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Lai L, Zhou C, Liu Z, Zhang J, Ni X, Liu J, Li N, Xia S, Dong Y, Zhou J. Impact of Hashimoto's thyroiditis on radiofrequency ablation for papillary thyroid micro-carcinoma: a cohort study of 391 patients. Int J Hyperthermia 2025; 42:2426607. [PMID: 39956545 DOI: 10.1080/02656736.2024.2426607] [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: 08/27/2024] [Revised: 10/18/2024] [Accepted: 11/01/2024] [Indexed: 02/18/2025] Open
Abstract
PURPOSE To assess the impact of Hashimoto's thyroiditis (HT) on radiofrequency ablation (RFA) outcomes for papillary thyroid microcarcinoma (PTMC). METHODS A retrospective study of 391 PTMC patients treated with RFA from March 2017 to August 2020, divided by HT accompanied or not. Ablation area size, volume reduction ratio (VRR), lesion disappearance, complications, and recurrences were analyzed. RESULTS 391 patients (mean age, 41.3 ± 11.2 [SD]; 317 women, 110 with HT) were evaluated. The follow-up time was 2 years. HT+ PTMC patients (Group A) exhibited larger ablation diameters at 1st and 3rd month post-RFA. In comparison, PTMC patients (Group B) had larger diameters at 1st and 3rd months but smaller at 6th months, returning to baseline around 6th month in Group B and 9th month in Group A. VRRs in Group B were greater than Group A at 3rd, 6th, 9th, 12th and 15th month, all p < 0.05). The Kaplan-Meier curves revealed a slower lesion disappearance rate in A (12th) compared to B group (9th). Complication and recurrence rates were similar for both groups (4.4% and 0.8% overall, Group B vs Group A: 4.3% vs 4.6%, p = 0.905; 0.4% vs 1.8%, p = 0.192). CONCLUSION HT delays the resorption of PTMC lesions following RFA, but it does not impact the procedure's effectiveness or safety. Regardless of HT status, RFA remains a viable alternative to surgery for PTMC.
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Affiliation(s)
- Limei Lai
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenhua Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingwen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Ni
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juan Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Li
- Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, Yunnan Province, China
| | - Shujun Xia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianqiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Du R, Wang R, Xu H, Xu Y, Fei Z, Luo Y, Zhu X, Li Y. A novel computer-aided energy decision-making system improves patient treatment by microwave ablation of thyroid nodule. Comput Biol Med 2025; 188:109823. [PMID: 39986198 DOI: 10.1016/j.compbiomed.2025.109823] [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: 07/19/2024] [Revised: 02/05/2025] [Accepted: 02/06/2025] [Indexed: 02/24/2025]
Abstract
The current basis of microwave ablation (MWA) energy use for thyroid nodules (TN) is inadequate, leading to tissue carbonization, which is strongly associated with complications and poor prognosis. This study aims to devise a novel energy decision-making system to improve the subjective use of energy in current MWA procedures. Data from 916 subjects (1364 TN) across three medical centers were collected. In the first two sets, the single-stitch ablation needle energy (ANE) was calculated by analyzing MWA procedure videos. The causes of TN over-ablation (carbonization) were examined, and the relationship between well-ablated TN and ANE was explored based on TN attributes (volume and Young's modulus). Three-dimensional (3D) reconstruction of TN was performed, and a computer-aided model was constructed to optimize the distribution of the ANE field within the 3D-TN. Subsequently, a novel energy decision-making system was developed and tested. The third set was used for external validation. The cause of TN carbonization was found to be related to the overload of ANE with corrected Young's modulus and the selection of mismatched ablation needle power (ANP). A precise ANE model (Model 1) based on well-ablated TN and a needle-placement model (Model 2) based on the 3D-TN and ANP were subsequently constructed. The coupled new energy decision-making system (Model 1 + 2) demonstrated strong clinical generalization capabilities. In conclusion, this novel energy decision-making system can effectively improve the use of MWA energy, significantly promoting the precise treatment of TN.
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Affiliation(s)
- Rui Du
- Department of Radiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Ranchao Wang
- School of Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Hu Xu
- School of Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Yuhao Xu
- Department of Neurology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Zhengdong Fei
- Department of Ultrasound, Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang, 223600, Jiangsu, China
| | - Yifeng Luo
- Department of Radiology, Affiliated Yixing Hospital of Jiangsu University, Yixing, 214200, Jiangsu, China
| | - Xiaolan Zhu
- Reproductive Center, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Yuefeng Li
- Department of Radiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
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Nguyen VC, Park JS, Song CM, Ji YB, Jeong JH, Tae K. Efficacy and Oncologic Outcomes of Thermal Ablation Techniques in the Treatment of Primary Low-Risk Papillary Thyroid Carcinoma: A Systematic Review and Network Meta-Analysis. Head Neck 2025; 47:759-775. [PMID: 39714077 DOI: 10.1002/hed.28029] [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: 05/16/2024] [Revised: 10/13/2024] [Accepted: 11/30/2024] [Indexed: 12/24/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the safety, efficacy, and oncologic outcomes of thermal ablation techniques, including radiofrequency, laser, and microwave ablation, in treating primary thyroid cancer compared with surgical resection. METHOD We conducted a systematic review and network meta-analysis, which included 21 comparative studies and 40 noncomparative studies. RESULTS The three thermal ablation techniques showed significant superiority over surgical resection in terms of operative time, pain, cost, quality of life, and complications. Three years after the procedure, the tumor volume reduction and complete disappearance rates for the three thermal ablation techniques were similar, at approximately 99% and 93%-95%, respectively. The recurrence rate remained comparable (approximately 2%-3%) among the three thermal ablation techniques and surgical resection during a follow-up period exceeding 3 years. CONCLUSIONS The safety, efficacy, and oncologic outcomes of thermal ablation techniques may be acceptable and comparable to surgical resection for selected cases of primary thyroid cancer.
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Affiliation(s)
- Van Cuong Nguyen
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jeong Seon Park
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jin Hyeok Jeong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Xu H, Yang JY, Zhao X, Ma Z. Advances in clinical research on ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma. Front Oncol 2024; 14:1422634. [PMID: 39040438 PMCID: PMC11260605 DOI: 10.3389/fonc.2024.1422634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
Ultrasound-guided radiofrequency ablation (RFA) emerges as a minimally invasive strategy for papillary thyroid microcarcinoma (PTMC), offering advantages over traditional surgical approaches. RFA employs high-frequency electric currents under precise ultrasound guidance to ablate cancerous tissue. Clinical trials consistently demonstrate RFA's efficacy in tumor control and patient-reported outcomes. However, long-term studies are essential to validate its durability and monitor for potential complications. Collaborative efforts among various medical disciplines ensure procedural accuracy and comprehensive postoperative care. Technological innovations, such as enhanced ultrasound imaging and temperature control, promise to refine RFA's precision and effectiveness. Nevertheless, challenges persist, including the need for standardized protocols and comparative studies with traditional treatments. Future research should focus on long-term outcomes, patient selection criteria, and optimization of procedural techniques to solidify RFA's role in PTMC management. RFA presents a promising avenue for PTMC treatment, warranting further investigation and refinement in clinical practice.
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Affiliation(s)
- Hua Xu
- Department of Ultrasound, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Jin-yan Yang
- Department of Ultrasound, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Xing Zhao
- Department of Medical Technology, Shaanxi Energy Institute, Xianyang, China
| | - Zhe Ma
- Department of Ultrasound, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China
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Heo DB, Won HR, Tae K, Kang YE, Jeon E, Ji YB, Chang JW, Choi JY, Yu HW, Ku EJ, Lee EK, Kim M, Choe JH, Koo BS. Clinical impact of coexistent chronic lymphocytic thyroiditis on central lymph node metastasis in low- to intermediate-risk papillary thyroid carcinoma: The MASTER study. Surgery 2024; 175:1049-1054. [PMID: 38281855 DOI: 10.1016/j.surg.2023.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/13/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND The clinicopathological impact of chronic lymphocytic thyroiditis on patients with papillary thyroid carcinoma patients is still controversial. This study aimed to evaluate the clinicopathologic differences and risk factors for central lymph node metastasis based on the presence of coexistent chronic lymphocytic thyroiditis in patients with low- to intermediate-risk papillary thyroid carcinoma. METHODS The medical records of 1,022 patients with low- to intermediate-risk papillary thyroid carcinoma who underwent lobectomy and central neck dissection between June 2020 and March 2022 were reviewed. Differences in clinicopathological factors were analyzed in patients with papillary thyroid carcinoma with or without chronic lymphocytic thyroiditis. Furthermore, risk factors for central lymph node metastasis in patients with low- to intermediate-risk papillary thyroid carcinoma with or without chronic lymphocytic thyroiditis were evaluated. RESULTS Among the 1,022 patients with low to intermediate-risk papillary thyroid carcinoma, 102 (10.0%) had coexisting chronic lymphocytic thyroiditis. Female sex (odds ratio = 3.536, P = .001, 95% confidence interval 1.781-8.069), a multifocal tumor (odds ratio = 2.162, P = .001, 95% confidence interval 1.358-3.395), and angiolymphatic invasion (odds ratio = 0.365, P < .001, 95% confidence interval 0.203-0.625) were independent factors associated with patients who had coexisting chronic lymphocytic thyroiditis compared to those without chronic lymphocytic thyroiditis. There were 358 (35%) patients who had central lymph node metastasis. Multivariate analysis showed that younger age (odds ratio = 0.667, P = .013, 95% confidence interval 0.482-0.555), male sex (odds ratio = 0.549, P < .001, 95% confidence interval 0.402-0.751), tumor size >1 cm (odds ratio = 1.454, P = .022, 95% confidence interval 1.053-2.003), extrathyroidal extension (odds ratio = 1.874, P < .001, 95% confidence interval 1.414-2.486), and angiolymphatic invasion (odds ratio = 3.094, P < .001, 95% confidence interval 2.339-4.101) were risk factors for central lymph node metastasis. Angiolymphatic invasion (odds ratio = 11.184, P < .001, 95% confidence interval 3.277-46.199) was identified as the sole independent risk factor for central lymph node metastasis in patients with papillary thyroid carcinoma with coexisting chronic lymphocytic thyroiditis. CONCLUSION Our data suggest that patients with low to intermediate-risk papillary thyroid carcinoma with coexistent chronic lymphocytic thyroiditis exhibit different clinical features than patients with papillary thyroid carcinoma without chronic lymphocytic thyroiditis. Additionally, the presence of chronic lymphocytic thyroiditis may be considered a potential factor against central lymph node metastasis.
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Affiliation(s)
- Da Beom Heo
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Ho-Ryun Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Kyung Tae
- Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University, College of Medicine, Seoul, Republic of Korea
| | - Yea Eun Kang
- Department of Internal Medicine, Chungnam National University, College of Medicine, Daejeon, Republic of Korea
| | - Eonju Jeon
- Department of Internal Medicine, Daegu Catholic University, School of Medicine, Daegu, Republic of Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University, College of Medicine, Seoul, Republic of Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eu Jeong Ku
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, South Korea
| | - Mijin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jun-Ho Choe
- Division of Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Bon Seok Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
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Yao Y, Zhu X, Zhang N, Wang P, Liu Z, Chen Y, Xu C, Ouyang T, Meng W. Microwave ablation versus radiofrequency ablation for treating spinal metastases. Medicine (Baltimore) 2023; 102:e34092. [PMID: 37352076 PMCID: PMC10289525 DOI: 10.1097/md.0000000000034092] [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: 01/17/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND This study aimed to compare the clinical efficacy and safety of microwave ablation (MWA) and radiofrequency ablation (RFA) for the treatment of spinal metastases. METHODS A literature search was performed using the PubMed, Web of Science, and Cochrane Library databases according to the PRISMA statement (as of September 20, 2022). Two independent investigators screened articles based on the inclusion and exclusion criteria and included studies with primary outcomes of pain relief, tumor control, and complications. Article quality was assessed using the Risk Of Bias In Non-randomized Studies of Interventions tool. RESULTS Sixteen articles were finally included in this study, including 630 patients with spinal metastases, with ages ranging from 51.4 to 71.3 years. Of these, 393 (62.4%) underwent MWA and 237 (37.6%) underwent RFA. After MWA and RFA treatment, visual analog scale scores significantly decreased, and the local tumor control rates were all above 80%. Complications were reported in 27.4% of patients treated with MWA compared with 10.9% of patients treated with RFA. CONCLUSION The results of this systematic review suggest that MWA alone or in combination with surgery and RFA in combination with other modalities may improve pain caused by primary tumor metastasis to the spine, and MWA alone or in combination with surgery may have better local tumor control. However, MWA appears to result in more major complications than RFA in combination with other treatment modalities.
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Affiliation(s)
- Yuming Yao
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
- The First Clinical Medical College of Nanchang University, Nanchang, China
| | - Xiang Zhu
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Na Zhang
- Department of Neurology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ping Wang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhizheng Liu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Chen
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cong Xu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Taohui Ouyang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Meng
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
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Issa PP, Omar M, Buti Y, Aboueisha M, Munshi R, Hussein M, Haidari M, Blair G, Issa CP, Shama M, Toraih E, Kandil E. Hashimoto's Thyroiditis: A Protective Factor against Recurrence in BRAF-Wild Type Differentiated Thyroid Carcinoma. Cancers (Basel) 2023; 15:cancers15082371. [PMID: 37190300 DOI: 10.3390/cancers15082371] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
A recent work analyzing the concomitant factors BRAF mutation (risk factor) and Hashimoto's thyroiditis (HT) (protective factor) found that the presence of HT reduced lymph node metastasis in BRAF-mutated papillary thyroid carcinoma. Whether this notion is upheld with respect to disease recurrence and differentiated thyroid carcinoma (DTC), however, is unknown. We aimed to investigate the effect of underlying HT in DTC patients and its influence on recurrence with a specific emphasis in BRAF-mutated tumors. A total of 469 patients were included. Patients were stratified according to BRAF and HT status. Multivariate regression analysis was conducted to determine protective and risk factors of disease recurrence in patients with DTC. HT was associated with less-aggressive carcinomas including more frequent microcarcinomas (HT: 45.0% vs. no-HT: 34.0%, p = 0.02), less lymph node involvement (HT: 16.4% vs. no-HT: 26.1%, p = 0.02), and less disease recurrence (HT: 2.9% vs. no-HT: 11.9%, p = 0.002). BRAF mutation was also significantly associated with higher rates of lymph node involvement (BRAF-mutant: 41.9% vs. BRAF-wild type: 14.6%, p < 0.001) and almost two times the rate of recurrence (BRAF-mutant: 14.9% vs. BRAF-wild type: 6.5%, p = 0.004). Underlying HT was the only protective factor determined, reducing the odds of developing recurrence by 70% (HR: 0.30, 95%CI: 0.11-0.88). In the BRAF-wild type cohort, regression analysis continued to determine HT as a protective factor (p = 0.03). However, in the BRAF-mutant cohort, HT was no longer an independent protective factor (p = 0.20) against recurrence. Sub-group regression analysis, including PTC patients, similarly found HT as a protective factor only in BRAF-wild type patients (p = 0.039) and not BRAF-mutant (p = 0.627). The presence of underlying HT is associated with less aggressive tumors and is an independent protective factor against DTC recurrence, reducing the risk by 70%. HT remains a protective factor in BRAF-wild type carcinoma, but not in patients with BRAF-mutant carcinoma. HT may potentially be considered as a parameter which enhances American Thyroid Association patient risk stratification.
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Affiliation(s)
- Peter P Issa
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Mahmoud Omar
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Yusef Buti
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohamed Aboueisha
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Ruhul Munshi
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohammad Hussein
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Muhib Haidari
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Graham Blair
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Chad P Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Mohamed Shama
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Eman Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Emad Kandil
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
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Chen Y, Liu W, Jin C, Xu X, Xu L, Lu J, Zheng J, Sun X, Feng J, Chen S, Li Z, Gong X. Ultrasound-guided microwave ablation for benign thyroid nodules results in earlier and faster nodule shrinkage in patients with Hashimoto's thyroiditis than in those with normal thyroid function. Front Surg 2023; 10:1077077. [PMID: 36778645 PMCID: PMC9909091 DOI: 10.3389/fsurg.2023.1077077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Objectives Given that the histological features of the thyroid parenchyma in patients with Hashimoto's thyroiditis (HT) differ from those of the normal thyroid gland, HT may affect the effectiveness of ultrasound-guided microwave ablation (MWA) for benign thyroid nodules (BTNs). The present study aimed to compare the effectiveness of MWA for the treatment of BTNs in patients with both BTNs and HT and those with BTNs and normal thyroid function, based on changes in the volume reduction ratio (VRR) of the BTNs. Methods Patients who had achieved a VRR ≥50% after MWA for BTN (July 2020-June 2021), followed up for 12 months, and their data were retrospectively analyzed. Results A total of 213 nodules were identified in 185 patients, including 167 in the "BTN" group and 46 in the "BTN + HT" group. A comparison of the fitting curves for VRR-follow-up time revealed that the VRR increased with time after MWA, although the relationship was nonlinear. Piece-wise linear regression model analysis of the threshold effect of VRR and follow-up time in the two groups indicated that the inflection point of the "BTN" group occurred at 2.1 months: VRR increased fastest within 2.1 months of MWA (rate of change: 32.9% per month; P < 0.001), following which the rate of change was slower and maintained at 1.0% per month (P = 0.006). In the "BTN + HT" group, the inflection point occurred 1.5 months after MWA, with the most significant increase occurring in this period (rate of change: 41.5% per month; P < 0.001), followed by a rate of 2.8% per month (P < 0.001) after 1.5 months. Conclusions The relationship between VRR and follow-up time for ultrasound-guided MWA for BTN is nonlinear and exhibits a threshold effect. The current results indicated that the VRR in both groups increased before and after the inflection point, although the rate of change was greater before than after the inflection point. The inflection point occurs earlier in patients with BTN + HT than in those with BTN yet normal thyroid function, and this difference may be related to the "oven effect" involved in the development of HT.
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Affiliation(s)
- Yihao Chen
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, China,Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Weizong Liu
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Chunchun Jin
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaohong Xu
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, China,Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Lifeng Xu
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jianghao Lu
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jing Zheng
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiangmei Sun
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jiaping Feng
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Sihan Chen
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhengyi Li
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China,Correspondence: Xuehao Gong Zhengyi Li
| | - Xuehao Gong
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, China,Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China,Correspondence: Xuehao Gong Zhengyi Li
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Xie F, Yan L, Li YM, Lan Y, Xiao J, Zhang MB, Jin Z, Zhang Y, Tian XQ, Zhu YQ, Li ZP, Luo YK. Targeting Diagnosis of High-Risk Papillary Thyroid Carcinoma Using Ultrasound Contrast Agent With the BRAF V600E Mutation: An Experimental Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2789-2802. [PMID: 35229905 DOI: 10.1002/jum.15967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE High-risk papillary thyroid carcinoma (PTC) patients with BRAF mutation have lymph node and distant metastases and poor prognosis. Therefore, this study aims to develop a targeted ultrasound contrast agent for the BRAFV600E mutation to screen high-risk PTC at early stage. METHODS The targeted lipid nanobubbles carrying BRAFV600E antibody were prepared using thin film hydration-sonication and avidin-biotin binding methods. The physicochemical properties and stability of the targeted nanobubbles were detected by transmission electron microscopy, atomic force microscopy, and confocal laser scanning microscopy. The target binding abilities of the targeted nanobubbles in the PTC cells (B-CPAP) overexpressed mutant BRAFV600E were evaluated by immunofluorescence staining, quantitative real-time polymerase chain reaction, western blot, and fluorescence microscopy. After PTC tumor models overexpressed mutant BRAFV600E were established, the enhanced images of targeted lipid nanobubbles and untargeted lipid nanobubbles on PTC tumors in nude mice were observed using contrast-enhanced ultrasound imaging. RESULTS The targeted lipid nanobubbles revealed uniform, round morphology, and good stability with a nanoscale size. Besides, BRAFV600E monoclonal antibody was observed to be combined on the surface of lipid nanobubbles. Furthermore, the targeted nanobubbles had a good targeting diagnosis ability in PTC cells with BRAFV600E overexpression. Moreover, the targeted nanobubbles had better ultrasound enhancement and peak intensity of the time-intensity curve (P < .001) in PTC tumors with BRAFV600E overexpression as compared to the untargeted lipid nanobubbles. CONCLUSION The targeted lipid nanobubbles carrying BRAFV600E antibody could be regarded as a potential targeted ultrasound contrast agent for the diagnosis of high-risk PTC.
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Affiliation(s)
- Fang Xie
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yi-Ming Li
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yu Lan
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Ming-Bo Zhang
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Zhuang Jin
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Ying Zhang
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Xiao-Qi Tian
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Ya-Qiong Zhu
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Zhi-Ping Li
- Pharmacology Research Department, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yu-Kun Luo
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
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Navin PJ, Thompson SM, Kurup AN, Lee RA, Callstrom MR, Castro MR, Stan MN, Welch BT, Schmitz JJ. Radiofrequency Ablation of Benign and Malignant Thyroid Nodules. Radiographics 2022; 42:1812-1828. [DOI: 10.1148/rg.220021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Patrick J. Navin
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Scott M. Thompson
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Anil N. Kurup
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Robert A. Lee
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Matthew R. Callstrom
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - M. Regina Castro
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Marius N. Stan
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Brian T. Welch
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - John J. Schmitz
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
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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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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: 12] [Impact Index Per Article: 4.0] [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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13
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Huang L, Yang S, Bai M, Lin Y, Chen X, Li G, Cui LG, Wang X. Thermal shielding performance of self-healing hydrogel in tumor thermal ablation. Colloids Surf B Biointerfaces 2022; 213:112382. [PMID: 35151993 DOI: 10.1016/j.colsurfb.2022.112382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 11/25/2022]
Abstract
Thermal ablation therapy is widely used in the surgical treatment of tumors. Clinically, normal saline is generally used as an insulator to protect adjacent tissues from local high-temperature burns caused by thermal ablation. However, the flow of saline causes fluid loss, requiring frequent injections and complex operation, which is easy to lead to complications such as secondary injury and hematoma. Here, a self-healing chitosan-PEG (CP) hydrogel was proposed as a protective medium to challenge the clinical preparations. Compared with saline and non-self-healing hydrogel F127, CP hydrogel exhibited outstanding thermal shielding performance in the thermal ablation of thyroid nodule in a Beagle dog model. The transient plane source (TPS) method is used to measure thermal properties, including thermal conductivity, thermal diffusivity and specific heat capacity. The thermal shielding mechanism and clinical advantages including operability, biodegradability, and biological safety of self-healing hydrogel are then revealed in-depth. Therefore, self-healing hydrogel can achieve much better thermal management in tumor thermal ablation.
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Affiliation(s)
- Lifei Huang
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China
| | - Shiyuan Yang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China
| | - Mingyu Bai
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China
| | - Yuxuan Lin
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China
| | - Xue Chen
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China
| | - Guofeng Li
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, PR China.
| | - Xing Wang
- Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, PR China.
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14
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Lai L, Liu Z, Zhang J, Ni X, Liu J, Luo T, Dong Y, Zhou J. Effect of Hashimoto's thyroiditis on the extent of the ablation zone in early stages of ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma: a large cohort study of 772 patients. Int J Hyperthermia 2022; 39:397-404. [PMID: 35209788 DOI: 10.1080/02656736.2022.2041736] [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: 10/19/2022] Open
Abstract
PURPOSE To evaluate the effect of Hashimoto's thyroiditis (HT) on the extent of ablation zone in ultrasound (US)-guided radiofrequency ablation (RFA) for early stages of papillary thyroid microcarcinoma (PTMC). METHOD We selected 772 patients with 797 PTMCs who underwent with RFA from August 2017 to August 2020. They were subdivided into two groups as follows: (i) 216 patients (224 PTMCs) with HT in the 'HT + PTMC' group and (ii) 556 patients (573 PTMCs) with healthy thyroid in the 'PTMC' group. We assessed the extent (maximum diameter and volume) of the ablation zone by contrast-enhanced ultrasound (CEUS) immediately, one day, and 1 week following RFA. RESULTS The ablation zone of the 'HT + PTMC' group was smaller than that of the 'PTMC' group at 1 week of RFA (maximum diameter: 14.6 ± 3.1 mm vs. 15.2 ± 3.2 mm and volume: 0.932 ± 0.498 mL vs. 1.028 ± 0.540 mL, respectively, p < .05). However, there were no differences before, immediately, and one day post-RFA (p > .05). Life-threatening complications did not develop in any of the patients. CONCLUSION RFA-treated PTMCs were smaller in size in patients with HT than in those with a healthy thyroid at 1 week of RFA. However, the exact mechanism underlying this phenomenon and its clinical significance warrant further investigation.
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Affiliation(s)
- Limei Lai
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhenhua Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingwen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaofeng Ni
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Juan Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting Luo
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yijie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianqiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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15
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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: 15] [Impact Index Per Article: 3.8] [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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16
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葛 现, 殷 德, 张 勤, 辛 群. [Clinical application of the disposable incision retractor fixator in resection for papillary thyroid carcinoma]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:1028-1030. [PMID: 34886609 PMCID: PMC10128365 DOI: 10.13201/j.issn.2096-7993.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Indexed: 04/30/2023]
Affiliation(s)
- 现才 葛
- 中国人民解放军海军第971医院普通外科(山东青岛，266071)
| | | | - 勤 张
- 中国人民解放军海军第971医院普通外科(山东青岛，266071)
| | - 群 辛
- 中国人民解放军海军第971医院普通外科(山东青岛，266071)
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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: 62] [Impact Index Per Article: 15.5] [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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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: 18] [Impact Index Per Article: 4.5] [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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19
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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: 29] [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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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: 4] [Impact Index Per Article: 1.0] [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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21
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Pan Q, Yuan T, Ding Q. Clinical value of matrix metalloproteinase-2 and -9 in ultrasound-guided radiofrequency ablation treatment for papillary thyroid carcinoma. J Int Med Res 2021; 48:300060520917581. [PMID: 32772889 PMCID: PMC7418228 DOI: 10.1177/0300060520917581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate serum matrix metalloproteinase (MMP)-2 and MMP-9 levels in patients with papillary thyroid carcinoma (PTC). METHODS Forty-one patients with PTC undergoing ultrasound-guided radiofrequency ablation (RFA) and 56 controls were included. Serum MMP-2 and MMP-9 levels were determined by enzyme-linked immunosorbent assay before and after surgery. Potential affecting factors were evaluated by logistic regression analysis. RESULTS Serum MMP-2 and MMP-9 levels were significantly higher in PTC patients compared with controls, and decreased significantly after surgery. According to receiver operating characteristic curve analysis, diagnostic values for preoperative serum MMP-2 and MMP-9 levels were 82.4% and 86.6%. There was no contrast-agent perfusion in the ablation zone in 88.5% of lesions, and enhancement within or at the lesion edge in 11.4%. The volume reduction at 3 months' follow-up was >40%. Age, microcalcification, irregular shape, and lesion diameter and number were influencing factors for PTC. Age, and lesion diameter and number were independent risk factors, while calcification and morphology were protective factors. CONCLUSION Serum MMP-2 and MMP-9 levels have important clinical values for the diagnosis and treatment of PTC by RFA. Preoperative serum MMP-2 and MMP-9 levels, combined with other affecting factors, contribute to disease prognosis.
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Affiliation(s)
- Qunyan Pan
- Department of Ultrasound, Beilun People's Hospital of Ningbo, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, Zhejiang, China
| | - Tao Yuan
- Department of Ultrasound, Beilun People's Hospital of Ningbo, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, Zhejiang, China
| | - Qian Ding
- Department of Ultrasound, Beilun People's Hospital of Ningbo, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, Zhejiang, China
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You JY, Kim HY. Balanced Arguments Against RFA in the Neck: a Surgeon’s Perspective. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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: 34] [Impact Index Per Article: 8.5] [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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Tong MY, Li HS, Che Y. Recurrent medullary thyroid carcinoma treated with percutaneous ultrasound-guided radiofrequency ablation: A case report. World J Clin Cases 2021; 9:864-870. [PMID: 33585633 PMCID: PMC7852637 DOI: 10.12998/wjcc.v9.i4.864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/29/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment for neck lymph node metastases after adequate initial surgery in medullary thyroid carcinoma (MTC) has been controversial. Ultrasound (US)-guided radiofrequency ablation (RFA) has been widely used in recurrent well-differentiated thyroid carcinoma. Here, we report for the first time the use of RFA in a patient with recurrent MTC.
CASE SUMMARY We report the case of a 56-year-old woman with cervical lymph node metastases of MTC. Four years previously, she had undergone a total thyroidectomy and neck lymph node dissection. A neck US revealed many enlarged nodes during the follow-up period. Moreover, the serum calcitonin jumped to 198.17 pg/mL, which strongly indicated the recurrence of MTC. Subsequently, two metastatic lymph nodes were confirmed by US-guided fine-needle aspiration-cytology and fine-needle aspiration-calcitonin, and then the patient was treated with RFA. Four months later, the neck US and a contrast-enhanced US showed obvious shrinkage in the ablation zones, and the serum calcitonin dropped to 11.80 pg/mL.
CONCLUSION This case suggests that RFA may be an effective and safe treatment for local recurrent MTC.
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Affiliation(s)
- Meng-Ying Tong
- Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Hu-Sha Li
- Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Ying Che
- Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, 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: 2] [Impact Index Per Article: 0.5] [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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Yan L, Zhang M, Song Q, Xiao J, Zhang Y, Luo Y. The Efficacy and Safety of Radiofrequency Ablation for Bilateral Papillary Thyroid Microcarcinoma. Front Endocrinol (Lausanne) 2021; 12:663636. [PMID: 34177804 PMCID: PMC8227434 DOI: 10.3389/fendo.2021.663636] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/03/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate the long-term clinical results of radiofrequency ablation (RFA) for bilateral papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS From October 2014 to February 2018, 47 patients (37 females, 10 males, mean age 43.39 ± 9.26 years) with 100 bilateral PTMC (mean volume 75.22 ± 73.87 mm3) treated by RFA were included in this retrospective study. Bilateral PTMC was defined as at least one tumor located in the contralateral lobe. Patients were followed up at 1, 3, 6, 12 months and every 6-12 months thereafter. Volume, volume reduction ratio (VRR) and local tumor recurrence were evaluated during the follow-up period. RESULTS After a mean follow-up period of 47.77 ± 11.54 months, the mean volume of bilateral PTMC decreased from 75.22 ± 73.87 mm3 to 0.09 ± 0.44 mm3. The mean VRR was 99.94 ± 0.28% and the complete disappearance rate was 92.00%. During the follow-up, one patient (2.13%) developed lymph node metastasis and two patients (4.26%) had recurrent PTMC. All the recurrent lesions underwent additional RFA and two of them disappeared completely. No life-threatening or delayed complications occurred. CONCLUSIONS With sufficient preoperative evaluation, RFA might be a promising alternative for bilateral PTMC patients who were unsuitable for surgery or refused surgery.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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Yan L, Zhang M, Li X, Li Y, Luo Y. A Nomogram to Predict Regrowth After Ultrasound-Guided Radiofrequency Ablation for Benign Thyroid Nodules. Front Endocrinol (Lausanne) 2021; 12:774228. [PMID: 35250847 PMCID: PMC8891142 DOI: 10.3389/fendo.2021.774228] [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: 09/11/2021] [Accepted: 12/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To develop and validate a nomogram to predict regrowth for patients with benign thyroid nodules undergoing radiofrequency ablation (RFA). METHODS A total of 200 patients with 220 benign thyroid nodules who underwent RFA were included in this respective study. After RFA, patients were followed up at 1, 3, 6, and 12 months, and every 12 months thereafter. Regrowth was defined as an increase in nodule volume 50% over the previously recorded smallest volume. A nomogram was developed based on the variables identified by multivariate logistic regression and the model performance was evaluated by discrimination(concordance index) and calibration curves. RESULTS The incidence of regrowth was 13.64% (30/220) after a mean follow-up period of 27.43 ± 17.99 months. Multivariate logistic regression revealed initial volume (OR = 1.047, 95%CI 1.020-1.075), vascularity (OR = 2.037, 95%CI 1.218-3.404), and location close to critical structure (OR = 4.713, 95%CI 1.817-12.223) were independent factors associated with regrowth. The prognostic nomogram incorporating these three factors achieved good calibration and discriminatory abilities with a concordance index of 0.779 (95%CI 0.686-0.872). CONCLUSIONS A prognostic nomogram was successfully developed to predict nodule regrowth after RFA, which might guide physician in stratifying patients and provide precise guidance for individualized treatment protocols.
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Choi Y, Jung SL. Efficacy and Safety of Thermal Ablation Techniques for the Treatment of Primary Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis. Thyroid 2020; 30:720-731. [PMID: 31801432 DOI: 10.1089/thy.2019.0707] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The increased incidence of primary papillary thyroid microcarcinoma (PTMC) has led to increased research in the field of nonsurgical therapeutic options for those who refuse surgery or are at high risk for surgery. The study aimed at comprehensively evaluating the efficacy and safety of thermal ablation techniques for the treatment of PTMC via a systematic review and meta-analysis. Methods: The Pubmed MEDLINE and EMBASE databases were searched for studies reporting the efficacy and safety of thermal ablations (radiofrequency-, laser-, and microwave-ablations [RFA, LA, and MWA]) until August 10, 2019. A review of 105 potential papers identified 11 eligible papers, including 715 patients. The pooled proportions of complete disappearance and recurrence, and the pooled estimates of mean volume reduction and its rate of the treated PTMC were assessed by using random-effects modeling. The pooled proportions of overall and major complications were calculated. Subgroup analysis was performed according to the treatment modality. Between-study heterogeneity was explored by using χ2 statistic for pooled estimates and inconsistency index I2. Quality of the studies was evaluated by using the Risk of Bias Assessment Tool for Nonrandomized Studies. Results: The pooled proportions of complete disappearance and recurrence of PTMC were 57.6% [95% confidence interval (CI): 35.4-79.8] and 0.4% [95% CI: 0-1.1], respectively. The pooled estimates of mean volume reduction and its rate were 73.5 mm3 [52.4-94.6 mm3] and 98.1% [95% CI: 96.7-99.5], respectively. The pooled proportions of overall and major complications were 3.2% [95% CI: 1.1-5.2] and 0.7% [95% CI: 0-1.5], respectively. Significant between-study heterogeneity was observed for complete disappearance (p < 0.001, I2: 99%), mean volume reduction (p < 0.001, I2: 93%), and its rate (p < 0.001, I2: 86%). Subgroup analysis revealed heterogeneity of the complete disappearance proportion among the treatment modality (I2 range: 95-100%). RFA showed the highest mean volume reduction rate (99.3%), followed by MWA (95.3%) and LA (88.6%) (p < 0.001). Conclusions: All thermal ablation techniques were effective and safe for the treatment of PTMC. However, each treatment modality had significant heterogeneity with respect to complete disappearance of PTMC. Compared with RFA and MWA, LA was less effective in reducing the volume of PTMC.
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Affiliation(s)
- Yangsean Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So-Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Xiao J, Zhang M, Zhang Y, Yan L, Lan Y, Zhu Y, Zhang Y, Lin L, Tang J, Luo Y. Efficacy and safety of ultrasonography-guided radiofrequency ablation for the treatment of T1bN0M0 papillary thyroid carcinoma: a retrospective study. Int J Hyperthermia 2020; 37:392-398. [PMID: 32340500 DOI: 10.1080/02656736.2020.1752945] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Jing Xiao
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yu Lan
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yaqiong Zhu
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ying Zhang
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Lin
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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30
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Tong M, Li S, Li Y, Li Y, Feng Y, Che Y. Efficacy and safety of radiofrequency, microwave and laser ablation for treating papillary thyroid microcarcinoma: a systematic review and meta-analysis. Int J Hyperthermia 2020; 36:1278-1286. [PMID: 31826684 DOI: 10.1080/02656736.2019.1700559] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: To evaluate the efficacy and safety of radiofrequency ablation (RFA), microwave ablation (MWA) and laser ablation (LA) for treating papillary thyroid microcarcinoma (PTMC).Materials and methods: PUBMED and EMBASE were searched for studies on the efficacy and safety of RFA, MWA and LA for treating PTMC. The standard mean difference of the tumor volume before and after therapy and the proportion of complete disappearance, local recurrence, distant metastasis and complications were assessed using both fixed or random-effects modeling. Heterogeneity among studies was determined using the Q statistic for the pooled estimates and the inconsistency index I2.Results: A total of 12 eligible studies, including a sample size of 1187 patients and 1284 PTMCs, were used. RFA, MWA and LA all showed a significant reduction in tumor volume of PTMCs (p < 0.05). Though MWA demonstrated superior efficacy over the other two therapies for volume reduction, the differences were not statistically significant. Additionally, the pooled proportion of complete disappearance after RFA was the highest (76.2%), and the pooled proportion of recurrence for RFA was the lowest (0.01%) among the three therapeutic methods, but no significant difference was detected. There was no event of distant metastasis during the follow-up in all of these studies. Few major complications were encountered; the pooled proportion of complications for RFA (1.73%), MWA (6.0%) and LA (0.92%) was low, revealing no significant differences (p > 0.05).Conclusion: RFA, MWA and LA are acceptable treatments to manage PTMCs in terms of efficacy and safety for non-surgical candidates.
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Affiliation(s)
- Mengying Tong
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Liaoning, Dalian, P.R. China
| | - Shuang Li
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Liaoning, Dalian, P.R. China
| | - Yulong Li
- Center of Genome and Personalized Medicine, Institute of Cancer Stem Cell, Dalian Medical University, Liaoning, Dalian, P. R. China
| | - Ying Li
- Center of Genome and Personalized Medicine, Institute of Cancer Stem Cell, Dalian Medical University, Liaoning, Dalian, P. R. China
| | - Yue Feng
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Liaoning, Dalian, P.R. China
| | - Ying Che
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Liaoning, Dalian, P.R. China
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Li M, Zhang Y, Zhang X. Effects of surgery and radiofrequency ablation in the treatment of spinal metastases and analysis of the influencing factors of prognosis. Exp Ther Med 2020; 19:1072-1078. [PMID: 32010271 PMCID: PMC6966132 DOI: 10.3892/etm.2019.8310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/03/2019] [Indexed: 12/16/2022] Open
Abstract
Effects of surgery and radiofrequency ablation in the treatment of spinal metastases were explored to analyze the influencing factors of prognosis. A total of 132 patients with spinal metastases admitted to Weifang People's Hospital were selected, 67 patients who underwent simple surgery were selected as the control group, and 65 patients who underwent radiofrequency ablation assisted surgery were the research group. The time of operation and intraoperative blood loss of patients in the two groups were recorded and compared. The visual analogue pain score (VAS), Karnofsky (KPS) score, Frankel spinal cord injury grading, and complications within 6 months after surgery were compared. The patients were followed up for 36 months and the survival rates were analyzed. Cox regression model was used to analyze the factors affecting the prognosis of patients. The time of operation and blood loss in the research group was significantly lower than that in the control group (P<0.05). The VAS, KPS scores, and Frankel grading of patients in the two groups after treatment were significantly improved compared with those before treatment, but the VAS and KPS scores of patients in the research group were significantly improved compared with those in the control group (P<0.05). The incidence rate of complications and 3-year recurrence rate in the research group were lower than those in the control group, and the 3-year survival rate was significantly higher than that in the control group (P<0.05). The number of pathological cones, visceral metastasis, malignant degree, and radiofrequency ablation therapy are independent risk factors for poor prognosis of patients. Radiofrequency ablation assisted surgery can effectively improve the clinical efficacy of patients with spinal metastases, reduce postoperative complications and recurrence rate of patients, and prolong the survival time of patients compared with simple surgical treatment. It is worthy of clinical application.
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Affiliation(s)
- Meiling Li
- Department of Gynecology, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Yan Zhang
- Department of General Surgery, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Xiujuan Zhang
- Department of General Surgery, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
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Zhang Y, Zhang MB, Luo YK, Li J, Zhang Y, Tang J. Effect of chronic lymphocytic thyroiditis on the efficacy and safety of ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma. Cancer Med 2019; 8:5450-5458. [PMID: 31359613 PMCID: PMC6746112 DOI: 10.1002/cam4.2406] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/05/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic lymphocytic thyroiditis (CLT) is an autoimmune disease commonly associated with papillary thyroid carcinoma characterized by a smaller primary tumor size at presentation. The efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) coexisting with CLT is still unknown. METHODS Sixty patients with unifocal PTMC were enrolled and classified into PTMC and PTMC+CLT groups (n = 30/group). CLT was diagnosed histopathologically. The ablation area exceeded the tumor margins, and was evaluated by US and contrast-enhanced US (CEUS) for residual tumor to prevent recurrence. Three months after ablation, US-guided core-needle biopsy was performed to assess the presence of residual and recurrent cancer. Preoperative and postoperative data on patients and tumors were recorded and analyzed. RESULTS There were no differences between groups in age, sex, preoperative tumor volume, ablation time, or ablation power (P > 0.05). There was also no significant difference in postoperative ablation zone volume between the groups at the 1-, 3-, 6-, 12-, and 18-month follow-ups (P > 0.05). The volume reduction rate significantly differed between the two groups at month 3 (P = 0.03). The ablation area could not be identified on US and CEUS at 9.8 ± 5.0 and 10.0 ± 4.8 months in the PTMC and PTMC + CLT groups, respectively (P = 0.197). No serious complications occurred during and after ablation. No residual cancer cells were found on biopsy after ablation. CONCLUSIONS RFA was effective in patients with PTMC+CLT, and its therapeutic efficacy and safety were similar to those in patients with PTMC without CLT.
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Affiliation(s)
- Yan Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ming-Bo Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu-Kun Luo
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Li
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ying Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Tang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
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