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1.
Radiology ; 311(1): e230459, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38563669

RESUMO

Background Microwave ablation (MWA) is currently under preliminary investigation for the treatment of multifocal papillary thyroid carcinoma (PTC) and has shown promising treatment efficacy. Compared with surgical resection (SR), MWA is minimally invasive and could preserve thyroid function. However, a comparative analysis between MWA and SR is warranted to draw definitive conclusions. Purpose To compare MWA and SR for preoperative US-detected T1N0M0 multifocal PTC in terms of overall and 1-, 3-, and 5-year progression-free survival rates and complication rates. Materials and Methods In this retrospective study, 775 patients with preoperative US-detected T1N0M0 multifocal PTC treated with MWA or SR across 10 centers between May 2015 and December 2021 were included. Propensity score matching (PSM) was performed for patients in the MWA and SR groups, followed by comparisons between the two groups. The primary outcomes were overall and 1-, 3-, and 5-year progression-free survival (PFS) rates and complication rates. Results After PSM, 229 patients (median age, 44 years [IQR 36.5-50.5 years]; 179 female) in the MWA group and 453 patients (median age, 45 years [IQR 37-53 years]; 367 female) in the SR group were observed for a median of 20 months (range, 12-74 months) and 26 months (range, 12-64 months), respectively. MWA resulted in less blood loss, shorter incision length, and shorter procedure and hospitalization durations (all P < .001). There was no evidence of differences in overall and 1-, 3-, or 5-year PFS rates (all P > .05) between MWA and SR (5-year rate, 77.2% vs 83.1%; P = .36) groups. Permanent hoarseness (2.2%, P = .05) and hypoparathyroidism (4.0%, P = .005) were encountered only in the SR group. Conclusion There was no evidence of a significant difference in PFS rates between MWA and SR for US-detected multifocal T1N0M0 PTC, and MWA resulted in fewer complications. Therefore, MWA is a feasible option for selected patients with multifocal T1N0M0 PTC. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Georgiades in this issue.


Assuntos
Micro-Ondas , Neoplasias da Glândula Tireoide , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Micro-Ondas/uso terapêutico , Estudos Retrospectivos , Câncer Papilífero da Tireoide/diagnóstico por imagem , Câncer Papilífero da Tireoide/cirurgia , Hospitalização , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia
2.
Int J Hyperthermia ; 41(1): 2308063, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38314664

RESUMO

OBJECTIVE: To evaluate the complications associated with microwave ablation (MWA) in treating persistent/recurrent hyperparathyroidism (HPT) post-surgical or ablative treatments. MATERIALS AND METHODS: From January 2015 to December 2022, 87 persistent/recurrent HPT patients (primary HPT [PHPT]: secondary HPT [SHPT] = 13:74) who underwent MWA after surgical or ablative treatment were studied. Grouping was based on ablation order (initial vs. re-MWA), prior treatment (parathyroidectomy [PTX] vs. MWA), and etiology (PHPT vs. SHPT). The study focused on documenting and comparing treatment complications and analyzing major complication risk factors. RESULT: Among the 87 patients, the overall complication rate was 17.6% (15/87), with major complications at 13.8% (12/87) and minor complications at 3.4% (3/87). Major complications included recurrent laryngeal nerve (RLN) palsy (12.6%) and Horner syndrome (1.1%), while minor complications were limited to hematoma (3.4%). Severe hypocalcemia noted in 21.6% of SHPT patients. No significant differences in major complication rates were observed between initial and re-MWA groups (10.7% vs. 13.8%, p = 0.455), PTX and MWA groups (12.5% vs. 15.4%, p = 0.770), or PHPT and SHPT groups (15.4% vs. 13.5%, p > 0.999). Risk factors for RLN palsy included ablation of superior and large parathyroid glands (>1.7 cm). All patients recovered spontaneously except for one with permanent RLN palsy in the PTX group (2.1%). CONCLUSION: Complication rates for MWA post-surgical or ablative treatments were comparable to initial MWA rates. Most complications were transient, indicating MWA as a viable and safe treatment option for persistent/recurrent HPT patients.


Assuntos
Técnicas de Ablação , Hiperparatireoidismo Secundário , Ablação por Radiofrequência , Humanos , Micro-Ondas/efeitos adversos , Técnicas de Ablação/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Hiperparatireoidismo Secundário/cirurgia , Paralisia/etiologia , Estudos Retrospectivos
3.
Acad Radiol ; 2024 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-38262812

RESUMO

RATIONALE AND OBJECTIVES: To evaluate the feasibility, efficiency, and safety of microwave ablation (MWA) for multifocal papillary thyroid microcarcinoma (PTMC). METHODS: This was a retrospective study, and the data of patients who underwent MWA for multifocal PTMC from October 2016 to December 2021 were reviewed. After ablation, the changes in tumor size and volume, as well as the rates of technical success, tumor disappearance, disease progression, and complications, were assessed. According to the tumor location, the cases were further divided into a unilateral multifocal disease (UMD) subgroup and a bilateral multifocal disease (BMD) subgroup. Further analyses were carried out. RESULTS: There was a total of 94 cases enrolled in the present study, which included 24 males and 70 females. The median age was 40 years (22-66 years); the median follow-up time was 14 months (6-48 months). Complete ablation was achieved in all enrolled cases. Therefore, the technical success rate was 100%. Due to expanding ablation, the MD and volume of the ablation zone increased at the 1st and 3rd months after ablation and decreased from the 12th month after ablation (p < 0.05 for all). The total complete tumor disappearance rates were 45/94 (47.87%) overall, 40.625% (13/32) in the UMD subgroup and 51.61% (32/62) in the BMD subgroup (p = 0.312). The total disease progression rates were 4.26% (4/94) overall, 6.25% (2/32) in the UMD subgroup and 3.23% (2/62) in the BMD subgroup (p = 0.881). The overall complication rate was 4.26% (4/94). CONCLUSION: This preliminary study indicates that MWA is a safe and effective treatment for multifocal PTMC.

4.
Int J Hyperthermia ; 40(1): 2250935, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37699584

RESUMO

OBJECTIVE: To compare the health-related quality of life (HRQoL) of patients with T1N0M0 papillary thyroid carcinoma (PTC) who underwent microwave ablation (MWA) and those who underwent total thyroidectomy (TT). MATERIALS AND METHODS: From February 2018 to February 2022, 180 T1N0M0 PTC patients were enrolled in present study, including 90 in the MWA group and 90 in the TT group, respectively. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QoL) were completed by patients to evaluate their HRQoL scores. RESULTS: According to the results of the EORTC-QLQ-C30, there was a significant difference in the scores of global health, physical, emotional, etc. between the two groups, which indicated that the quality of life in these items in the MWA group was better than those in the TT group (all p < 0.05). According to the results of the THYCA-QoL, all items had significant differences between the two groups except for headache, which demonstrated the thyroid-specific quality of life was higher in the MWA group than in the TT group (all p < 0.05). CONCLUSION: Ultrasound (US)-guided MWA offers a significant advantage in HRQoL over TT in T1N0M0 PTC patients, which provides an important reference for MWA as an alternative strategy to TT.


Assuntos
Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Qualidade de Vida , Câncer Papilífero da Tireoide/cirurgia , Micro-Ondas/uso terapêutico , Neoplasias da Glândula Tireoide/cirurgia
5.
Int J Hyperthermia ; 40(1): 2243408, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37544651

RESUMO

OBJECTIVE: To study the safety of improved hydrodissection based on the periparathyroidal fascial space during microwave ablation (MWA) for secondary hyperparathyroidism (SHPT). MATERIALS AND METHODS: Data from 337 patients (162 males and 175 females; mean age, 50.8 ± 12.8 [range, 16-84] years) who underwent MWA for SHPT were retrospectively reviewed. Among them, 177 patients underwent traditional hydrodissection (traditional group) and 160 patients underwent improved hydrodissection based on periparathyroidal fascial spaces (improved group). Safety enhancement was analyzed by comparing the complications between the two groups. The characteristics of the hydrodissected fascial spaces, complications, and the follow-up results were recorded. The baseline data, clinical parameters, laboratory indices and characteristics of SHPT lesions were analyzed to assess the risk factors associated with hoarseness. RESULTS: Hydrodissection was successfully performed in all the enrolled patients according to the protocol. Six periparathyroid fascial spaces were hydrodissected, depending on the location of the SHPT lesions. The incidence of hoarseness due to recurrent laryngeal nerve injury, the most common complication of thermal ablation for SHPT lesions, was lower in the improved group than in the traditional group (6.9% vs. 13.0%, p = 0.044). The median hoarseness recovery time in the improved group was shorter than that in the traditional group (2 vs. 6 months, p < 0.001). There was no difference in technical efficiency between the two groups (improved group vs. traditional group: 75.0% vs. 70.6%; p > 0.05). CONCLUSIONS: Compared with traditional hydrodissection, improved hydrodissection based on periparathyroidal fascial spaces could enhance safety during MWA for SHPT.


Assuntos
Técnicas de Ablação , Hiperparatireoidismo Secundário , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Ablação/métodos , Rouquidão/complicações , Hiperparatireoidismo Secundário/cirurgia , Micro-Ondas/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Adolescente , Adulto Jovem , Idoso , Idoso de 80 Anos ou mais
6.
Eur Radiol ; 33(12): 8727-8735, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37466709

RESUMO

OBJECTIVES: Microwave ablation (MWA) has been widely used for unifocal papillary thyroid carcinoma (U-PTC) and has recently been preliminarily used in multifocal papillary thyroid carcinoma (M-PTC). However, the efficacy and safety of MWA for M-PTC have not been investigated in large samples. The aim of the present study was to evaluate the efficacy and safety of MWA for M-PTC and compare them with MWA for U-PTC. MATERIALS AND METHODS: This retrospective multicentre study enrolled 504 patients (376 females) who underwent MWA for U-PTC (340 cases) or M-PTC (164 cases) from Jan 2015 to Dec 2020. The median age of the patients was 43 years (age range, 20-80 years). Propensity score matching (PSM) was used to balance the baseline characteristics between M-PTC group and U-PTC group. The tumour progression, tumour disappearance, and complication rates were compared between the two groups. RESULTS: The complete ablation was achieved in all enrolled cases in one session. According to the statistical results, no significant differences were shown in tumour progression-free survival (p  = 0.29) or cumulative tumour progression rate (6.7% vs. 4.3%, p  = 0.33) between the M-PTC and U-PTC groups during the follow-up time. However, the tumour disappearance rate in the M-PTC group was lower in the U-PTC group (40.9% vs. 62.8%, p < 0.001), and tumour disappearance was slower in the M-PTC group (p < 0.001). The complication rate showed no significant difference (3.0% vs. 4.9%, p  = 0.571). CONCLUSIONS: MWA is an effective and safe treatment for selected patients with M-PTC, and the prognosis is similar to that of U-PTC. CLINICAL RELEVANCE STATEMENT: The present study provided evidence that compared with unifocal papillary thyroid cancer, microwave ablation could also treat multifocal T1N0M0 papillary thyroid cancer safely with similar clinical outcome, which could promote the application of minimally invasive treatment for papillary thyroid cancer. KEY RESULTS: • Microwave ablation for multifocal and unifocal T1N0M0 papillary thyroid carcinoma had similar tumour progression rates after propensity score matching (6.7% vs. 4.3%, p = 0.33). • The tumour disappearance rate in the multifocal group was lower than that in the unifocal group (40.9% vs. 62.8%, p < 0.001), and tumour disappearance was slower in the multifocal group (p < 0.001). • Tumour size, number, and location were not risk factors for tumour progression in the multifocal papillary thyroid cancer group.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Câncer Papilífero da Tireoide/cirurgia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Estudos Retrospectivos , Resultado do Tratamento , Micro-Ondas/uso terapêutico , Carcinoma Papilar/cirurgia , Carcinoma Papilar/patologia
7.
Int J Hyperthermia ; 40(1): 2202373, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37121576

RESUMO

OBJECTIVES: To study the efficacy and safety of an improved hydrodissection protocol based on the perithyroidal fascial space during microwave ablation for papillary thyroid carcinoma (PTC). METHODS: The data of 341 patients (94 men and 247 women, median age 41 years old, 25%-75% interquartile range 34-53 years old, nodule maximum diameter 0.2-1.9 cm) who underwent microwave ablation for PTC were retrospectively reviewed. Among them, 185 patients underwent traditional hydrodissection and served as a control group, and 156 patients underwent improved hydrodissection based on perithyroidal fascial spaces, constituting the improved group. Improvements in safety were analyzed by comparing complications between the two groups. The characteristics of hydrodissected spaces, complications, and follow-up results were recorded. RESULTS: Hydrodissection was successfully performed in all enrolled patients according to the protocol. The incidence of hoarseness caused by recurrent laryngeal nerve injury, the most common complication in thermal ablation of thyroid nodules, was significantly lower in the improved group than in the control group (1.9% vs. 8.1%, p = 0.021). The median hoarseness recovery time in the improved group was shorter than that in the control group (2 months vs. 3 months, p = 0.032). During follow-up, no local recurrence was encountered in either group. The tumor disappearance rate was not significantly different between the two groups (69.9% vs. 75.7%, p = 0.228). CONCLUSIONS: Improved hydrodissection based on perithyroidal fascial spaces had better protective effects than traditional hydrodissection.


Assuntos
Micro-Ondas , Neoplasias da Glândula Tireoide , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Câncer Papilífero da Tireoide/cirurgia , Estudos Retrospectivos , Micro-Ondas/uso terapêutico , Rouquidão , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Resultado do Tratamento
8.
J Vasc Interv Radiol ; 34(6): 999-1006, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36758743

RESUMO

PURPOSE: To study the feasibility, safety, and effectiveness of microwave ablation (MWA) in patients with multifocal papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS: This retrospective study included patients who underwent MWA for multifocal PTMC (number of nodules ≤3). A total of 44 patients were included, and the mean age was 43 years (SD ± 11). After ablation, progression-free survival (PFS) at 6, 12, 24, 36, and 48 months; disease progression; change in tumor size and volume; tumor disappearance rate; and adverse events (AEs) were assessed, and the feasibility, safety, and effectiveness of MWA for PTMC were evaluated on the basis of statistical analysis. RESULTS: The median follow-up period was 18 months (interquartile range, 12-33 months). The PFS rates at 6, 12, 24, 36, and 48 months were 100.0%, 96.4%, 96.4%, 70.3%, and 52.7%, respectively. The disease progression rate was 11.4% (5 of 44 patients). The maximum diameter (MD) and volume of the ablation zone were larger at the 3-month follow-up than before ablation (median MD, 13.0 vs 7.0 mm; P < .001; median volume, 503.8 vs 113.0 mm3; P < .001). Subsequently, the tumors exhibited a reduction in both size and volume after 18 months (median MD, 4.0 vs 7.0 mm; P = .04; median volume, 12.6 vs 113.0 mm3; P = .055). At the end of the follow-up period, the complete response rate was 59% (26 of 44 patients). The overall AE rate was 6.8%. CONCLUSIONS: MWA is a feasible treatment for PTMC (number of nodules ≤3), and this study preliminarily demonstrated the safety and effectiveness of this technique.


Assuntos
Micro-Ondas , Neoplasias da Glândula Tireoide , Humanos , Adulto , Estudos Retrospectivos , Micro-Ondas/efeitos adversos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Progressão da Doença , Resultado do Tratamento
9.
Int J Endocrinol ; 2022: 7916327, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36147726

RESUMO

Purpose: Microwave ablation (MWA) is a minimally invasive method for the thermal ablation of benign thyroid nodules and papillary thyroid cancer (PTC) and has shown promising results. The aim of this study was to investigate the impact of MWA on thyroid antibodies and associated influencing factors. Materials and Methods: A total of 119 patients, including 69 with benign thyroid nodules and 50 with PTC, underwent MWA between June 2019 and June 2021. The serum levels of (free) triiodothyronine, (free) thyroxine, thyrotropin, and antibodies against Tg (TGAb), thyrotropin receptors (TRAb), and thyroid peroxidase (TPOAb) were measured during the follow up. Results: One month after ablation, three patients (4.3%) in the benign group had hypothyroidism, and one (1.4%) had hyperthyroidism. Four patients (5.8%) had subclinical hypothyroidism, and two (2.9%) had subclinical hyperthyroidism. Among the PTC patients, two (4%) had hypothyroidism, and one (2%) had hyperthyroidism. Two patients (4%) had subclinical hypothyroidism, and one (2%) had subclinical hyperthyroidism. In the benign group, among patients with normal preablation antibodies, the postablation TGAb abnormal rate was 12.7%, the TPOAb level was 4.8%, and the TRAb level was 0%. Among PTC patients, the postablation TGAb abnormal rate was 11.4%, the TPOAb level was 8.7%, and the TRAb level was 4.0%. The cutoff value of preablation TGAb for predicting postoperative antibody abnormalities was 19.0 IU/mL, while that of TPOAb was 11.4 IU/mL. Conclusions: MWA of thyroid nodules had little influence on thyroid function and antibodies. Elevations in TGAb, TPOAb, and TRAb beyond the normal ranges after MWA may be related to high preablation levels of TGAb and TPOAb.

10.
Radiology ; 304(3): 704-713, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35536133

RESUMO

Background Microwave ablation (MWA) has attracted interest as a minimally invasive treatment for papillary thyroid carcinoma (PTC). However, comparisons between MWA and surgical resection (SR) in the management of T1N0M0 PTC are rare. Purpose To compare the technical effectiveness, disease progression, and complications of MWA and SR for solitary T1N0M0 PTC. Materials and Methods This retrospective study was conducted in a single center. A total of 1029 patients with T1N0M0 PTC treated with either MWA or SR from January 2015 to May 2021 were studied and divided into two groups according to treatment modality. Propensity score matching and inverse probability of treatment weighting were used to control for confounding factors. Disease progression was analyzed in T1N0M0 PTCs as well as T1a and T1b subgroups by using Kaplan-Meier curves and Cox proportional hazards regression models. Results A total of 404 patients (mean age, 43 years ± 12 [SD]; 289 women; 337 with T1a PTC) underwent MWA, and 625 (mean age, 46 years ± 12; 495 women; 521 with T1a PTC) underwent SR. During the follow-up (median, 25 months; IQR, 7-61 months), there was no evidence of differences regarding disease progression in T1N0M0 (4.0% vs 4.0%; P = .97), T1a (3.4% vs 3.8%; P = .89), or T1b PTCs (6.8% vs 5.0%; P = .72). Compared with SR, MWA resulted in less blood loss (2 mL vs 10 mL) and a shorter procedure time (23 minutes vs 72 minutes) (both P < .001). The rate of major complications was 5.4% (19 of 350 patients) in the MWA group and 6.3% (22 of 350 patients) in the SR group (P = .75). Permanent hoarseness only occurred in the SR group (1.7%; P = .03). Conclusion For T1a and T1b solitary T1N0M0 papillary thyroid carcinomas, there was no evidence of differences regarding disease progression and major complications between microwave ablation and surgical resection. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by vanSonnenberg and Simeone in this issue.


Assuntos
Ablação por Cateter , Neoplasias da Glândula Tireoide , Adulto , Ablação por Cateter/métodos , Progressão da Doença , Feminino , Humanos , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Resultado do Tratamento
11.
Eur Radiol ; 32(9): 5821-5830, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35381852

RESUMO

OBJECTIVE: To compare the clinical outcomes between microwave ablation (MWA) and parathyroidectomy (PTX) for the treatment of primary hyperparathyroidism (pHPT). MATERIALS AND METHODS: This retrospective study enrolled 212 patients with pHPT treated by either MWA (MWA group) or PTX (PTX group) from January 2015 to October 2020. The baseline data were balanced through propensity score matching. Clinical cure was evaluated by the Kaplan-Meier method and compared between the MWA and PTX groups. The risk factors related to persistent or recurrent pHPT were screening out using a Cox proportional hazards regression model. RESULTS: After propensity score matching, a total of 174 patients were enrolled in the present study, with 87 patients in each group. During the follow-up period (median, 28.5 months), there were no differences between the two groups regarding the clinical cure (hazard ratio, 1.71; 95% confidence interval: 0.81-3.62; p = .155), persistent pHPT rate (13.8% vs. 10.3%, p = .643), recurrent pHPT rate (6.9% vs. 3.4%, p = .496), or major complications (6.9% vs. 3.4%, p = .496). MWA resulted in a shorter procedure time (30 min vs. 60 min), smaller incision length (0.1 cm vs. 7 cm) and slightly higher costs (25745 CNY vs. 24111 CNY) (all p < .001). High levels of preoperative intact parathyroid hormone (p = .01) and multiple pHPT nodules (p < .001) were independent risk factors for recurrent and persistent pHPT in the two groups. CONCLUSION: MWA and PTX have comparable clinical outcomes for pHPT. MWA has a shorter procedure time and smaller incision length. KEY POINTS: • There were no differences in terms of clinical cure, persistent pHPT, recurrent pHPT, or major complications between MWA and PTX in the treatment of pHPT. • MWA is minimally invasive and results in a shorter procedure time. • Multiple nodules and high levels of iPTH were the independent risk factors for recurrent and persistent pHPT.


Assuntos
Hiperparatireoidismo Primário , Paratireoidectomia , Estudos de Coortes , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/cirurgia , Micro-Ondas/uso terapêutico , Estudos Retrospectivos
12.
J Clin Endocrinol Metab ; 107(7): e2930-e2937, 2022 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-35311971

RESUMO

CONTEXT: Recurrent laryngeal nerve (RLN) injury is a complication of thermal thyroid nodule treatment. OBJECTIVE: We investigated the influencing factors of RLN injury in patients who underwent thermal ablation of thyroid nodules. METHODS: The data of 1004 patients (252 male, 752 female; median age 44 years) who underwent thermal thyroid nodule ablation were retrospectively reviewed. Patients were divided into benign cystic, benign solid, and papillary thyroid cancer (PTC) groups. The parameters related to RLN injury were analyzed, including the largest diameter, location of the nodules, and shortest distance of the nodule to thyroid capsule and tracheoesophageal groove (TEG). Univariate and multivariate analyses were performed to select risk factors for RLN injury. RESULTS: The RLN injury rate was higher in PTC (6.3%) than in benign cystic (1.2%, P = 0.019) and solid nodules (2.9%, P = 0.018). PTC subgroup analysis showed that the RLN injury rate was higher in T1b (10.7%) and T2 (28.6%) PTC than in T1a PTC (5.0%, P < 0.05). In the PTC group, TEG distance, anterior capsule distance, median capsule distance, posterior capsule distance, and maximum nodule diameter were risk factors for RLN injury. The logistic regression fitting of the nomogram showed high prediction efficiency (C-Index 0.876). The main cause of RLN injury was insufficient medial isolating fluid (MIF). The safety thicknesses of MIF for benign cystic, benign solid, and PTC nodules were 3.1 mm, 3.7 mm, and 3.9 mm, respectively. CONCLUSION: Several risk factors for RLN injury should be considered before thermal ablation of thyroid nodules. The RLN injury rate could be predicted with the nomogram.


Assuntos
Traumatismos do Nervo Laríngeo Recorrente , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Adulto , Feminino , Humanos , Masculino , Traumatismos do Nervo Laríngeo Recorrente/epidemiologia , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Traumatismos do Nervo Laríngeo Recorrente/cirurgia , Estudos Retrospectivos , Fatores de Risco , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/complicações , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos
13.
Int J Hyperthermia ; 39(1): 372-378, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35184656

RESUMO

OBJECTIVE: To evaluate the feasibility, efficiency, and safety of microwave ablation (MWA) for T1N0M0 papillary thyroid carcinoma (PTC) with capsular invasion (CI). METHODS: The data of 69 T1N0M0 PTC with CI underwent MWA from August 2015 to January 2020 were retrospectively analyzed. All PTC nodules were pathologically confirmed by fine needle aspiration (FNA). The extended ablation was performed in all cases, that is, the ablation zone completely covered the tumor and extended the tumor edge by at least 2 mm. The strategy of fluid isolation was successfully applied before and during ablation. The strategy of multiple point ablation was applied. After ablation, the changes in tumor size at different time points, local recurrence, new lesions, lymph node metastasis (LNM), and complications were evaluated and recorded. The technical feasibility, technical success rate, and safety were analyzed. RESULTS: Based on the contrast-enhanced ultrasound results, complete ablation has been achieved in all enrolled cases after ablation. The mean maximum tumor diameter and the mean volume of PTC nodules before ablation were 0.84 ± 0.39 cm (range, 0.3-2 cm) and 0.26 ± 0.35 ml (range, 0.01-1.72 ml) respectively. The mean follow-up time was 26 ± 10 months (range, 9-48 months). Nodules in 47 cases (68.1%) completely disappeared in the follow-up period. No local recurrence was detected. The incidence of new lesions and LNM was 4.3% (3/69) and 4.3% (3/69) respectively. Further ablations have been successfully employed for all of the new lesions and LMN. Light voice changes (2.9%, 2/69) were the only major complication, which was relieved within 6 months after MWA. The sizes of the ablation zone increased firstly within 6 months after MWA compared with the pretreatment tumor size (p < 0.05). Twelve months later, the sizes were smaller than those before MWA (p < 0.05 for all). CONCLUSIONS: MWA is an effective, safe, and feasible method in treating T1N0M0 PTC with CI.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Carcinoma Papilar/cirurgia , Humanos , Micro-Ondas/uso terapêutico , Estudos Retrospectivos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Resultado do Tratamento
14.
Sci Rep ; 12(1): 578, 2022 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-35022480

RESUMO

Cervical lymph node metastasis (CLNM) is common in patients with papillary thyroid carcinoma (PTC), which is responsible for tumor staging and surgical strategy. The accurate preoperative identification of CLNM is essential. In this study, twenty consecutive patients with PTC received a parenchyma injection of Sonazoid followed by contrast enhanced ultrasound (CEUS) to identify CLNM. The specific lymphatic CEUS (LCEUS) signs for diagnosing CLNM were summarized, which were further compared with the resected specimens to get the pathological basis. After the injection of contrast agent, lymphatic vessel and lymph node (LN) could be exclusively displayed as hyperperfusion on LCEUS. The dynamic perfusion process of contrast agent in CLNM over time can be clearly visualized. Perfusion defect and interruption of bright ring were the two characteristic LCEUS signs in diagnosing CLNM. After comparing with pathology, perfusion defect was correlated to the metastatic foci in medulla and interruption of bright ring was correlated to the tumor seeding in marginal sinus (all p values < 0.001). The diagnostic efficacies of these two signs were high (perfusion defect vs. interruption of bright ring: AUC, 0.899, 95% CI 0.752-1.000 vs. 0.904, 0.803-1.000). LCEUS has advantages in identifying CLNM from PTC. The typical LCEUS signs of CLNM correlated with pathology.


Assuntos
Meios de Contraste , Compostos Férricos , Ferro , Linfonodos/diagnóstico por imagem , Óxidos , Câncer Papilífero da Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pescoço , Estudos Prospectivos , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia
16.
Int J Hyperthermia ; 38(1): 1217-1224, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34384314

RESUMO

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.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Carcinoma Papilar/cirurgia , Estudos de Viabilidade , Humanos , Micro-Ondas/uso terapêutico , Recidiva Local de Neoplasia , Estudos Retrospectivos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Resultado do Tratamento
17.
Int J Hyperthermia ; 38(1): 1023-1030, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34219596

RESUMO

OBJECTIVE: To compare the clinical outcomes of microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of primary hyperparathyroidism (pHPT). METHOD: This retrospective study included 104 pHPT patients treated by MWA or RFA between January 2015 and March 2020 in four centers. The clinical outcomes including effectiveness and complications were compared between the two groups. Ablation cure was defined as the reestablishment of normal values of serum calcium and intact parathyroid hormone (iPTH) at least more than 6 months. Clinical cure was defined as the reestablishment of normal values of serum calcium and iPTH throughout the entire follow-up period. RESULTS: A total of 77 patients underwent MWA (mean age, 55.5 ± 16.4 years) and 27 underwent RFA (mean age, 58.9 ± 15.6 years). During the follow-up (median, 18.7 months in the MWA group; 12 months in the RFA group), no difference was observed between ablation cure rates (88.3% vs. 88.9%, p = 1.000), clinical cure rates (87.0% vs. 82.3%, p = .880), recurrent pHPT (5.2% vs. 3.7%, p = .447), persistent pHPT (11.7% vs. 11.1%, p = 1.000) and complication rate (9.1% vs. 3.7%, p = .677). A maximum diameter less than 0.7 cm was an independent prognostic factor of uncured pHPT in ablation (hazard ratio, 0.1; 95% confidence interval: 0.02, 0.54; p = .007). Major complication - voice change encountered in five patients (6.5%) in the MWA group and in one patient (3.7%) in the RFA group. CONCLUSION: Both RFA and MWA are safe and effective techniques for patients with pHPT, with comparable clinical outcomes.


Assuntos
Ablação por Cateter , Hiperparatireoidismo Primário , Ablação por Radiofrequência , Adulto , Idoso , Humanos , Hiperparatireoidismo Primário/cirurgia , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Hormônio Paratireóideo , Estudos Retrospectivos , Resultado do Tratamento
18.
Int J Hyperthermia ; 38(1): 916-922, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34148494

RESUMO

PURPOSE: Ultrasound-guided thermal ablation (including microwave ablation [MWA] and radiofrequency ablation [RFA]) has emerged as a remarkable technology for the treatment of benign and malignant diseases. The objective of this multicenter study was to assess the efficacy and safety of thermal ablation in a large cohort of patients with papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS: Retrospective study of 725 patients who underwent MWA/RFA at 11 centers between March 2015 and March 2020. The mean age of patients was 46 ± 11 years (range, 22-81); the mean follow-up time was 21 ± 13 months (range, 6-60). Changes in size of tumor, the rates of tumor disappearance, disease progression, and complications were assessed. RESULTS: From 6 months post-ablation, the size of tumors was significantly reduced compared with those recorded pre-ablation (p < 0.001 for all). Five hundred and fifteen (71.0%) PTMCs had completely disappeared as assessed by ultrasound examination. Six (0.8%) patients developed disease progression post-ablation; of these, 5 (0.7%) patients developed new PTMCs, while one (0.1%) patient developed cervical lymph node metastasis. Nineteen (2.6%) patients developed complications post-ablation; of these 14 (1.9%) patients developed voice hoarseness, 4 (0.6%) developed hematoma, and one (0.1%) patient developed cough. CONCLUSIONS: Ultrasound-guided thermal ablation represents an effective and safe treatment for patients with PTMC besides active surveillance and surgery.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/cirurgia , Criança , Pré-Escolar , Humanos , Lactente , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Ultrassonografia de Intervenção
19.
Radiology ; 300(1): 209-216, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33904775

RESUMO

Background Microwave ablation (MWA) and radiofrequency ablation (RFA) have recently attracted interest as minimally invasive treatment modalities for papillary thyroid carcinoma (PTC). However, the ablation outcomes of T1N0M0 PTC are not well characterized. Purpose To evaluate the efficacy and safety of thermal ablation (MWA or RFA) of solitary T1N0M0 PTC in patients who were ineligible for (due to presence of comorbid cardiovascular disease, renal failure, other malignancy, etc) or who refused surgery. Materials and Methods This was a retrospective multicenter study of 847 patients (660 women) who underwent thermal ablation for PTC (673 T1a, 174 T1b) between March 2015 and March 2020; of these patients, 645 underwent MWA and 202 underwent RFA. The mean age of patients was 46 years ± 11 (standard deviation) (age range, 18-81 years); the mean follow-up time was 22 months ± 13 (range, 6-60 months). Changes in tumor size and volume and the rates of technical success, tumor disappearance, disease progression, and complications were assessed. Results The technical success rate was 100%. Relative to preablation measurements, the maximum diameter and volume of the ablation zone increased during the 1st month after ablation (P < .001), whereas there was no difference by the 3rd month; subsequently, the tumors showed reduction in size at 6, 9, and 12 months (all P < .001). Complete disappearance of tumors occurred in 68% of patients (577 of 847; 69% [466 of 673] in the T1a group vs 64% [111 of 174] in the T1b group; P < .001). The postablation disease progression rate was 1.1% (nine of 847 patients; 0.9% [six of 673 patients] in the T1a group vs 1.7% [three of 174 patients] in the T1b group; P = .54). The overall complication rate was 3.4% (29 of 847 patients; 2.7% [18 of 673 patients] in the T1a group vs 6.3% [11 of 174 patients] in the T1b group; P = .02). Conclusion This multicenter study provided evidence that thermal ablation is an effective and safe treatment option in selected -patients with solitary T1N0M0 papillary thyroid carcinoma. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Baek and Cho in this issue.


Assuntos
Micro-Ondas/uso terapêutico , Ablação por Radiofrequência , Câncer Papilífero da Tireoide/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Câncer Papilífero da Tireoide/patologia
20.
J Clin Endocrinol Metab ; 106(9): 2707-2717, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-33846740

RESUMO

CONTEXT: Ultrasound (US)-guided thermal ablation has generated recent interest as minimally invasive treatments of primary hyperparathyroidism (pHPT). But definitive evidence for the efficacy of thermal ablation in treating pHPT is not well characterized. OBJECTIVE: This work aims to evaluate the effectiveness and safety of thermal ablation for pHPT. METHODS: From January 2015 to March 2020, data pertaining to patients who received thermal ablation for pHPT at 4 centers were retrospectively analyzed. The median follow-up duration was 18.1 months (interquartile range, 6.5-42.2 months). A cure referred to the reestablishment of normal values of serum calcium and intact parathyroid hormone throughout the entire follow-up period, at least more than 6 months. The technical success, effectiveness, and safety of treatment were analyzed. RESULTS: A total of 119 patients (mean age, 57.2 ±â€…16.3 years; 81 female) with 134 parathyroid nodules were enrolled. The mean maximum diameter of the parathyroid glands was 1.6 ±â€…0.9 cm. Ninety-six patients underwent microwave ablation (MWA), and 23 patients underwent radiofrequency ablation (RFA). The technical success rate was 98.3% and the cure rate was 89.9%. Significant differences were found in the maximum diameter between the cured patients and the patients who did not undergo ablation of the target lesions. Except for cases with pHPT nodules less than 0.6 cm in diameter, the cure rate was 95%. There were no difference in cure rates at 6 months between the MWA and RFA groups (MWA vs RFA, 90.6% vs 87.0%; χ 2 = 0.275, P = .699). The volume reduction rate of the ablation zone was 94.6% at 12 months. The complication rate was 6.7% (8/119). With the exception of one patient with persistent voice impairment, other symptoms spontaneously resolved within 6 months. CONCLUSION: Thermal ablation is effective and safe for pHPT.


Assuntos
Ablação por Cateter/métodos , Hiperparatireoidismo Primário/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/efeitos adversos , Feminino , Humanos , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Ablação por Radiofrequência/métodos , Estudos Retrospectivos , Adulto Jovem
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