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Papini E, Guglielmi R, Novizio R, Pontecorvi A, Durante C. Management of low-risk papillary thyroid cancer. Minimally-invasive treatments dictate a further paradigm shift? Endocrine 2024:10.1007/s12020-024-03864-7. [PMID: 38767774 DOI: 10.1007/s12020-024-03864-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Current management options for PTMC include lobo-isthmectomy and active surveillance (AS). Recently, ultrasound-guided minimally invasive procedures (MITs) are offered as a nonsurgical therapy for PTMC because they do not require hospitalization and general anaesthesia, and do not result in loss of thyroid function or cosmetic damage. MITs are reported to consistently provide, mostly in large retrospective series of patients, a rapid, safe, and cost-effective way to eradicate low-risk thyroid malignancies. However, conclusive data from well-conducted prospective studies on the histologically-proven completeness of tumor ablation and the long-term clinical advantages versus AS are still lacking. OBJECTIVES This study aimed to evaluate the efficacy and safety of ultrasound-guided minimally invasive treatments (MITs) for PTMC in comparison to traditional surgical methods and active surveillance, and to assess their role in current clinical practice. METHODS A structured literature review was conducted using keywords related to PTMC, MIT, and comparative techniques. Studies were evaluated based on treatment modality, patient selection, follow-up duration, complication rates, and clinical outcomes. RESULTS MITs have shown promising results in the management of PTMC. These treatments offer several advantages over surgery, such as reduced use of surgical resources, lower costs, minimal work disruption, and fewer major complications. However, there are still limitations, including the need for long-term surveillance and the potential risk of incomplete tumor ablation. CONCLUSIONS MITs represent a promising non-surgical option for managing low-risk PTMC, especially for patients ineligible for or refusing surgery. Despite favorable outcomes, more robust prospective data are needed to confirm their long-term benefits and completeness of tumor ablation. Interdisciplinary discussions and thorough patient education on the advantages and limitations of MITs are crucial for informed decision-making.
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Affiliation(s)
- E Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - R Guglielmi
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - R Novizio
- Department of Endocrinology, Catholic University of The Sacred Heart, Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - A Pontecorvi
- Department of Endocrinology, Catholic University of The Sacred Heart, Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - C Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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Zhang J, Liu J, Yi W, Liu Y, Liu Y, Xu J. Thermal ablation for multifocal papillary thyroid microcarcinoma: a systematic review and meta-analysis. Endocrine 2024:10.1007/s12020-024-03710-w. [PMID: 38319587 DOI: 10.1007/s12020-024-03710-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Clinical studies have indicated the potential safety and efficacy of thermal ablation (TA) in treating multifocal papillary thyroid microcarcinoma (MPTMC). However, a comprehensive systematic evaluation of its effectiveness was still lack. METHODS PubMed, EMBASE and Cochrane Library databases were systematically searched for studies published until October 23, 2023, that reported on the effectiveness of thermal ablation in the management of MPTMC. Data extraction and methodological quality assessment were independently conducted by two reviewers following the guidelines outlined in the PRISMA. RESULTS This systematic review and meta-analysis identified 389 tumors in 169 patients from four studies. After treatment with different TA, the combined rate of complete disappearance of MPTMC was 92.8% [95% confidence interval (CI): 68.2-100] and the combined rate of overall complications was 4.4% [95% CI: 1.5-8.5]. During the follow-up period, local tumor recurrence was observed in only 2 patients with a combined rate of 0.2% [95% CI: 0.0-2.6]; lymph node metastasis (LNM) was observed in 3 patients with a combined rate of 1.2% [95% CI: 0-4.1]. Additionally, 6 patients developed new PTMC. It is noteworthy that no patients were observed to develop distant metastases during the follow-up period, and no patients had delayed surgery after underwent ablation. CONCLUSIONS For patients grappling with MPTMC, TA emerges as an excellent approach for achieving localized tumor control. Nonetheless, achieving favorable outcomes necessitates stringent inclusion criteria and a profound level of expertize.
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Affiliation(s)
- Junping Zhang
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jiarong Liu
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wanting Yi
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yanling Liu
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Ying Liu
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, Jiangxi, China
| | - Jixiong Xu
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, China.
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, Jiangxi, China.
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Tikhtman R, Steward DL. Overview of Thyroid and Parathyroid Disease: The Otolaryngology Perspective. Otolaryngol Clin North Am 2024; 57:1-9. [PMID: 37648633 DOI: 10.1016/j.otc.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The management of thyroid and parathyroid pathology varies widely, with unifying goals of symptomatic control and mitigating patient morbidity. In general, surgery is indicated when addressing malignancy or when medical management is insufficient. Over the last few decades, treatment paradigms for patients with head and neck endocrine disease have shifted significantly as our understanding of disease processes has expanded and with the advent of numerous relevant technologies. Here we provide a general overview of thyroid and parathyroid disease that may be managed by the otolaryngologist, with attention to emerging strategies in diagnosis and treatment.
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Affiliation(s)
- Raisa Tikhtman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Medical Sciences Building Room #6507, 231 Albert Sabin Way, Cincinnati, OH 45267-0528, USA
| | - David L Steward
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Medical Sciences Building Room #6507, 231 Albert Sabin Way, Cincinnati, OH 45267-0528, USA.
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Guo MH, Dou JP, Zheng L, Liu FY, Yu J, Cheng ZG, Yu XL, Che Y, Wang SR, Cong ZB, Bai N, Liu C, Hao Y, Yu MA, Xu ZF, Han ZY, Liang P, Chen L. Ultrasound-guided microwave ablation versus surgery for solitary T1bN0M0 papillary thyroid carcinoma: a prospective multicenter study. Eur Radiol 2024; 34:569-578. [PMID: 37548692 DOI: 10.1007/s00330-023-09908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/24/2023] [Accepted: 05/02/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Microwave ablation (MWA) has emerged as a minimally invasive technology for papillary thyroid microcarcinoma (PTMC), but it has not been widely applied to treat T1bN0M0 PTC with high-level evidence. This study was designed to compare the real-world efficacy and safety of MWA or surgery for treating T1bN0M0 PTC. METHODS From December 2019 to April 2021, 123 continuous unifocal T1bN0M0 PTC patients without lymph node metastasis (LNM) or distant metastasis (DM) were included from 10 hospitals. Patients were allocated into the MWA or surgery group based on their willingness. The main outcomes were local tumour progression (LTP), new thyroid cancer, LNM, and DM. The secondary outcomes included changes in tumour size and volume, complications, and cosmetic results. Subgroup analyses were conducted to identify influencing factors. RESULTS Fifty-two patients chose MWA, and 71 patients chose surgery. Patients had similar demographic information and tumour characteristics in the two groups. The follow-up durations after MWA and surgery were 10.6 ± 4.2 and 10.4 ± 3.4 months, respectively. The LNM rate was 5.8% in the MWA group and 1.4% in the surgery group (p = 0.177). No LTP, new thyroid cancer, or distant metastasis (DM) occurred in either group. Five (9.6%) of the 52 patients in the MWA group and 8 (11.3%) of the 71 patients in the surgery group had complications (p = 0.27). Better cosmetic results were found in the MWA group (p < 0.01). CONCLUSION MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further. CLINICAL RELEVANCE STATEMENT MWA achieved comparable short-time treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC. KEY POINTS • MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further. • The complication rate in the surgery group was higher than that in the MWA group without a significant difference. • There was no statistically significant difference in the LNM rate between the MWA and surgery groups.
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Affiliation(s)
- Mo-Han Guo
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jian-Ping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Lin Zheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Zhi-Bin Cong
- Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Nan Bai
- Department of Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Cun Liu
- Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Ying Hao
- Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China
| | - Ming-An Yu
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhi-Feng Xu
- First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
| | - Lei Chen
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.
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Dong P, Teng DK, Sui GQ, Lin YQ, Luo Q, Wang QM, Li HQ, Wang H. Long-term efficacy of microwave ablation for multifocal papillary thyroid microcarcinoma: a 5-year follow-up study. Eur Radiol 2024; 34:715-723. [PMID: 37581653 DOI: 10.1007/s00330-023-10117-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES Microwave ablation (MWA) has achieved excellent long-term efficacy in treating unifocal papillary thyroid microcarcinoma (UPTMC). The therapeutic effect of this treatment on multifocal papillary thyroid microcarcinoma (MPTMC) is unknown. Therefore, we evaluated the long-term efficacy of MWA for low-risk MPTMC and to provide evidence-based medicine for the revision of clinical guidelines. METHODS This study included 66 MPTMC patients with a total of 158 lesions, all of whom received MWA. We collected and retrospectively analyzed the patients' follow-up data before MWA, at 1, 3, 6, and 12 months posttreatment and every 6 months thereafter until 5 years posttreatment. We evaluated the MWA complication rate, technical success rate (TSR), lesion volume reduction rate (VRR), and complete disappearance rate (CDR) during follow-up and in those patients with tumor progression and delayed surgery. RESULTS After 60 months of follow-up, all 158 lesions disappeared in 66 patients, and the volume was reduced from 43.82 mm3 to 0.00 mm3. The TSR and VRR were both 100%. The CDRs at 1 year, 2 years, and 3 years were 57.59%, 93.67%, and 100%, respectively. The complication rate was 3.03% (2/66), and the incidence of tumor progression was 3.03% (2/66), including one new intrathyroidal lesion and one cervical lymph node metastasis (LNM). These lesions were retreated with MWA, and the lesions disappeared during the follow-up period. CONCLUSIONS Ultrasound-guided MWA for low-risk MPTMC is safe and effective and may serve as an alternative option for patients who refuse surgery or active surveillance (AS). CLINICAL RELEVANCE STATEMENT This study concludes that ultrasound-guided microwave ablation for low-risk multifocal papillary thyroid microcarcinoma is safe and effective and may serve as an alternative option for patients who refuse surgery or active surveillance. KEY POINTS • Ultrasound-guided microwave ablation for low-risk multifocal papillary thyroid microcarcinoma is safe and effective. • During 5 years of follow-up, multifocal papillary thyroid microcarcinoma patients treated with microwave ablation had a favorable prognosis. • To provide evidence-based medicine for the revision of clinical guidelines.
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Affiliation(s)
- Peng Dong
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Guo-Qing Sui
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Yuan-Qiang Lin
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Qiang Luo
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Qi-Meihui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - He-Qun Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China.
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Gao X, Yang Y, Wang Y, Huang Y. Efficacy and safety of ultrasound-guided radiofrequency, microwave and laser ablation for the treatment of T1N0M0 papillary thyroid carcinoma on a large scale: a systematic review and meta-analysis. Int J Hyperthermia 2023; 40:2244713. [PMID: 37604507 DOI: 10.1080/02656736.2023.2244713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND To analyze the efficacy and safety of radiofrequency ablation (RFA), microwave ablation (MWA) and laser ablation (LA) in T1N0M0 papillary thyroid carcinoma (PTC) patients by evaluating data on several outcomes on a large scale. MATERIALS AND METHODS Literature searches were conducted in PUBMED, EMBASE and the Cochrane Library for studies of thermal ablation (TA) for treating T1N0M0 PTC. Data on the volume reduction rate (VRR) at the 12-month follow-up and final follow-up, complete disappearance rate, local recurrence rate, lymph node metastasis rate, and complication rate of RFA, MWA and LA were evaluated separately. RFA effects were compared between T1aN0M0 and T1bN0M0 patients. RESULTS A total of 36 eligible studies were included. RFA presented superior efficacy than MWA in 12-month VRR. At the final follow-up, the difference was slight in subgroups, showing a significant reduction. The complete disappearance rate of LA (93.00%) was higher than that of RFA (81.00%) and MWA (71.00%). Additionally, the local recurrence rate pooled proportions of MWA and RFA were both 2.00%, lower than that of the LA group (3.00%). There was no event of distant metastasis. The lymph node metastasis rates were similar, as RFA (1.00%) had the lowest. For minor complication rates, the pooled proportions of RFA (3.00%) were smaller than those of LA (6.00%) and MWA (13.00%). T1aN0M0 lesions presented with better outcomes than T1bN0M0 lesions. CONCLUSION RFA, MWA and LA were reliable in curing PTC, and RFA presented advantages in most outcomes. T1aN0M0 patients may experience fewer side effects than T1bN0M0 patients.
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Affiliation(s)
- Xuemeng Gao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yang Yang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yitong Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Zhao ZL, Dong G, Wang SR, Liu Y, He JF, Shi LL, Guo JQ, Wang ZH, Cong ZB, Liu LH, Yang BB, Qu CP, Wei Y, Peng LL, Li Y, Lu NC, Wu J, Yu MA. Efficacy and safety of microwave ablation for the treatment of multifocal versus unifocal T1N0M0 papillary thyroid carcinoma: a propensity-matched multicentre retrospective study. Eur Radiol 2023; 33:8727-8735. [PMID: 37466709 DOI: 10.1007/s00330-023-09932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/07/2023] [Accepted: 05/15/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Microwave ablation (MWA) has been widely used for unifocal papillary thyroid carcinoma (U-PTC) and has recently been preliminarily used in multifocal papillary thyroid carcinoma (M-PTC). However, the efficacy and safety of MWA for M-PTC have not been investigated in large samples. The aim of the present study was to evaluate the efficacy and safety of MWA for M-PTC and compare them with MWA for U-PTC. MATERIALS AND METHODS This retrospective multicentre study enrolled 504 patients (376 females) who underwent MWA for U-PTC (340 cases) or M-PTC (164 cases) from Jan 2015 to Dec 2020. The median age of the patients was 43 years (age range, 20-80 years). Propensity score matching (PSM) was used to balance the baseline characteristics between M-PTC group and U-PTC group. The tumour progression, tumour disappearance, and complication rates were compared between the two groups. RESULTS The complete ablation was achieved in all enrolled cases in one session. According to the statistical results, no significant differences were shown in tumour progression-free survival (p = 0.29) or cumulative tumour progression rate (6.7% vs. 4.3%, p = 0.33) between the M-PTC and U-PTC groups during the follow-up time. However, the tumour disappearance rate in the M-PTC group was lower in the U-PTC group (40.9% vs. 62.8%, p < 0.001), and tumour disappearance was slower in the M-PTC group (p < 0.001). The complication rate showed no significant difference (3.0% vs. 4.9%, p = 0.571). CONCLUSIONS MWA is an effective and safe treatment for selected patients with M-PTC, and the prognosis is similar to that of U-PTC. CLINICAL RELEVANCE STATEMENT The present study provided evidence that compared with unifocal papillary thyroid cancer, microwave ablation could also treat multifocal T1N0M0 papillary thyroid cancer safely with similar clinical outcome, which could promote the application of minimally invasive treatment for papillary thyroid cancer. KEY RESULTS • Microwave ablation for multifocal and unifocal T1N0M0 papillary thyroid carcinoma had similar tumour progression rates after propensity score matching (6.7% vs. 4.3%, p = 0.33). • The tumour disappearance rate in the multifocal group was lower than that in the unifocal group (40.9% vs. 62.8%, p < 0.001), and tumour disappearance was slower in the multifocal group (p < 0.001). • Tumour size, number, and location were not risk factors for tumour progression in the multifocal papillary thyroid cancer group.
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Affiliation(s)
- Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Gang Dong
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shu-Rong Wang
- Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, Shandong, China
| | - Ying Liu
- Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, Shandong, China
| | - Jun-Feng He
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China
| | - Li-Li Shi
- Department of Ultrasound, Laixi Municipal Hospital, Laixi, Shandong, China
| | - Jian-Qin Guo
- Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical Univeristy, Haikou, Hainan, China
| | - Zhong-Hua Wang
- Department of Special Inspection, Wendeng District People's Hospital, Weihai, Shandong, China
| | - Zhi-Bin Cong
- Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Li-Hong Liu
- Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Bei-Bei Yang
- Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Chun-Ping Qu
- Department of Special Inspection, Muping Zhongyi Hospital, Yantai, Shandong, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Nai-Cong Lu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China.
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Ren Y, Lu C, Xu S. Ultrasound-guided thermal ablation for papillary thyroid microcarcinoma: the devil is in the details. Int J Hyperthermia 2023; 40:2278823. [PMID: 37940134 DOI: 10.1080/02656736.2023.2278823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023] Open
Abstract
Thermal ablation (TA) has harvested favorable outcomes in treating low-risk papillary thyroid microcarcinoma (PTMC). Preoperative assessment, intraoperative procedures and postoperative follow-up are all closely linked with the success and safety of TA on PTMC. However, many details in these aspects have not been systematically reviewed. This review firstly described the influence of preoperative assessment, especially for the risk of lymph node metastasis (LNM), as well as the molecular testing on the selection of TA for PTMC. Besides, we also summarized the experiences in treating special PTMC cases by TA, like multifocal lesions, PTMC located in the isthmus or adjacent to the dorsal capsule. At last, we discussed the follow-up strategies, the influence of the thyroid-stimulating hormone (TSH) level on the prognosis of PTMCs, and the management for recurrent cases. In conclusion, the procedures during the entire perioperative period should be standardized to improve the outcomes of TA in treating PTMC patients.
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Affiliation(s)
- Yujie Ren
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Chenya Lu
- Department of Endocrinology, Dongyang Hospital of Chinese Medicine, Dangyang, China
| | - Shuhang Xu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
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9
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Tong M, Wang L, Gai Z, Zhu Y, Che Y. Clinical outcomes of radiofrequency ablation for solitary T1aN0M0 versus T1bN0M0 papillary thyroid carcinoma: a propensity-matched cohort study. Int J Hyperthermia 2023; 40:2257908. [PMID: 37848402 DOI: 10.1080/02656736.2023.2257908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/05/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To conduct a cohort study comparing the treatment outcomes of radiofrequency ablation (RFA) therapy for solitary T1aN0M0 (T1a) versus T1bN0M0 (T1b) papillary thyroid carcinoma (PTC). METHODS This retrospective analysis comprised 310 patients with low-risk PTC undergoing RFA classified into T1a (n = 272) and T1b (n = 38) groups according to the tumor size. A comparative analysis between the two groups was conducted for the volume reduction ratio (VRR), volume, local tumor progression (LTP), and recurrence-free survival (RFS) before and after 1:2 propensity score matching (PSM). Cox analysis was conducted to examine the influence of several variables, including T1b, on recurrence following RFA for PTC. RESULTS The total VRR was 99.99 ± 0.11% throughout the median follow-up duration of 26 months, and the overall incidence of LTP was 2.58% (8/310). No irrecoverable complications occurred after RFA. The variations between the T1a and T1b groups following PSM were insignificant in terms of volume (p = 0.574), VRR (p = 0.574), complete disappearance rate (p = 0.210), LTP incidence (p = 1.000), and RFS rate (p = 0.610). The correlation between T1b and LTP continued to be insignificant (p = 0.686). No distant metastasis or delayed surgery occurred. CONCLUSIONS The presence of T1b did not influence the patients' prognoses following RFA for T1N0M0 PTC. After appropriate patient selection and adequate preoperative assessment, RFA has the potential to serve as an effective therapy for individuals with T1a and T1b PTC.
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Affiliation(s)
- Mengying Tong
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Linchun Wang
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Ziru Gai
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Yalin Zhu
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P.R. China
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Song B, Lin Z, Feng C, Zhao X, Teng W. Global research landscape and trends of papillary thyroid cancer therapy: a bibliometric analysis. Front Endocrinol (Lausanne) 2023; 14:1252389. [PMID: 37795362 PMCID: PMC10546338 DOI: 10.3389/fendo.2023.1252389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Background Papillary thyroid cancer (PTC) is the most common endocrine malignancy worldwide. The treatment of PTC has attracted extensive attention and discussion from the public and scholars. However, no article has systematically assessed the related literature. Therefore, we conducted a bibliometric and knowledge map analysis to reveal the dynamic scientific developments in the PTC therapy field. Methods We retrieved publications related to PTC therapy from the Web of Scientific Core Collection (WoSCC) on May 1, 2023. The bibliometric package in R software, VOSviewer and CiteSpace software were used to analyze countries/regions, institutions, journals, authors, references, and keywords. Then, we systematized and summarized the research landscape, global trends and hot topics of research. Results This bibliometric analysis spanned from 2012 to 2022 and involved 18,501 authors affiliated with 3,426 institutions across 87 countries/regions, resulting in the publication of 3,954 papers in 860 academic journals. Notably, the number of publications and citations related to PTC therapy research has exhibited a steady increase over the past decade. China and the United States have emerged as leading contributors in terms of publication count, with the United States also being the most cited country. Furthermore, among the top 10 institutions with the highest number of published papers, half were located in China. Among the journals, Thyroid is ranked first in terms of total publications and citations. The most productive individual author was Miyauchi Akira. While previous research primarily focused on surgery and radioactive iodine therapy, the increasing emphasis on health awareness and advancements in medical technology have led to the emergence of active surveillance, thermal ablation, and genomic analysis as prominent areas of research. Conclusion In conclusion, this comprehensive and quantitative bibliometric analysis elucidates the research trends and hotspots within PTC therapy, drawing from a substantial body of publications. This study provides valuable insights into the historical and current landscape of PTC therapy research while also offering guidance for future research directions. This study serves as a valuable resource for researchers and practitioners seeking new avenues of exploration in the field.
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11
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Hu C, Liang S, Liu H, Yang J, Kang H, Guan S, Yan R, Xu E. Prediction of ablation zone disappearance after microwave ablation for the patients with papillary thyroid microcarcinoma using nomograph. Front Endocrinol (Lausanne) 2023; 14:1145958. [PMID: 37600691 PMCID: PMC10433776 DOI: 10.3389/fendo.2023.1145958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives To construct a prognostic nomogram to predict the ablation zone disappearance for patients with papillary thyroid microcarcinoma (PTMC) after microwave ablation (MWA). Materials and methods From April 2020 to April 2022, patients with PTMC who underwent MWA treatment were collected retrospectively. Ultrasound (US) or contrast-enhanced ultrasound (CEUS) was performed at 1 day, 1, 3, 6, 12, 18 and 24 months after MWA to observe the curative effect after ablation. The volume, volume reduction rate (VRR) and complete disappearance rate of the ablation zone at each time point were calculated. Univariate and multivariate logistic regression analysis were used to determine the prognostic factors associated with the disappearance of the ablation zone after MWA, and the nomogram was established and validated. Results 72 patients with PTMCs underwent MWA were enrolled into this study. After MWA, no tumor progression (residual, recurrence or lymph node metastasis) and major postoperative complications occurred. The ablation zone in 28 (38.89%) patients did not completely disappear after MWA in the follow-up period. Three variables, including age (odds ratio [OR]: 1.216), calcification type (OR: 12.283), initial maximum diameter (OR: 2.051) were found to be independent prognostic factors predicting ablation zone status after MWA by multivariate analysis. The above variables and outcomes were visualized by nomogram (C-index=0.847). Conclusions MWA was a safe and effective treatment for PTMC. Older patients with macrocalcification and larger size PTMCs were more unlikely to obtain complete disappearance of ablation zones. Incomplete disappearance of ablation zone was not related to recurrence.
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Affiliation(s)
- Cai Hu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Shuang Liang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Huahui Liu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Jing Yang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Haiyu Kang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Sainan Guan
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Ronghua Yan
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzen, China
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
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12
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Chen Z, Zhang W, He W. Ultrasound-guided thermal ablation for papillary thyroid microcarcinoma: A systematic review. Clin Endocrinol (Oxf) 2023; 98:296-305. [PMID: 36471482 DOI: 10.1111/cen.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Thyroidectomy is the first-line treatment for papillary thyroid microcarcinoma (PTMC), but often involves aggressive overtreatment. Thermal ablation (TA) has been gradually used for the treatment of recurrent PTMC. However, it is not recommended for the treatment of primary PTMC according to the Korean and Italian guidelines. Therefore, this systematic review aimed to analyse the indications, efficacy, and safety of TA in the treatment of PTMC. DESIGN Systematic review. PATIENTS AND MEASUREMENTS A search strategy was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A total of 27 articles were included in this study until January 2022. RESULTS According to current guidelines and studies, we divided the indications of TA for PTMC into six primary and three secondary indications. Laser ablation (LA) has the advantages of a small needle, accurate output energy and precision ablation, and it is safe to important organs around the lesion. The patients recover quickly after radiofrequency ablation (RFA), with no major complications, recurrence, or lymph node metastasis. The volume reduction rate after RFA was the highest, followed by microwave ablation and LA, and the improvement in patient quality of life after TA was significantly better than after thyroidectomy. CONCLUSIONS TA is an effective alternative method for surgery in the treatment of low-risk PTMC and has the advantages of being minimally invasive, economical, having less bleeding and having a high postoperative quality of life.
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Affiliation(s)
- Zhiguang Chen
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Meta-Analysis of the Application Effect of Different Modalities of Thermal Ablation and Surgical Treatment in Papillary Thyroid Microcarcinoma. DISEASE MARKERS 2022; 2022:9714140. [PMID: 36217504 PMCID: PMC9547687 DOI: 10.1155/2022/9714140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 12/07/2022]
Abstract
Background Papillary thyroid microcarcinoma (PTMC) refers to papillary thyroid carcinoma (PTC) with a maximum diameter of 10 mm. Thermal ablation, including radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA), has been applied in the treatment of benign thyroid nodules and captured extensive attention. At present, the application of thermal ablation in PTMC has been extensively reported, but outcomes such as volume reduction rate (VRR), complete remission rate (CRR), and adverse reaction rate (ARR) vary considerably. Therefore, this meta-analysis was performed to evaluate the safety and efficacy of different treatment methods of PTMC. Methods We did a systematic review and network meta-analysis. We searched PubMed, EMBase, and Cochrane-Library from the date of inception to January 10, 2022, to retrieve the VRR, CRR, and ARR of MWA, RFA, LA and surgical treatment of PTMC, and a meta-analysis was performed using the R meta-package. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and sensitivity analyses, cumulative meta-analyses, and publication bias were also performed. Relevant literature was retrieved with keywords; the eligible cohort studies were screened based on the established inclusion and exclusion criteria. Results A total of 1515 patients were included in the 12-month follow-up. The overall VRR was 86.25% (95% CI: 77.89, 94.60), and the VRR was RFA > WMA > LA, but the differences were not significant. A total of 1483 patients were included in the last follow-up. The overall VRR was 99.41% (95% CI: 99.11, 99.72), and the VRR was RFA > WMA > LA, but the differences were not significant. A total of 1622 patients showed complete remission at the last follow-up, and the overall CRR was 0.63 (95% CI: 0.46, 0.79). The CRR was RFA > LA > WMA, but the differences were not significant. A total of 1883 patients had adverse reactions at the last follow-up, and the overall ARR was 0.06 (95% CI: 0.03, 0.08). The ARR at the last follow-up was RFA = Surg < LA < WMA. The ARR of the RFA and Surg subgroups was significantly lower than that of the WMA subgroup. Conclusions Similar good efficacy and safety profiles were observed in WMA, RFA, LA, and surgical treatment in PTMC, among which RFA showed the best volume reduction, complete remission rate, and adverse reaction reduction. However, there is a slight bias in the limited literature included in this study, and we did not conduct or refer to mechanistic studies to confirm its specific mechanism of action. Clinicians are advised to use their discretion in the choice of treatment.
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14
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Yue W, Wang S, Xu H. Thermal ablation for papillary thyroid microcarcinoma: Some clarity amid controversies. J Interv Med 2022; 5:171-172. [DOI: 10.1016/j.jimed.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/03/2022] [Accepted: 07/23/2022] [Indexed: 12/07/2022] Open
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15
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Efficacy and Safety of Different Thermal Ablation Modalities for Papillary Thyroid Microcarcinoma: A Network Meta-Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2022. [DOI: 10.1155/2022/9448349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Small thyroid-like carcinoma (PTMC) is one of the most common subtypes of thyroid cancer. The main treatment options include surgery and radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA). Thermal ablation has the advantage of being less invasive and has fewer complications than traditional surgical treatment. Objective. The objective is to explore the efficacy and safety of PTMC by different thermal ablation modalities through a network meta-analysis. Methods. From the database establishment to October 2021, a computerized search of the Chinese Knowledge Infrastructure (CKNI), VIP Chinese Science and Technology Journal Full-Text Database (VP-CSJFD), WanFang Data journal article resource (WangFang), PubMed, the Cochrane Library, and Embase were performed to include the different methods of thermal ablation for small thyroid carcinoma. A retrospective study of different methods of thermal ablation of small thyroid carcinoma was included. Results. A total of 12 retrospective studies involving 1,926 patients with PTMC were included, all of which were of high quality. This study mainly involved RFA, MWA, LA, and ethanol combined with radiofrequency ablation (EA + RFA). Network meta-analysis showed no significant difference between interventions (
> 0.05) in terms of recurrence rate. Conclusions. Surgical resection may be the measure with the lowest recurrence rate after treatment of PTMC, LA may be the measure with the lowest incidence of complications after treatment, and RFA may be the measure with the least length of hospital stay, operation time, and postoperative lymph node metastasis rate. However, due to the limitations of network meta-analysis, this result still needs to be treated with caution, and more high-quality, large-sample clinical studies are recommended for further verification.
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Ou D, Chen C, Jiang T, Xu D. Research Review of Thermal Ablation in the Treatment of Papillary Thyroid Carcinoma. Front Oncol 2022; 12:859396. [PMID: 35847945 PMCID: PMC9283792 DOI: 10.3389/fonc.2022.859396] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022] Open
Abstract
Background Minimally invasive treatment of thyroid tumors has become increasingly common, but has mainly focused on benign thyroid tumors, whereas thermal ablation of thyroid cancer remains controversial. Clinical studies analyzing the efficacy of thermal ablation of papillary thyroid carcinoma (PTC) have been conducted in several countries to verify its safety. Here, we screened and reviewed recent studies on the efficacy and safety of thermal ablation of PTC as well as psychological assessment, patient prognosis, recurrence, and factors affecting ablation. Summary The most significant controversy surrounding ablative treatment of PTC centers on its effectiveness and safety, and >40 studies have been conducted to address this issue. The studies include papillary thyroid microcarcinoma (PTMC) and non-PTMC, single PTC and multiple PTC, and controlled studies of ablative therapy and surgical treatment. In general, ablation techniques can be carefully performed and promoted under certain conditions and with active follow-up of postoperative patients. Ablation is a promising alternative treatment especially in patients who are inoperable. Conclusions Clinical studies on PTC ablation have provided new perspectives on local treatment. However, because PTC grows very slowly, it is an indolent tumor; therefore, studies with larger sample sizes and extended post-procedure follow-ups are necessary to confirm the investigators’ hypotheses.
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Affiliation(s)
- Di Ou
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Chen Chen
- Graduate School, Wannan Medical College, Wuhu, China
| | - Tian Jiang
- The Postgraduate Training Base, Wen Zhou Medical University, Hangzhou, China
| | - Dong Xu
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
- *Correspondence: Dong Xu,
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Microwave ablation vs. surgery for papillary thyroid carcinoma with minimal sonographic extrathyroid extension: a multicentre prospective study. Eur Radiol 2022; 33:233-243. [PMID: 35771248 DOI: 10.1007/s00330-022-08962-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/24/2022] [Accepted: 06/11/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Minimal extrathyroid extension (mETE) was removed from the TNM staging system. This study was designed prospectively to compare the safety and efficacy of microwave ablation (MWA) versus surgery for treating T1N0M0 papillary thyroid carcinomas (PTC) with sonographically detected mETE. METHODS From December 2019 to April 2021, 198 patients with T1N0M0 mETE-PTCs evaluated by preoperative ultrasound from 10 hospitals were included. Ninety-two patients elected MWA, and 106 patients elected surgery for treatment. MWA was performed using extensive ablation with hydrodissection. Surgery consisted of lobectomy with ipsilateral central lymph node dissection (CLD), lobe and isthmus excision with ipsilateral CLD and total thyroidectomy with ipsilateral CLD. The rates of technical success, cost, oncologic outcomes, complications and quality of life of the two groups were assessed. RESULTS The follow-up times for the MWA and surgery groups were 12.7 ± 4.1 and 12.6 ± 5.0 months, respectively. The technical success rate was 100% for both groups. Oncological outcomes of the two groups were similar during the follow-up (all p > 0.05). The MWA group had a shorter operation time, less blood loss and lower costs (all p < 0.001). Three complications (3.3%) were reported in the MWA group and 4 (3.8%) in the surgery group (p = 0.846). The surgery group had higher scores for scar problems and anxiety (p < 0.001 and p = 0.003, respectively). CONCLUSIONS Microwave ablation was comparable in the short term to surgery in terms of treatment safety and efficacy in selected patients with T1N0M0 mETE-PTC detected by ultrasound. KEY POINTS • Microwave ablation is comparable to surgery in the safety and short-term efficacy for PTCs with sonographically detected mETE. • Thermal ablation is technically feasible for mETE-PTC treatment. • Patients with mETE-PTC have similar quality of life in the two groups, except for worse scar problems and anxiety in the surgery group.
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18
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Thermal Ablation for the Management of Papillary Thyroid Microcarcinoma in the Era of Active Surveillance and Hemithyroidectomy. Curr Oncol Rep 2022; 24:1045-1052. [PMID: 35384589 DOI: 10.1007/s11912-022-01268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE OF REVIEW Thermal ablation presents a therapeutic option other than active surveillance and immediate surgery for patients with low-risk papillary thyroid microcarcinomas (PTMC). Here, we have reviewed the current oncologic outcome of thermal ablation in PTMC cases and compared it with active surveillance and surgery. RECENT FINDINGS Thermal ablation in PTMC cases revealed no tumor progression for pooled 5-year follow-up data. This oncologic outcome of thermal ablation was comparable to that of immediate surgery with less morbidity. Additionally, no patient who underwent thermal ablation received delayed surgery during the follow-up period due to anxiety. However, active surveillance has indicated that a substantial proportion (range, 8-32%) of patients underwent surgery mainly due to anxiety. In a subset of PTMC patients who are high-risk surgical candidates or who refuse surgery, especially those who have failed or are reluctant to pursue active surveillance, thermal ablation can be a good option.
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19
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Chen S, Mao Y, Chen G. Economic effect between surgery and thermal ablation for patients with papillary thyroid microcarcinoma: a systemic review and meta-analysis. Endocrine 2022; 76:9-17. [PMID: 35122627 PMCID: PMC8817154 DOI: 10.1007/s12020-022-02991-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/19/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND At present, there are still many controversies regarding the treatment of papillary thyroid microcarcinoma (PTMC). It is worth noting that thermal ablation has become a viable alternative for patients at high risk of surgery or those who wish to receive more active treatment than active surveillance. OBJECTIVE To investigate the economic benefits, efficacy, and safety of thermal ablation for patients with PTMC. METHODS We searched PubMed, Cochrane Library, Web of Science, and Embase for articles published from the database establishment to August 2021. All of the studies included were retrospective cohort analyses. In addition, meta-analysis was performed using the Stata15.1 versions and Review Manager5.3. Data were extracted according to the PRISMA guidelines by two professional doctors. RESULTS A total of 7 articles (1582 patients) were included in our systematic review and meta-analysis. We discovered that thermal ablation could shorten the hospitalization time (SMD, -3.82[95%CI, -5.25 to -2.40]), operation time (SMD, -5.67[95%CI, -6.65 to -4.68]), cost (SMD, -3.40 [95%CI, -5.06 to -1.75]) and reduce postoperative complications (OR, 0.07 [95%CI, 0.01 to 0.44]) than surgical treatment. In addition, our study also found that compared with surgery, there was no significant difference in the recurrence rate (OR, 1.53 [95% CI, 0.63 to 3.73]) and metastasis rate (OR, 0.47 [95% CI, 0.12 to 1.86]). CONCLUSION On the premise of being safe and effective, thermal ablation has better economic benefits than surgical treatment for patients with PTMC.
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Affiliation(s)
- Shuqian Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Yaqian Mao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Gang Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China.
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20
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Wu J, Wei Y, Zhao ZL, Peng LL, Li Y, Lu NC, Yu MA. A preliminary study of microwave ablation for solitary T1N0M0 papillary thyroid carcinoma with capsular invasion. Int J Hyperthermia 2022; 39:372-378. [PMID: 35184656 DOI: 10.1080/02656736.2022.2040607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Affiliation(s)
- Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Nai-Cong Lu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
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21
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Ding M, Wu GS, Gu JH, Shen DJ, Zhou R, Liu Y, Xie RL, Wang SR, Wang HC, Fei J. Pathology confirmation of the efficacy and safety of microwave ablation in papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:929651. [PMID: 35983517 PMCID: PMC9379369 DOI: 10.3389/fendo.2022.929651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/01/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The incidence of papillary thyroid carcinoma (PTC) has rapidly increased in recent years. Microwave ablation (MWA) was proposed as an alternative treatment for PTC. This study aimed to investigate the efficacy and safety of MWA by exploring the postoperative pathology results of post-ablation lesions in patients with PTC. METHODS This study retrospectively analyzed data from 12 patients who underwent thyroid surgery after MWA treatment for primary PTC between January 2015 and November 2021 in six hospitals. RESULTS The average age of the 12 patients (8 female) was 45.3 ± 9.7 years. There was one patient with PTC (size > 1 cm) and 11 patients with micro-PTC (size ≤ 1 cm), of which eight patients had unifocal micro-PTC and three patients had multifocal micro-PTC. A total of 17 tumor foci with mean size of 6.2 ± 2.6 mm were treated by MWA. The median interval time between MWA and surgery was 6.6 months (range: 0.4-21.9 months). Intraoperatively, adherence to the anterior cervical muscle group was observed in three cases (3/12). Upon postoperative pathologic examination, all the post-ablation lesions of the eight unifocal micro-PTC and two multifocal micro-PTC showed no residual carcinomas. Outside the ablation zone, PTCs were detected in three cases, including two of the eight patients with unifocal micro-PTC and one of the three patients with multifocal micro-PTC. Cervical lymph node metastases were detected in seven patients (7/12). CONCLUSION MWA was feasible for the treatment of primary unifocal low-risk micro-PTC (T1aN0M0) with good efficacy and safety. However, the use of MWA for treating PTC (size > 1 cm) and multifocal micro-PTC remains controversial.
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Affiliation(s)
- Min Ding
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gao-Song Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jian-Hua Gu
- Department of General Surgery, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
- Department of General Surgery, Shanghai Punan Hospital, Shanghai, China
| | - Dong-Jie Shen
- Department of General Surgery, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Zhou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying Liu
- Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China
| | - Rong-Li Xie
- Department of General Surgery, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China
- Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
- *Correspondence: Jian Fei, ; Shu-Rong Wang, ; Hong-Cheng Wang,
| | - Hong-Cheng Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- *Correspondence: Jian Fei, ; Shu-Rong Wang, ; Hong-Cheng Wang,
| | - Jian Fei
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Shanghai Jiao Tong University, Shanghai, China
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Jian Fei, ; Shu-Rong Wang, ; Hong-Cheng Wang,
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22
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Tang W, Tang X, Jiang D, Zhang X, Wang R, Niu X, Zang Y, Zhang M, Wang X, Zhao C. Safety and efficacy of thermal ablation for cervical metastatic lymph nodes in papillary thyroid carcinoma: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:967044. [PMID: 36072932 PMCID: PMC9441577 DOI: 10.3389/fendo.2022.967044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/01/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) for the treatment of cervical metastatic lymph nodes (CMLNs) of papillary thyroid carcinoma (PTC). METHODS The Pubmed, EMBASE, Web of Science, and Cochrane Library databases were searched for studies on the safety and efficacy of thermal ablations (RFA, MWA, and LA) for the treatment of CMLNs of PTC until March 30, 2022. A review of 334 potential papers identified 17 eligible papers including 312 patients. Fixed-effects model or random-effects model was used to evaluate the pooled proportions of volume reduction rate (VRR), complete disappearance, and recurrence, and pooled estimates of changes in the largest diameter, volume, and serum Tg after ablation. The pooled proportions of overall and major complications were calculated. Subgroup analysis based on treatment modalities. The heterogeneity among studies was analyzed by using Q statistics and inconsistency index I2 . MINORS scale was used to evaluate the quality of the studies. RESULTS 17 eligible studies were finally identified, including 312 patients and 559 CMLNs. The pooled proportions of VRR, complete disappearance and recurrence of CMLNs were 91.28% [95% confidence interval (CI): 86.60-95.97%], 67.9% [95% CI: 53.1-81.1%] and 7.8% [95%CI: 3.0-14.1%], respectively. The pooled estimates of changes in the largest diameter, volume and serum Tg were 8.12 mm [95%CI: 6.78-9.46 mm], 338.75 mm3 [95%CI: 206.85 -470.65 mm3] and 5.96 ng/ml [95%CI: 3.68-8.24 ng/ml], respectively. The pooled proportions of overall and major complications were 2.9% [95%CI: 0.3-7.1%] and 0.3% [95%CI: 0-1.9%], respectively. Significant between-study heterogeneity was observed for complete disappearance (P<0.01, I2 =88.6%), VRR (P<0.001, I2 =99.9%), recurrence (P=0.02, I2 =47.76%), overall complications (P<0.02, I2 =44.8%), and changes in the largest diameter (P < 0.001, I2 =82.6%), volume (P<0.001, I2 =97.0%), and serum Tg (P < 0.001, I2 =93.7%). Subgroup analysis showed heterogeneity of the VRR among the treatment modality (I2 range: 84.4-100%). The VRR of MWA was the highest (97.97%), followed by RFA (95.57%) and LA (84.46%) (P < 0.001). CONCLUSION All thermal ablations were safe and effective for the treatment of CMLNs of PTC. However, each treatment had significant heterogeneity in VRR. Compared with RFA and MWA, LA was less effective in reducing the volume of CMLNs of PTC.
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Affiliation(s)
- Wanqing Tang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiuyun Tang
- Department of Ultrasound, Zibo Central Hospital, Zibo, China
| | - Danni Jiang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojuan Zhang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Rongling Wang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoyan Niu
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yichen Zang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingzhu Zhang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinya Wang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Zhao
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Cheng Zhao,
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Du JR, Li WH, Quan CH, Wang H, Teng DK. Long-term outcome of microwave ablation for benign thyroid nodules: Over 48-month follow-up study. Front Endocrinol (Lausanne) 2022; 13:941137. [PMID: 35979439 PMCID: PMC9377466 DOI: 10.3389/fendo.2022.941137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The short-term effects of microwave ablation (MWA) for the treatment of benign thyroid nodules (BTNs) were satisfactory in previous studies. However, as a slowly progressing disease, the long-term efficacy of MWA for BTNs at present is not clear. Our study aim was to assess the long-term results of MWA for BTNs after a 48-month follow-up. METHODS From June 2015 to September 2017, 148 patients had 148 BTNs. All patients were from the China-Japan Union Hospital of Jilin University. Careful ultrasound examinations were performed 1 day, 1 month, 3 months, 6 months, 12 months, and every 6 months after MWA. The volume, volume reduction rate (VRR), recurrence rate of the ablated area and thyroid function were recorded. RESULTS The mean volumes of the 148 nodules were 15.6 ± 9.4 cm3 (range: 1.3-48.9 cm3) and 0.6 ± 0.6 cm3 (range: 0-3.5 cm3) before and 48 months after MWA, respectively, with a nodule VRR of 96.9 ± 2.5% (range: 90.4-100%). Two patients (1.35%) had recurrence after MWA. Compared with thyroid function before MWA, no significant variation was observed after MWA. Five patients experienced complications (3.38%): two patients (1.35%) had bleeding, two patients (1.35%) had ear pain and toothache during MWA, and one patient (0.68%) had hoarseness after MWA. No cases of oesophageal injury, tracheal injury, infection, skin burns, etc., were reported during or after MWA. CONCLUSIONS Based on a long-term follow-up, MWA is an effective method for treating BTNs and is expected to be a potential first-line treatment.
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Affiliation(s)
- Jia-Rui Du
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wen-Hui Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Cheng-Hai Quan
- Department Of Oncology, Hospital of Jilin Bureau of Geologic Exploration and Mineral Development, Changchun, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Hui Wang, ; Deng-Ke Teng,
| | - Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Hui Wang, ; Deng-Ke Teng,
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Zhang L, Zhang GP, Zhan WW, Zhou W. The feasibility and efficacy of ultrasound-guided percutaneous laser ablation for multifocal papillary thyroid microcarcinoma. Front Endocrinol (Lausanne) 2022; 13:921812. [PMID: 36060950 PMCID: PMC9428260 DOI: 10.3389/fendo.2022.921812] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility and efficacy of percutaneous laser ablation (PLA) for patients with multifocal papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS A cohort of patients who underwent ultrasound (US)-guided PLA for primary PTMC were enrolled in this study. The patients were divided into a multifocal PTMC (multi-PTMC) group and a unifocal PTMC (uni-PTMC) group. Before PLA, conventional US and contrast-enhanced ultrasound (CEUS) were performed to evaluate the PTMC and cervical lymph nodes. The operation time, energy, power, amount of isolation liquid, and complications during PLA were recorded. Patients were followed up at 2 days, 1 month, 3 months, and 6 months, and every 6 months after that. Volume reduction rate (VRR), local tumor recurrence, and lymph node metastasis after PLA were observed. RESULTS The study included 12 patients with 26 PTMCs and 60 patients with 60 PTMCs. The operation time, total energy, and amount of isolation liquid in the multi-PTMC group were more than those in the uni-PTMC group (p = 0.000, 0.007, and 0.020, respectively). The mean follow-up durations in multi-PTMC and uni-PTMC groups were 19.75 ± 11.46 months (6-36 months) and 16.33 ± 10.01 months (4-40 months), with a similar VRR of the ablated lesions in the two groups. One and three cases with newly developed PTMCs were observed in the multi-PTMC group and the uni-PTMC group during follow-up, respectively. There was no regrowth of treated lesions, lymph node metastasis, or distant metastasis. At the end of the follow-up, all the ablated lesions in the two groups completely disappeared or only remained scar strips. CONCLUSION PLA is a safe and effective technique for treating multifocal PTMC, which might be an alternative technique for patients who are not eligible or are unwilling to undergo surgery.
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Agyekum EA, Fu JH, Xu FJ, Ren YZ, Akortia D, Chen Q, Qian XQ, Wang Y, Wang X. Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules. Front Oncol 2021; 11:761005. [PMID: 34868975 PMCID: PMC8637803 DOI: 10.3389/fonc.2021.761005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/28/2021] [Indexed: 12/07/2022] Open
Abstract
Thyroid nodules are commonly encountered in health care practice. They are usually benign in nature, with few cases being malignant, and their detection has increased in the adult population with the help of ultrasonography. Thyroidectomy or surgery is the first-line treatment and traditional method for thyroid nodules; however, thyroidectomy leaves permanent scars and requires long-term use of levothyroxine after surgery, which makes patients more reticent to accept this treatment. Thermal ablation is a minimally-invasive technique that have been employed in the treatment of benign and malignant thyroid nodules nodules, and have been shown to be effective and safe. Several studies, including long-term, retrospective, and prospective studies, have investigated the use of ablation to treat benign thyroid nodules and malignant thyroid nodules, including papillary thyroid carcinoma. Here, we review the recent progress in thermal ablation techniques for treating benign and malignant nodules, including their technicalities, clinical applications, pitfalls and limitations, and factors that could affect treatment outcomes. Special in-depth elaboration on the recent progress of the application of thermal ablation therapy in malignant thyroid nodules.
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Affiliation(s)
- Enock Adjei Agyekum
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China.,School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jian-Hua Fu
- Department of Interventional Radiology, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Fei-Ju Xu
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Yong-Zhen Ren
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Debora Akortia
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Qing Chen
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Xiao-Qin Qian
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Yuguo Wang
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Xian Wang
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
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Lan Y, Li N, Song Q, Zhang MB, Luo YK, Zhang Y. Correlation and agreement between superb micro-vascular imaging and contrast-enhanced ultrasound for assessing radiofrequency ablation treatment of thyroid nodules: a preliminary study. BMC Med Imaging 2021; 21:175. [PMID: 34809604 PMCID: PMC8609811 DOI: 10.1186/s12880-021-00697-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/22/2021] [Indexed: 12/29/2022] Open
Abstract
Background To evaluate the correlation and agreement between superb micro-vascular imaging (SMI) mode and the contrast-enhanced ultrasound (CEUS) mode for the ablative completeness and the volumes of ablation lesions to determine the clinical application value of SMI in follow-up after radiofrequency ablation.
Methods From April 2020 to June 2020, two radiologists used SMI and CEUS mode to measure the volume of the ablation lesion. We use intra-class correlation coefficient (ICC), scatter plots and Bland–Altman plots to evaluate the correlation and agreement of the two techniques. In addition, intra- and inter-observer reliability in volume measurement of ablation lesions with SMI mode was assessed. Results SMI mode and CEUS mode have good agreement in the evaluation of ablative completeness. The ICC was 0.876 and 0.928 of reader A and reader B between SMI mode and CEUS mode in terms of ablation lesions volume measurement. There was a strong correlation between the two modes in both reader A and reader B (rA = 0.808; rB = 0.882). The ICC was 0.836 for the inter-observer reliability of SMI technique. The scatter plot showed a good linear relation (r = 0.715). In the Bland–Altman plot, 4.35% (1/23) of the points was outside the 95% limits of agreement. The ICC was 0.965 for the intra-observer reliability of SMI technique, the scatter plot also showed a strong linear correlation (r = 0.965). In the Bland–Altman plot, 8.70% (2/23) of the points was outside the 95% limits of agreement. Conclusions SMI and CEUS have good agreement and correlation in the ablation volume measurement. SMI technology is expected to be applied as an alternative to CEUS in the clinical follow-up of ablation lesions.
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Affiliation(s)
- Yu Lan
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, 94 Weijin Road, Nankai District, Tianjin, China.,Department of Ultrasound, The People's Hospital of Liaoning Province, Shenyang, China
| | - Nan Li
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China
| | - Qing Song
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China
| | - Ming-Bo Zhang
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China.
| | - Yu-Kun Luo
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China. .,School of Medicine, Nankai University, 94 Weijin Road, Nankai District, Tianjin, China.
| | - Yan Zhang
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China.
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Zu Y, Liu Y, Zhao J, Yang P, Li J, Qian L. A cohort study of microwave ablation and surgery for low-risk papillary thyroid microcarcinoma. Int J Hyperthermia 2021; 38:1548-1557. [PMID: 34719323 DOI: 10.1080/02656736.2021.1996643] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The optimal treatment method for papillary thyroid microcarcinoma (PTMC) is lacking consensus. Here we aimed to compare the efficacy and safety of surgery and microwave ablation (MWA) for PTMC. METHODS The clinical data of 644 patients with PTMC treated between July 2013 and June 2020 were retrospectively analyzed. A total of 320 and 324 patients underwent MWA and surgery, respectively. We observed lesion changes in the MWA group and compared the recurrence, metastasis, complications, and other health economic indicators between the 2 groups. RESULTS The mean follow-up time was 890.7 ± 532.9 (187.9-2679.0) days in the MWA group and 910.9 ± 568.4 (193.8-2821.5) days in the surgery group. In the MWA group, lesion volume increased significantly after ablation and then gradually decreased. The final lesion volume reduction rate was 90.73% ± 7.94%, and 193 lesions (60.3%) disappeared completely. There were no significant intergroup differences in recurrence or metastasis. The incidence of main complications (temporary hypothyroidism, hypoparathyroidism, and temporary hoarseness) was significantly lower in the MWA group than in the surgery group (p < 0.001). The treatment time, intraoperative blood loss, and hospital stay were significantly lower in the MWA group than in the surgery group (p < 0.001). CONCLUSIONS MWA is effective for treating PTMC, with a low incidence of complications and less trauma. The rates of post-treatment recurrence and metastasis are similar to those of surgery, indicating that MWA is a suitable alternative to surgery.
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Affiliation(s)
- Yuan Zu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yujiang Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Junfeng Zhao
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peipei Yang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianming Li
- Department of Interventional Ultrasound, The General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Yan L, Zhang M, Song Q, Luo Y. Ultrasound-Guided Radiofrequency Ablation Versus Thyroid Lobectomy for Low-Risk Papillary Thyroid Microcarcinoma: A Propensity-Matched Cohort Study of 884 Patients. Thyroid 2021; 31:1662-1672. [PMID: 34269611 DOI: 10.1089/thy.2021.0100] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Thermal ablation (TA) has been applied in patients with low-risk papillary thyroid microcarcinoma (PTMC) who refuse surgery or active surveillance (AS). Recently, TA has been proposed as a potential therapeutic option for patients who are suitable for surgery or AS. However, the clinical outcomes of TA versus surgery remains controversial because of a lack of sufficient data. This study aimed to compare the clinical outcomes between radiofrequency ablation (RFA) versus thyroid lobectomy (TL) for low-risk PTMC in a large cohort. Methods: This retrospective study evaluated 884 patients with unifocal low-risk PTMC treated with TL or RFA from June 2014 to March 2018. Among them, 460 patients underwent TL (TL group) and 424 patients, who refused surgery or AS, underwent RFA (RFA group). Patients were regularly followed up after treatment. Local tumor progression, recurrence-free survival (RFS), complications, and treatment variables, including procedure time, estimated blood loss, hospitalization, and cost, were compared after propensity score matching (PSM). Results: After PSM, a total of 332 patients underwent TL (mean ages 43.8 ± 9.5 years) and 332 underwent RFA (mean ages 44.1 ± 9.5 years). During the follow-up (median [interquartile ranges], 48.3 [23.2] months), no significant differences were observed in local tumor progression (1.8% vs. 3.3%, p = 0.209), lymph node metastasis (0.6% vs. 0.6%, p = 1.000), recurrent PTMC (1.2% vs. 2.4%, p = 0.244), persistent lesion (0% vs. 0.3%, p = 0.317), and 4-year RFS rates (98.2% vs. 97.0%, p = 0.223) between the TL and RFA groups. Distant metastasis was not detected. None of the patients who were treated by RFA underwent delayed surgery. Patients undergoing RFA had shorter procedure time (3.4 [2.5] vs. 86.0 [37.0] minutes, p < 0.001), lower estimated blood loss (0 vs. 20 [10.0] mL, p < 0.001), shorter hospitalization (0 vs. 7.0 [3.0] days, p < 0.001), lower cost ($2035.7 [254.0] vs. $2269.1 [943.4], p < 0.001) and lower complication rate (0% vs. 4.5%, p < 0.001) than those treated by TL. The association between treatment modality and recurrence remained nonsignificant after Cox analysis (p = 0.247). Conclusions: This large matched study revealed comparable four-year clinical outcomes between RFA and TL for low-risk PTMC. As a minimally invasive modality, RFA may be a promising alternative to the existing treatment options for low-risk PTMC.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Kim HJ, Chung SM, Kim H, Jang JY, Yang JH, Moon JS, Son G, Oh JR, Bae JY, Yoon H. Long-Term Efficacy of Ultrasound-Guided Laser Ablation for Papillary Thyroid Microcarcinoma: Results of a 10-Year Retrospective Study. Thyroid 2021; 31:1723-1729. [PMID: 34445885 DOI: 10.1089/thy.2021.0151] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: The aim of this study was to evaluate the 10-year efficacy and safety of laser ablation (LA) for the treatment of solitary papillary thyroid microcarcinoma (PTMC). Methods: LA was performed on patients with low-risk PTMC (diagnosed using fine-needle aspiration cytology) who refused or were ineligible for surgery between 2008 and 2011. Ultrasonography was performed to evaluate the ablated volumes and potential recurrences on the day after the procedure, as well as at 1 week, 1, 3, and 6 months, and every 6 months thereafter for 10 years. Computed tomography (CT) with contrast enhancement and positron emission tomography/CT was performed to evaluate local recurrences and distant metastases. Results: A total of 90 PTMCs in 90 patients were treated in a single session of LA, and the procedure was well tolerated by the patients. The mean follow-up duration was 112 months. By 3-10 months after the LA, all the ablation areas had disappeared or presented as scars. The disappearance rate was 100% after 12 months. Thyroid hormone and autoantibody levels did not change significantly after the treatment. Three patients experienced transient voice changes, but each recovered within 1 month. Additional PTMC foci were subsequently detected in previously untreated areas in five patients (5.5%) 17-56 months after the treatment. A metastatic lymph node was detected in one patient (1.1%) within two months of the treatment; however, it was determined to be an undetected cancer metastasis, rather than a recurrence. All the patients with recurrence underwent surgery, and there were no instances of recurrence after >5 years. Conclusions: LA is effective and safe for the treatment of low-risk PTMCs. A thorough examination of multifocality and lymph node metastasis status is required before considering LA treatment.
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Affiliation(s)
- Ho Jin Kim
- Department of Internal Medicine, Raphael Hospital, Daegu, Republic of Korea
| | - Seung Min Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Hanbyul Kim
- Department of Internal Medicine, Raphael Hospital, Daegu, Republic of Korea
| | - Ju Young Jang
- Department of Internal Medicine, Raphael Hospital, Daegu, Republic of Korea
| | - Jae Hong Yang
- Department of Internal Medicine, Raphael Hospital, Daegu, Republic of Korea
| | - Jun Sung Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Gitak Son
- Department of Surgery, Raphael Hospital, Daegu, Republic of Korea
| | - Jong-Ryool Oh
- Department of Nuclear Medicine, and Raphael Hospital, Daegu, Republic of Korea
| | - Jong Yup Bae
- Department of Pathology, Raphael Hospital, Daegu, Republic of Korea
| | - Hyundae Yoon
- Department of Internal Medicine, Raphael Hospital, Daegu, Republic of Korea
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30
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Wang X, Niu X, Mu S, Zhang M, Jiang W, Zhai L, Jiang D, Tang W, Zhao C. Analysis and evaluation of the efficacy of ultrasound-guided microwave ablation for papillary thyroid microcarcinoma. Int J Hyperthermia 2021; 38:1476-1485. [PMID: 34645358 DOI: 10.1080/02656736.2021.1988152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The choice of the most appropriate therapeutic approach for a diagnosed papillary thyroid microcarcinoma (PTMC) remains controversial. The present study aimed to evaluate the efficacy of microwave ablation (MWA) for unifocal PTMC with a diameter of ≤0.6 cm. METHODS A total of 63 consecutive patients with PTMC treated with MWA were studied retrospectively. MWA was performed using the hydrodissection technique and multidimensional fixed-needle principle. We analyzed the absorption of the MWA area and evaluated the prognosis over a follow-up period of 24 months. In addition, 83 patients with PTMC who underwent surgery were selected. The operating room characteristics and procedural complications of the two groups were compared. RESULTS In the MWA group, the volume of nodules (p < 0.05) decreased from 0.04 ± 0.03 cm3 to 0.0001 ± 0.0004 cm3 at the 24-month follow-up after MWA, and the volume reduction rate (p < 0.05) was 99.43 ± 1.58%. The incidence of temporary reactive hyperplastic lymphadenectasis was higher and that of other complications was lower in the MWA group than in the surgery group. One percent of the patients in the surgery group had recurrence or metastasis, but none were detected in the MWA group. The loss of thyroid tissue volume (p < 0.001), operating room time (p < 0.001), and the mean length of hospital stay (p < 0.001) were significantly lower in the MWA group than in the surgery group. CONCLUSION Ultrasound-guided MWA is an effective treatment strategy for unifocal PTMC with a diameter of ≤0.6 cm.
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Affiliation(s)
- Xinya Wang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaoyan Niu
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuang Mu
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mingzhu Zhang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wenbin Jiang
- Health Management Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lixue Zhai
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Danni Jiang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wanqing Tang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Cheng Zhao
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Sanabria A, Pinillos P, Lira RB, Shah JP, Tufano RP, Zafereo ME, Nixon IJ, Randolph GW, Simo R, Vander Poorten V, Rinaldo A, Medina JE, Khafif A, Angelos P, Mäkitie AA, Shaha AR, Rodrigo JP, Hartl DM, Kowalski LP, Ferlito A. Current therapeutic options for low-risk papillary thyroid carcinoma: A scoping evidence review. Head Neck 2021; 44:226-237. [PMID: 34590380 DOI: 10.1002/hed.26883] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 01/04/2023] Open
Abstract
Most cases of thyroid carcinoma are classified as low risk. These lesions have been treated with open surgery, remote access thyroidectomy, active surveillance, and percutaneous ablation. However, there is lack of consensus and clear indications for a specific treatment selection. The objective of this study is to review the literature regarding the indications for management selection for low-risk carcinomas. Systematic review exploring inclusion and exclusion criteria used to select patients with low-risk carcinomas for treatment approaches. The search found 69 studies. The inclusion criteria most reported were nodule diameter and histopathological confirmation of the tumor type. The most common exclusions were lymph node metastasis and extra-thyroidal extension. There was significant heterogeneity among inclusion and exclusion criteria according to the analyzed therapeutic approach. Alternative therapeutic approaches in low-risk carcinomas can be cautiously considered. Open thyroidectomy remains the standard treatment against which all other approaches must be compared.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/IPS Universitaria/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello/Clínica Las Vegas-grupo Quirónsalud, Medellín, Colombia
| | - Pilar Pinillos
- Department of Surgery, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia-Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Renan B Lira
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
| | - Ralph P Tufano
- Director of the FPG Thyroid and Parathyroid Center, Division of Head and Neck Endocrine Surgery, The Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Gregory W Randolph
- Thyroid/Parathyroid Endocrine Surgical Division, Thyroid Surgical Oncology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ricard Simo
- Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, King's College London, London, UK
| | - Vincent Vander Poorten
- Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | | | - Jesus E Medina
- Department of Otolaryngology and Head and Neck Surgery, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Avi Khafif
- Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 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
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
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Kim HJ, Cho SJ, Baek JH. Comparison of Thermal Ablation and Surgery for Low-Risk Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis. Korean J Radiol 2021; 22:1730-1741. [PMID: 34585542 PMCID: PMC8484147 DOI: 10.3348/kjr.2020.1308] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 01/26/2023] Open
Abstract
Objective Although thermal ablation is effective in treating low-risk papillary thyroid microcarcinomas (PTMCs), comparison of treatment outcomes between thermal ablation and surgery has not yet been systematically evaluated. This study aimed to compare the efficacy and safety of thermal ablation and surgery for the treatment of low-risk PTMCs. Materials and Methods Ovid-MEDLINE and EMBASE databases were searched for studies reporting comparisons of treatment results between thermal ablation and surgery for patients with low-risk PTMC published up to April 6, 2020. The analysis evaluated the efficacy (local tumor recurrence, occurrence of new tumor, metastasis, and rescue surgery) and safety (complication rate) of thermal ablation and surgery. Results This systematic review included four studies with a total of 339 PTMCs in 339 patients who underwent thermal ablation and 320 PTMCs in 314 patients who underwent surgery. There was no local tumor recurrence or distant metastasis in either group. There was no significant difference in the pooled proportion of lymph node metastasis (2.6% with thermal ablation vs. 3.3% with surgery, p = 0.65), occurrence of new tumors (1.4% with thermal ablation vs. 1.3% with surgery, p = 0.85), or rescue surgery (2.6% with thermal ablation vs. 1.6% with surgery, p = 0.62). However, the pooled complication rate was significantly higher in the surgery group than in the ablation group (3.3% with thermal ablation vs. 7.8% with surgery, p = 0.03). Conclusion Both thermal ablation and surgery are effective and safe options for the management of low-risk PTMCs, with thermal ablation achieving a lower complication rate. Therefore, thermal ablation may be considered as an alternative treatment option for low-risk PTMC in patients who refuse surgery and active surveillance or are ineligible for surgery.
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Affiliation(s)
- Hyun Jin Kim
- Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Honglei G, Shahbaz M, Farhaj Z, Ijaz M, Kai SY, Davrieux CF, Cheng SZ. Ultrasound guided microwave ablation of thyroid nodular goiter and cystadenoma: A single center, large cohort study. Medicine (Baltimore) 2021; 100:e26943. [PMID: 34449459 PMCID: PMC8389940 DOI: 10.1097/md.0000000000026943] [Citation(s) in RCA: 5] [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] [Received: 07/19/2019] [Accepted: 07/15/2021] [Indexed: 01/04/2023] Open
Abstract
Thyroid nodules are one of the most common entities that affect the thyroid gland. Traditionally, their treatment was surgery. Currently, ablation combination with percutaneous procedure became a good option.To analyze safety, efficacy, and describe our experience in microwave-ablation using ultrasound-guidance for benign thyroid nodules.A total of 304 patients with 1180 thyroid nodules (thyroid cystadenoma and nodular goiter) were studied retrospectively. Two hundred sixty-seven patients who underwent microwave-ablation successfully in our hospital were enrolled in this study. The baseline, follow-up nodule volume, thyroid function tests, thyroid antibodies, and posttherapy complications were analyzed. The informed written consent was obtained from patients or guardians. The study was approved by the ethics committee of our hospital.The average age was 50.1 ± 11.7 (21-83 years), 214 were women (80.1%) and 53 (19.9%) were men. The average number of nodules per patient was 4.02 ± 1.8 (1-8), 9.86%, 6.13%, and 84% located in the right thyroid lobe, left lobe, and bilateral, respectively. The average size of the nodules was 5.28 cm2 ± 3.63 (0.09-23.45 cm2). The average ablation time was 11 minutes ± 5.36 (3-20 minutes). The hospitalization period was 24 hours ± 10.16 (7-48 hours). Eighteen complications were reported. Postablation volume reduction rate was 54.74% and 93.3% at 3 and 12 months follow-up respectively (P < .05). The thyroid function tests, pre and postablation showed no significant changes (P > .05).Ultrasound-guided microwave-ablation of thyroid nodules is safe and effective. More clinical trials are needed to define the true use of microwave-ablation.
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Affiliation(s)
- Gao Honglei
- Department of General Surgery, Weifang People's Hospital, Shandong, China
| | - Muhammad Shahbaz
- Department of Radiology, Qilu Hospital, Shandong University, China
- Research Center for Sectional and Imaging Anatomy, Digital Human Institute, School of Basic Medical Sciences, Shandong University, Jinan, Shandong, China
- Department of General Surgery, Qilu Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Zeeshan Farhaj
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Muhammad Ijaz
- Department of Pharmacology, Shandong University, School of Pharmaceutical Sciences, China
| | - Sun Yu Kai
- Department of General Surgery, Weifang People's Hospital, Shandong, China
| | - Carlos Federico Davrieux
- DAICIM Foundation, Teaching, Research, Assistance in Minimal Invasive Surgery, Buenos Aires, Argentina
- Sanatorio de la Mujer, Rosario, Argentina
| | - Sun Zuo Cheng
- Department of General Surgery, Weifang People's Hospital, Shandong, China
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Wu J, Zhao ZL, Cao XJ, Wei Y, Peng LL, Li Y, Yu MA. A feasibility study of microwave ablation for papillary thyroid cancer close to the thyroid capsule. Int J Hyperthermia 2021; 38:1217-1224. [PMID: 34384314 DOI: 10.1080/02656736.2021.1962549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To evaluate the feasibility, efficiency, and safety of microwave ablation (MWA) for papillary thyroid carcinoma (PTC) close to the thyroid capsule. METHODS The data of 106 cases who underwent thermal ablation from June 2014 to September 2020 were retrospectively analyzed. The mean follow-up time was 25 ± 11 months (range, 9-48 months). The strategy of fluid isolation was successfully applied in all cases, and all PTC nodules underwent extended ablation. The technical feasibility, technical success rate, and safety were analyzed. Changes in tumor size at different time points after MWA were evaluated. RESULTS According to the contrast-enhanced ultrasound results after ablation, MWA has been successfully applied in all enrolled cases. The capsular ablation has also been achieved for all cases. Nodules in 71 cases (70.0%) completely disappeared in the follow-up period. No local recurrence was detected. The incidence of lymph node metastasis and new tumors was 1.9% (2/106) respectively. Light voice changes were the only complication, with a rate of 5.7% (6/106), which were relieved within 6 months after MWA. The size of the ablation zone increased firstly in 6 months after MWA compared with the pretreatment tumor size (p < 0.05). At 12, 18, 24, 30, 36 and 42 months after MWA, the ablation zone shrank and the sizes were smaller than the tumor size before MWA (p < 0.05 for all). CONCLUSIONS MWA is an effective, safe, and feasible method in treating PTC close to the thyroid capsule.
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Affiliation(s)
- Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xiao-Jing Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
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Yan L, Zhang M, Song Q, Xie F, Luo Y. Clinical outcomes of radiofrequency ablation for multifocal papillary thyroid microcarcinoma versus unifocal papillary thyroid microcarcinoma: a propensity-matched cohort study. Eur Radiol 2021; 32:1216-1226. [PMID: 34357450 DOI: 10.1007/s00330-021-08133-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate and compare the clinical outcomes of radiofrequency ablation (RFA) for multifocal papillary thyroid microcarcinoma (PTMC) versus unifocal PTMC in a large cohort. METHODS Patients with low-risk PTMC (n = 487) who underwent RFA were included in this retrospective study and divided into the unifocal group (U group) (n = 432) and the multifocal group (M group) (n = 55) according to the number of lesions. After 1:1 propensity score matching (PSM), volume, volume reduction ratio (VRR), the development of local tumor progression including lymph node metastasis (LNM), recurrent PTMC and persistent lesions, and recurrence-free survival (RFS) rate were evaluated and compared between the two groups. The different impacts of multifocality on recurrence after RFA for PTMC were investigated by Cox analysis. RESULTS During a mean follow-up time of 49.25 ± 12.98 months, the overall VRR was 99.40 ± 4.43% and the overall incidence of local tumor progression was 3.70% (18/487). No complications occurred after RFA. After PSM, no significant differences were found in volume (0.11 ± 0.69 mm3 vs 0 mm3, p = 0.441), VRR (99.87 ± 0.78% vs 100%, p = 0.441), complete disappearance rate (95.61% vs 89.09%, p = 0.201), incidence of local tumor progression (5.45% vs 5.45%, p = 1.000), LNM (1.82% vs 0%, p = 0.317), recurrent PTMC (1.82% vs 5.45%, p = 0.611), persistent lesions (1.82% vs 0%, p = 0.317), and RFS rate (96.36% vs 94.55%, p = 0.632) between the M group and U group. The association between multifocality and local tumor recurrence also remained nonsignificant (p = 0.619). No distant metastasis or delayed surgery occurred. CONCLUSIONS The impact of multifocality on the prognosis after RFA for low-risk PTMC was little. RFA might be a promising treatment for both unifocal and multifocal PTMC in properly selected patients after sufficient preoperative evaluation. KEY POINTS • No significant differences are found in the local tumor progression between the unifocal PTMC and multifocal PTMC. • Multifocality is not associated with higher recurrence after RFA for low-risk PTMC. • RFA is a promising alternative for both unifocal and multifocal PTMC.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Qing Song
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Fang Xie
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Al-Mohammed HI, Sulieman A, Mayhoub FH, Salah H, Lagarde C, Alkhorayef M, Aldhebaib A, Kappas C, Bradley DA. Occupational exposure and radiobiological risk from thyroid radioiodine therapy in Saudi Arabia. Sci Rep 2021; 11:14557. [PMID: 34267237 PMCID: PMC8282852 DOI: 10.1038/s41598-021-93342-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/17/2021] [Indexed: 01/05/2023] Open
Abstract
Worldwide, thyroid cancer accounts for some 10% of total cancer incidence, most markedly for females. Thyroid cancer radiotherapy, typically using 131I (T1/2 8.02 days; β- max energy 606 keV, branching ratio 89.9%), is widely adopted as an adjunct to surgery or to treat inoperable cancer and hyperthyroidism. With staff potentially receiving significant doses during source preparation and administration, radiation protection and safety assessment are required in ensuring practice complies with international guidelines. The present study, concerning a total of 206 patient radioiodine therapies carried out at King Faisal Specialist Hospital and Research Center over a 6-month period, seeks to evaluate patient and occupational exposures during hospitalization, measuring ambient doses and estimating radiation risk. Using calibrated survey meters, patient exposure dose-rate estimates were obtained at a distance of 30-, 100- and 300 cm from the neck region of each patient. Occupational and ambient doses were measured using calibrated thermoluminescent dosimeters. The mean and range of administered activity (AA, in MBq) for the thyroid cancer and hyperthyroidism treatment groups were 4244 ± 2021 (1669-8066), 1507.9 ± 324.1 (977.9-1836.9), respectively. The mean annual occupational doses were 1.2 mSv, that for ambient doses outside of the isolation room corridors were found to be 0.2 mSv, while ambient doses at the nursing station were below the lower limit of detection. Exposures to staff from patients being treated for thyroid cancer were less compared to hyperthyroidism patients. With a well-defined protocol, also complying with international safety requirements, occupational exposures were found to be relatively high, greater than most reported in previous studies.
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Affiliation(s)
- H I Al-Mohammed
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - A Sulieman
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, P.O. Box 422, Alkharj, 11942, Saudi Arabia.
| | - Fareed H Mayhoub
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hassan Salah
- Nuclear Medicine Department, INAYA Medical Collage, Riyadh, 13541, Saudi Arabia
- College of Medical Radiologic Science, Sudan University of Science and Technology, P.O. Box 1908, Khartoum, 11111, Sudan
| | - Celestino Lagarde
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - M Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
- Department of Physics, Centre for Nuclear and Radiation Physics, University of Surrey, Guildford, GU2 7XH, Surrey, UK
| | - Ali Aldhebaib
- Radiological Sciences Program, College of Applied Medical Sciences (COMAS), King Saud Bin Abdulaziz University for Health Sciences (KSAU-US), King Abdul Aziz Medical City (KAMC), King Abdullah International Medical Research Centre (KAIMRC), National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia
| | - C Kappas
- Department of Medical Physics, Medical School, University of Thessaly, 41110, Larissa, Greece
| | - D A Bradley
- Department of Physics, Centre for Nuclear and Radiation Physics, University of Surrey, Guildford, GU2 7XH, Surrey, UK
- Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, Jalan Universiti, 47500, Bandar Sunway, Selangor, Malaysia
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Ntelis S, Linos D. Efficacy and safety of radiofrequency ablation in the treatment of low-risk papillary thyroid carcinoma: a review. Hormones (Athens) 2021; 20:269-277. [PMID: 33822327 DOI: 10.1007/s42000-021-00283-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/16/2021] [Indexed: 12/23/2022]
Abstract
Ultrasound-guided radiofrequency ablation (RFA) has recently been used for the treatment of thyroid carcinomas. In this study, we aimed to evaluate the efficacy and safety of RFA for treating low-risk papillary thyroid carcinomas (PTCs). We searched the MEDLINE and the SCOPUS databases up to December 29, 2020, for studies assessing the efficacy and safety of RFA in the management of low-risk PTCs. Data on volume reduction ratio (VRR), complete disappearance, carcinoma recurrence, and complication frequency were collected. Thirteen studies with a total of 1389 patients and 1422 tumors were included in the synthesis of this study. Mean VRR varied between 47.8 and 100%, with most studies reporting a ratio of 98.5-100%. The ratio of complete disappearance ranged between 33.7 and 100%, although studies with a prolonged follow-up period reported a frequency of 56-100%. The tumor progression/recurrence frequency was 0-4.5%. Complications occurred in 45 patients (3.2%). Mild-moderate pain and cervical discomfort were the most common complications and no life-threatening complications were reported. Based on these data, we suggest that ultrasound-guided RFA can serve as an efficacious and safe alternative for the treatment of low-risk PTC in patients who are unable or unwilling to receive surgical therapy.
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Affiliation(s)
- Spyridon Ntelis
- Institute of Preventive Medicine, Environmental and Occupational Health Prolepsis, Maroussi, Greece
| | - Dimitrios Linos
- Department of Surgery, Hygeia Hospital, Maroussi, Greece.
- National and Kapodistrian University of Athens, Athens, Greece.
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Cao XJ, Wang SR, Che Y, Liu J, Cong ZB, He JF, Wang HL, Liu G, Guo JQ, Hao Y, Wang ZH, Zhou Y, Jian M, Shi LL, Qi L, Zhu YL, Wang X, Yan GZ, Shataer A, Liu XF, Wei Y, Zhao ZL, Peng LL, Li Y, Yu MA. Efficacy and Safety of Thermal Ablation for Treatment of Solitary T1N0M0 Papillary Thyroid Carcinoma: A Multicenter Retrospective Study. Radiology 2021; 300:209-216. [PMID: 33904775 DOI: 10.1148/radiol.2021202735] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Microwave ablation (MWA) and radiofrequency ablation (RFA) have recently attracted interest as minimally invasive treatment modalities for papillary thyroid carcinoma (PTC). However, the ablation outcomes of T1N0M0 PTC are not well characterized. Purpose To evaluate the efficacy and safety of thermal ablation (MWA or RFA) of solitary T1N0M0 PTC in patients who were ineligible for (due to presence of comorbid cardiovascular disease, renal failure, other malignancy, etc) or who refused surgery. Materials and Methods This was a retrospective multicenter study of 847 patients (660 women) who underwent thermal ablation for PTC (673 T1a, 174 T1b) between March 2015 and March 2020; of these patients, 645 underwent MWA and 202 underwent RFA. The mean age of patients was 46 years ± 11 (standard deviation) (age range, 18-81 years); the mean follow-up time was 22 months ± 13 (range, 6-60 months). Changes in tumor size and volume and the rates of technical success, tumor disappearance, disease progression, and complications were assessed. Results The technical success rate was 100%. Relative to preablation measurements, the maximum diameter and volume of the ablation zone increased during the 1st month after ablation (P < .001), whereas there was no difference by the 3rd month; subsequently, the tumors showed reduction in size at 6, 9, and 12 months (all P < .001). Complete disappearance of tumors occurred in 68% of patients (577 of 847; 69% [466 of 673] in the T1a group vs 64% [111 of 174] in the T1b group; P < .001). The postablation disease progression rate was 1.1% (nine of 847 patients; 0.9% [six of 673 patients] in the T1a group vs 1.7% [three of 174 patients] in the T1b group; P = .54). The overall complication rate was 3.4% (29 of 847 patients; 2.7% [18 of 673 patients] in the T1a group vs 6.3% [11 of 174 patients] in the T1b group; P = .02). Conclusion This multicenter study provided evidence that thermal ablation is an effective and safe treatment option in selected -patients with solitary T1N0M0 papillary thyroid carcinoma. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Baek and Cho in this issue.
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Affiliation(s)
- Xiao-Jing Cao
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Shu-Rong Wang
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ying Che
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Juan Liu
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Zhi-Bin Cong
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Jun-Feng He
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Hong-Ling Wang
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Geng Liu
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Jian-Qin Guo
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ying Hao
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Zhong-Hua Wang
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ying Zhou
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Mei Jian
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Li-Li Shi
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Lu Qi
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ya-Lin Zhu
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Xue Wang
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Guo-Zhen Yan
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Aini Shataer
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Xiao-Fang Liu
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ying Wei
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Zhen-Long Zhao
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Li-Li Peng
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Yan Li
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
| | - Ming-An Yu
- From the Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China (X.J.C., Y.W., Z.L.Z., L.L.P., Y.L., M.A.Y.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (S.R.W., L.Q.); Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C., Y.L.Z.); Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China (J.L.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China (J.F.H., G.Z.Y.); Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous, Wulumuqi, China (H.L.W., A.S.); Department of Ultrasound, Wuhai People's Hospital, Wuhai, China (G.L.); Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China (J.Q.G.); Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H., X.F.L.); Special Inspection Section, Wendeng District People's Hospital, Wendeng, China (Z.H.W.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Y.Z.); Department of Ultrasound, Bayannur Hospital, Bayannur China (M.J.); and Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.)
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Cho SJ, Baek SM, Na DG, Lee KD, Shong YK, Baek JH. Five-year follow-up results of thermal ablation for low-risk papillary thyroid microcarcinomas: systematic review and meta-analysis. Eur Radiol 2021; 31:6446-6456. [PMID: 33713168 DOI: 10.1007/s00330-021-07808-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/18/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Confidence in long-term treatment results of thermal ablation for papillary thyroid microcarcinoma (PTMC) is required in comparison with active surveillance. The objective of this meta-analysis is to report 5-year follow-up results of thermal ablation for PTMC. METHODS Ovid MEDLINE and EMBASE databases were searched through May 30, 2020, for studies reporting outcomes in patients with PTMC treated with thermal ablation and followed up for at least 5 years. Data were extracted and methodological quality was assessed independently by two radiologists according to the PRISMA guidelines. RESULTS Three studies, involving 207 patients with 219 PTMCs, met the inclusion criteria through database searches. None of these patients experienced local tumor recurrence, lymph node metastasis, or distant metastasis or underwent delayed surgery during a mean pooled 67.8-month follow-up. Five new tumors appeared in the remaining thyroid gland of four patients, with four of these tumors successfully treated by repeat thermal ablation. The pooled mean major complication rate was 1.2%, with no patient experiencing life-threatening or delayed complications. CONCLUSIONS Thermal ablation is an excellent local tumor control method in patients with low-risk PTMC, with low major complication rates at 5 years. KEY POINTS • No local tumor recurrence, lymph node metastasis, or distant metastasis was noted by thermal ablation during follow-up of 5 years and none underwent delayed surgery. • The pooled mean major complication rate was 1.2%.
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Affiliation(s)
- Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, 502, Jwadongsunhwan-ro, Haeundae-gu, Busan, 48101, Republic of Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Republic of Korea
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Republic of Korea
| | - Kang Dae Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan, 49267, Republic of Korea
| | - Young Kee Shong
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
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Cao XJ, Zhao ZL, Wei Y, Peng LL, Li Y, Wu J, Yu MA. Microwave ablation for papillary thyroid cancer located in the thyroid isthmus: a preliminary study. Int J Hyperthermia 2021; 38:114-119. [PMID: 33530750 DOI: 10.1080/02656736.2021.1880028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To assess the feasibility, efficacy, and safety of ultrasound (US)-guided microwave ablation (MWA) for the treatment of papillary thyroid cancer (PTC) located in the thyroid isthmus. MATERIALS AND METHODS Thirty-four patients (mean age, 43 ± 11 years; 26 women) with isthmic PTC treated with MWA between June 2014 and September 2020 were included in this retrospective study. The follow-up time after MWA was 17 ± 9 months (range, 8-50 months). Changes in thyroid function, parathyroid function, and tumor size were evaluated, along with the rates of tumor disappearance and complications. RESULTS The treatment was technically feasible and successfully completed in all 34 patients (100%). Measures of thyroid function (i.e. serum triiodothyronine, free thyroxine, and thyrotropin) and parathyroid function (i.e. serum calcium and intact parathyroid hormone) showed no changes from pretreatment levels at 1, 3, and 6 months after MWA (p > 0.05 for all). Tumor size was found to be increased at 1 and 3 months after MWA compared with before MWA (p < 0.05). However, the tumor sizes measured at 6, 9, 12, and 18 months after MWA were smaller than the pretreatment sizes (p < 0.05 for all). In 24 cases (70.6%), the tumors completely disappeared on US examination. Five cases (2.9%) experienced side effects from MWA treatment, but no major or minor complications were recorded. CONCLUSION The results of this study demonstrate that US-guided MWA is a feasible, effective, and safe treatment option for selected patients with PTC located in the thyroid isthmus.
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Affiliation(s)
- Xiao-Jing Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
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The Clinical Application of Radiofrequency Ablation in the Treatment of Primary Low-risk Papillary Thyroid Microcarcinoma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00327-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Cao XJ, Liu J, Zhu YL, Qi L, Liu G, Wang HL, Wang ZH, Zhou Y, He JF, Guo JQ, Shi LL, Jian M, Shataer A, Yan GZ, Zhao ZL, Wei Y, Peng LL, Li Y, Che Y, Wang SR, Yu MA. Efficacy and Safety of Thermal Ablation for Solitary T1bN0M0 Papillary Thyroid Carcinoma: A Multicenter Study. J Clin Endocrinol Metab 2021; 106:e573-e581. [PMID: 33107573 DOI: 10.1210/clinem/dgaa776] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ultrasound-guided thermal ablation plays an important role in the management of thyroid disease. The objective of this study was to evaluate the feasibility, efficacy, and safety of thermal ablation for patients with solitary T1bN0M0 papillary thyroid carcinoma (PTC) who are ineligible for or unwilling to undergo surgery. MATERIALS AND METHODS Data pertaining to 172 patients (38 males and 134 females) who received thermal ablation therapy at 12 hospitals between April 2015 and March 2020 were retrospectively analyzed. The mean duration of follow-up was 24.9 ± 14.1 months (range, 12-60). The technical feasibility, technical success, efficacy, and safety of treatment were analyzed. Postablation tumor size at various time points was compared with preablation measurement. RESULTS All patients selected for thermal ablation received enlarged ablation, according to contrast-enhanced ultrasound postablation. The maximum diameter and volume of ablation zone at 6, 12, 18, 24, 36, and 48 months postablation were significantly smaller than those recorded preablation (P < 0.05 for all). At the most recent follow-up, 106 (61.6%) tumors had completely disappeared. The rate of lymph node metastasis was 0.6% (1/172) and the incidence of new tumors was 1.2% (2/172). The overall complication rate was 5.2% (9/172) (major complications: 4.6% [8/172]; minor complications: 0.6% [1/172]). All major complications were relieved within 4 months postablation. CONCLUSION Thermal ablation may be a feasible, effective, and safe treatment option for patients with solitary T1bN0M0 PTC who are ineligible for or unwilling to undergo surgery. It may provide a novel treatment option for selected patients.
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Affiliation(s)
- Xiao-Jing Cao
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Juan Liu
- Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China
| | - Ya-Lin Zhu
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lu Qi
- Department of Medical Ultrasound, Yantai Affliated Hospital of Binzhou Medical University, Yantai, China
| | - Geng Liu
- Department of Ultrasound, Wuhai People's Hospital, Wuhai, China
| | - Hong-Ling Wang
- Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Zhong-Hua Wang
- Special Inspection Section, Wendeng District People's Hospital, Weihai, China
| | - Ying Zhou
- First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Jun-Feng He
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China
| | - Jian-Qin Guo
- Department of Interventional Ultrasound, Qinghai Provincial People's Hospital, Xining, China
| | - Li-Li Shi
- Department of Ultrasound, Laixi Municipal Hospital, Laixi, China
| | - Mei Jian
- Department of Ultrasound, Bayannur Hospital, Bayannur, China
| | - Aini Shataer
- Department of Breast and Thyroid Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Guo-Zhen Yan
- Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, China
| | - Zhen-Long Zhao
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shu-Rong Wang
- Department of Thyroid, Beijing Beicheng Chinese Medicine Hospital, Beijing, China
- Department of Medical Ultrasound, Yantai Affliated Hospital of Binzhou Medical University, Yantai, China
| | - Ming-An Yu
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
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Hua Y, Yang JW, He L, Xu H, Huo HZ, Zhu CF. Residual tumor and central lymph node metastasis after thermal ablation of papillary thyroid carcinoma: A case report and review of literature. World J Clin Cases 2021; 9:252-261. [PMID: 33511193 PMCID: PMC7809668 DOI: 10.12998/wjcc.v9.i1.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/06/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Debate exists regarding the use of thermal ablation (TA) to treat papillary thyroid carcinoma (PTC). Some studies have recommended TA as a new, efficient and safe technology for PTC. In this article, we report one case of a residual tumor and central lymph node metastasis (CLNM) after TA for PTC.
CASE SUMMARY A 63-year-old female underwent bilateral ultrasound (US)-guided radiofrequency ablation for PTC. Three months later, she was diagnosed as thyroid cancer with suspected CLNM by US and contrast-enhanced computed tomography. The subsequent fine-needle aspiration (FNA) biopsies were negative. Due to her strong personal preference, she underwent total thyroidectomy and central lymph node dissection. Local tissue adhesion and a difficult dissection were noted during the operation. The pathology of the frozen sections during the operation was still negative. The final pathology results of paraffin-embedded sections revealed residual tumor cells at the edge of the PTC and CLNM.
CONCLUSION TA may lead to a residual tumor in patients with PTC. Follow-up using US and FNA biopsy may not be adequate to evaluate the residual tumor. TA should be carefully considered in PTC treatment.
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Affiliation(s)
- Yu Hua
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Jia-Wen Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Liu He
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Hua Xu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Hai-Zhong Huo
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Chen-Fang Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
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Lu C, Li X, Chu X, Li R, Li J, Wang J, Wang Y, Xu Y, Chen G, Xu S, Liu C. Clinical Effects of Microwave Ablation in the Treatment of Low-Risk Papillary Thyroid Microcarcinomas and Related Histopathological Changes. Front Endocrinol (Lausanne) 2021; 12:751213. [PMID: 34603216 PMCID: PMC8482998 DOI: 10.3389/fendo.2021.751213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/27/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the feasibility and efficacy of ultrasound-guided percutaneous microwave ablation (MWA) in the treatment of low-risk papillary thyroid microcarcinoma (PTMC), and to observe the histopathological changes after MWA. METHODS MWA was performed under ultrasound guidance for 73 unifocal PTMC patients without clinically cervical or distant metastasis. The target ablation zone exceeded the tumor edge (judged by contrast-enhanced US) to avoid marginal residue and recurrence. Ultrasound evaluation was performed at 1 day, 1, 3, 6, 12 and 24 months after treatment, and thyroid function evaluation at the first 6 months. Repeated fine needle aspiration cytology or core needle biopsy pathology was performed at 3 or 6 months after MWA to evaluate residual tumors. Any adverse event associated with MWA was evaluated. RESULTS The follow-up after MWA lasted 6 (6, 12) months. Tumor volume decreased significantly from 0.06 mm3 (0.04, 0.11 mm3) to 0.03 mm3 (0.00, 0.06 mm3) at 12 months after MWA (P< 0.001), with a median volume reduction ratio of 80.28% (-7.43, 100%) and 16 cases (21.92%) presenting complete remission. The largest diameter, volume and ablation energy were found to be different in patients with and without complete remission 12 months after MWA. On histopathological examinations, no atypical or malignant follicular cells were identified after thermal ablation. The most common pathological characteristics were fibroblastic proliferation (34/39, 87.18%) and chronic inflammation (32/39, 82.05%), followed by infarction (21/39, 53.85%). Five patients were transferred to thyroidectomy and 4 of them were confirmed with local recurrence and/or lymph node metastasis. Serum thyrotropin decreased transiently after MWA (P< 0.01) but normalized thereafter. No serious and permanent complications were reported. CONCLUSIONS MWA is a safe and effective treatment for low-risk PTMC. Fibroblastic proliferation and chronic inflammation are the most common pathological changes after MWA of PTMC.
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Affiliation(s)
- Chenya Lu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xingjia Li
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xiaoqiu Chu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Ruiping Li
- Department of Pathology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Jie Li
- Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Jianhua Wang
- Department of General Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yalin Wang
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yang Xu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Guofang Chen
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Shuhang Xu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Shuhang Xu, ; Chao Liu,
| | - Chao Liu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Shuhang Xu, ; Chao Liu,
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Min Y, Wang X, Chen H, Chen J, Xiang K, Yin G. Thermal Ablation for Papillary Thyroid Microcarcinoma: How Far We Have Come? Cancer Manag Res 2020; 12:13369-13379. [PMID: 33380841 PMCID: PMC7769090 DOI: 10.2147/cmar.s287473] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/05/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose Thermal ablation (TA), as one of the most currently remarkable technologies, has achieved great success in many malignant diseases including but not limited to hepatic and renal carcinoma. In recent years, this technology was gradually introduced to the treatment of papillary thyroid microcarcinoma (PTMC) and even papillary thyroid carcinoma (PTC). Thereby, we summarized the current progress of TA development in the treatment of PTMC. Methods The latest relevant literature from the PubMed database with keywords "thermal ablation", "papillary thyroid microcarcinoma", "microwave ablation", "radio-frequency ablation", and "laser ablation", among others, were comprehensively reviewed in this article. The follow-up outcomes of patients in these articles were analyzed. Results The efficacy and safety of TA including microwave ablation (MWA), laser ablation (LA), and radiofrequency ablation (RFA) in the treatment of PTC and PTC have been intensively studied. Based on existing clinical trials, the relatively long-term follow-up (range, from 6 to 64.2 months) results in MWA, LA, and RFA were satisfactory that tumor volume reduction rate (VRR) reached and even surpass 99%. Compared with routine surgery methods (total thyroidectomy and lobectomy), the incidence rate of complications was relatively lower and the recurrence rate of TA techniques was not statistically significant, whereas the operative time, blood loss, length of hospital stay, and hospital cost were significantly decreased. Conclusion TA presents the same satisfactory therapeutic effects but minimal postoperative trauma can significantly improve the patients' quality of life. However, future larger sample, multicenter, and prospective randomized controlled trials are urgently needed to validate the feasibility of TA in dealing with PTMC.
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Affiliation(s)
- Yu Min
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
| | - Xing Wang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
| | - Hang Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
| | - Jialin Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
| | - Ke Xiang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
| | - Guobing Yin
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 404100, People's Republic of China
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Mo HS, Wei L, Ye H, Li ZX. Microwave Ablation of Visible Benign Thyroid Nodules with Different Internal Characteristics: A Comparative Study with Follow-up Results. J INVEST SURG 2020; 35:347-353. [PMID: 33292024 DOI: 10.1080/08941939.2020.1854903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the effects of microwave ablation (MWA) on visible benign thyroid nodules (BTN) with different internal characteristics. MATERIALS & METHODS A total of 51 cases with 53 visible BTN were treated by ultrasound-guided percutaneous MWA. The 53 nodules were classified into three categories according to the internal characteristics, which were simple solid, mainly solid and mainly cystic nodules. Ultrasound examinations were performed to evaluate the volume shrinkage rations during follow-up. The thyroid functions and the cervical cosmetic scores were evaluated. The complications were observed during and after ablation. RESULTS A total of 53 symptomatic BTN were treated by MWA completely. The average volume of the nodules was 11.68 ± 10.16 ml, the volume reduction rates (VRR) at 1st, 3rd, 6th, 12th, and 18th months after ablation were 0.29 ± 0.27, 0.46 ± 0.25, 0.67 ± 0.19, 0.83 ± 0.10, and 0.92 ± 0.10, respectively. The VRR was significantly different among the three categories of lesions (p < 0.05). The symptoms of all patients were improved. Thyroid function indicators were fluctuated in normal range. There were no serious complications during and after the procedure. CONCLUSION MWA of visible BTN is safe and effective, and the short-time ablation effect is significantly different due to the internal characteristics of the nodule.
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Affiliation(s)
- Hai She Mo
- Ultrasound Center, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Li Wei
- Department of Ultrasound, The Peoplés Hospital of QIANNAN, Duyun, Guizhou, China
| | - Hui Ye
- Department of Thyroid Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhi Xian Li
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Teng DK, Li WH, Du JR, Wang H, Yang DY, Wu XL. Effects of Microwave Ablation on Papillary Thyroid Microcarcinoma: A Five-Year Follow-Up Report. Thyroid 2020; 30:1752-1758. [PMID: 32458748 DOI: 10.1089/thy.2020.0049] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Some researchers have achieved favorable efficacy in the treatment of primary papillary thyroid microcarcinoma (PTMC) using microwave ablation (MWA). However, as PTMC is a slowly progressing disease, a long follow-up period is required to confirm treatment efficacy. Our study aim was to investigate the long-term efficacy and safety of ultrasound (US)-guided MWA in PTMC. Methods: In this study, 41 patients with thyroid masses (41 nodules) were diagnosed with PTMC by fine-needle aspiration or core needle biopsy. They underwent US-guided MWA. Preablation ultrasonic images of the thyroid nodules were collected, and the volumes were measured. The patients had follow-up at 1, 3, 6, and 12 months in the first year and every 6 months from the second year on, after MWA. The volume reduction rates (VRRs) of the thyroid nodules were analyzed. Results: In total, 40 of 41 nodules were completely ablated by MWA. After 60 months of follow-up, the volume significantly decreased from a median of 55.78 mm3 (quartile: 21.50, 112.20 mm3) to 0 mm3 (0, 0 mm3) (p < 0.001), with a VRR of 99.37% ± 4.02%. Two patients developed hoarseness after ablation; one recovered within 10 minutes, and the hoarseness in the other patient resolved 2 months after the ablation. No recurrence, metastatic cervical lymph nodes, or distal metastasis was found during the follow-up period. Conclusions: In this five-year follow-up, MWA presented favorable efficacy with satisfactory safety for the treatment of PTMC. It should be considered an alternative therapy to surgery and active surveillance for solitary PTMC.
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Affiliation(s)
- Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wen-Hui Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jia-Rui Du
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dong-Yan Yang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiao-Li Wu
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, China
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Cho SJ, Baek SM, Lim HK, Lee KD, Son JM, Baek JH. Long-Term Follow-Up Results of Ultrasound-Guided Radiofrequency Ablation for Low-Risk Papillary Thyroid Microcarcinoma: More Than 5-Year Follow-Up for 84 Tumors. Thyroid 2020; 30:1745-1751. [PMID: 32375570 DOI: 10.1089/thy.2020.0106] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Despite reports describing favorable short-term results for thermal ablation of thyroid cancer, there remains a need to evaluate long-term results because of its indolent characteristics. The purpose of this study was to evaluate the long-term efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC) over a follow-up period of more than five years. Methods: From a cohort of patients under surveillance after US-guided RFA for primary low-risk PTMC, those with a record of follow-up data of more than five years were selected for this study. Before RFA, all patients underwent US and computed tomography to evaluate the PTMC and the presence of neck metastasis. RFA was performed using thyroid-dedicated electrodes. Follow-up US was performed 6 and 12 months after initial RFA, and then every 12 months. The status of ablated tumors was evaluated according to volume reduction, local tumor progression, newly developed cancers, lymph node (LN) or distant metastasis, and delayed surgery during follow-up. Complications during the procedure and follow-up period were evaluated. Results: A total of 84 nodules from 74 patients were included in this study. All patients tolerated RFA, and the mean follow-up duration was 72 months. After RFA, complete disappearance rates of 98.8% and 100% were achieved at 24 and 60-month follow-up, respectively. Additional ablations were performed in 13 of 84 tumors. The mean number of RFA sessions was 1.2. There were four newly developed cancers in three patients, and these were also treated with RFA and completely disappeared. During the follow-up period, there was no local tumor progression, no LN or distant metastasis, and no patients underwent delayed surgery. The major complication rate was 1.4% (1/74), and there was no delayed complication or procedure-related death. Conclusions: RFA is effective for treating low-risk PTMC patients, without occurrence of local tumor progression, LN or distant metastasis, delayed complications, procedure-related death, or delayed surgery over more than five years of follow-up.
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Affiliation(s)
- Se Jin Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Republic of Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Kang Dae Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Republic of Korea
| | - Jung Min Son
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Bo XW, Lu F, Xu HX, Sun LP, Zhang K. Thermal Ablation of Benign Thyroid Nodules and Papillary Thyroid Microcarcinoma. Front Oncol 2020; 10:580431. [PMID: 33194708 PMCID: PMC7658440 DOI: 10.3389/fonc.2020.580431] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
Due to the increasing rates of physical examination and application of advanced ultrasound machines, incidences of benign thyroid nodules (BTNs) and papillary thyroid microcarcinoma (PTMC) were dramatically up-regulated in recent years. Thermal ablation (TA) has been widely used and regarded as a safe and effective method to eliminate or reduce BTNs and recurrent low-risk PTMC. However, conclusions using TA to treat primary PTMC are controversial. Recently, several long-term and prospective studies on TA treatment of BTNs and primary PTMC have been reported. Here, we review current literatures and progress on TA treatment of BTNs and PTMC and underline the way to get the best treatment outcomes, providing a comprehensive insight into the research progresses in this field.
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Affiliation(s)
- Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Feng Lu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Kun Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
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Yan L, Lan Y, Xiao J, Lin L, Jiang B, Luo Y. Long-term outcomes of radiofrequency ablation for unifocal low-risk papillary thyroid microcarcinoma: a large cohort study of 414 patients. Eur Radiol 2020; 31:685-694. [PMID: 32813103 DOI: 10.1007/s00330-020-07128-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/10/2020] [Accepted: 07/31/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the long-term efficacy and safety of radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC) in a large population. METHODS From June 2014 to December 2017, 414 patients (323 females, 91 males, mean age 43.56 ± 9.79 years, range 18-73 years) with unifocal low-risk PTMC confirmed by core-needle biopsy (CNB) were treated by RFA. Patients were followed up at 1, 3, 6, and 12 months and every 6-12 months thereafter by ultrasound and contrast-enhanced ultrasound (CEUS). The volume and the volume reduction ratio (VRR) were calculated. Recurrence and lymph node or distant metastasis were evaluated. RESULTS The mean initial volume was 92.74 ± 83.43 mm3 (range 4.19-490.07 mm3), which decreased significantly to 1.37 ± 7.94 mm3 (range 0-67.97 mm3) at a mean follow-up time of 42.15 ± 11.88 months (range 24-69 months) with a mean VRR of 98.81 ± 6.41% (range 50-100%). No life-threatening or delayed complications occurred. After RFA, 366 tumors (88.41%) completely disappeared. The overall incidence of local tumor progression rate was 3.62%. Among them, one patient (0.24%) was diagnosed to have residual cancer by CNB and underwent additional RFA. Four patients (0.97%) developed metastatic lymph node, and 10 patients (2.42%) had recurrent PTMC. A total of 13 patients underwent additional RFA, and 11 lesions completely disappeared during the follow-up. CONCLUSIONS RFA is an effective and safety treatment for low-risk PTMC after a long-term follow-up period for a large cohort with careful patient enrollment evaluation. KEY POINTS • Radiofrequency ablation is an effective and safe alternative for low-risk PTMC. • The overall incidence of local tumor progression rate was low. • No life-threatening or delayed complications occurred.
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Affiliation(s)
- Lin Yan
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
- Health Management Center, The Second Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian, China
| | - Yu Lan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Lin Lin
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Bo Jiang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yukun Luo
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China.
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China.
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