interval (CI): 86.60-95.97%], 67.9% [95% CI: 53.1-81.1%] and 7.8% [95%CI: 3.0-14.1%], respectively. The pooled estimates of changes in the largest diameter, volume and serum Tg were 8.12 mm [95%CI: 6.78-9.46 mm], 338.75 mm³ [95%CI: 206.85 -470.65 mm³] and 5.96 ng/ml [95%CI: 3.68-8.24 ng/ml], respectively. The pooled proportions of overall and major complications were 2.9% [95%CI: 0.3-7.1%] and 0.3% [95%CI: 0-1.9%], respectively. Significant between-study heterogeneity was observed for complete disappearance (P<0.01, I² =88.6%), VRR (P<0.001, I² =99.9%), recurrence (P=0.02, I² =47.76%), overall complications (P<0.02, I² =44.8%), and changes in the largest diameter (P < 0.001, I² =82.6%), volume (P<0.001, I² =97.0%), and serum Tg (P < 0.001, I² =93.7%). Subgroup analysis showed heterogeneity of the VRR among the treatment modality (I² range: 84.4-100%). The VRR of MWA was the highest (97.97%), followed by RFA (95.57%) and LA (84.46%) (P < 0.001).

CONCLUSION

All thermal ablations were safe and effective for the treatment of CMLNs of PTC. However, each treatment had significant heterogeneity in VRR. Compared with RFA and MWA, LA was less effective in reducing the volume of CMLNs of PTC.