Microwave Ablation versus Surgical Resection for US-detected Multifocal T1N0M0 Papillary Thyroid Carcinoma: A 10-Center Study.

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.

Complications of microwave ablation in patients with persistent/recurrent hyperparathyroidism after surgical or ablative treatment.

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.

Efficacy and safety of microwave ablation for the treatment of multifocal versus unifocal T1N0M0 papillary thyroid carcinoma: a propensity-matched multicentre retrospective study.

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.

Preliminary Study of Microwave Ablation for Multifocal Papillary Thyroid Microcarcinoma in Nonoperative Candidates.

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.

Safety enhancement of improved hydrodissection for microwave ablation in secondary hyperparathyroidism.

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.

A comparative study of quality of life in patients with papillary thyroid carcinoma undergoing microwave ablation vs. Total thyroidectomy.

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.

Upgraded hydrodissection and its safety enhancement in microwave ablation of papillary thyroid cancer: a comparative study.

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.

Microwave Ablation versus Surgical Resection for Solitary T1N0M0 Papillary Thyroid Carcinoma.

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.

Microwave ablation versus parathyroidectomy for the treatment of primary hyperparathyroidism: a cohort study.

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.

A preliminary study of microwave ablation for solitary T1N0M0 papillary thyroid carcinoma with capsular invasion.

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.

Efficacy and Safety of Thermal Ablation for Treatment of Solitary T1N0M0 Papillary Thyroid Carcinoma: A Multicenter Retrospective Study.

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.

Microwave ablation for papillary thyroid cancer located in the thyroid isthmus: a preliminary study.

PURPOSE: To assess the feasibility, efficacy, and safety of ultrasound (US)-guided microwave ablation (MWA) for the treatment of papillary thyroid cancer (PTC) located in the thyroid isthmus. MATERIALS AND METHODS: Thirty-four patients (mean age, 43 ± 11 years; 26 women) with isthmic PTC treated with MWA between June 2014 and September 2020 were included in this retrospective study. The follow-up time after MWA was 17 ± 9 months (range, 8-50 months). Changes in thyroid function, parathyroid function, and tumor size were evaluated, along with the rates of tumor disappearance and complications. RESULTS: The treatment was technically feasible and successfully completed in all 34 patients (100%). Measures of thyroid function (i.e. serum triiodothyronine, free thyroxine, and thyrotropin) and parathyroid function (i.e. serum calcium and intact parathyroid hormone) showed no changes from pretreatment levels at 1, 3, and 6 months after MWA (p > 0.05 for all). Tumor size was found to be increased at 1 and 3 months after MWA compared with before MWA (p < 0.05). However, the tumor sizes measured at 6, 9, 12, and 18 months after MWA were smaller than the pretreatment sizes (p < 0.05 for all). In 24 cases (70.6%), the tumors completely disappeared on US examination. Five cases (2.9%) experienced side effects from MWA treatment, but no major or minor complications were recorded. CONCLUSION: The results of this study demonstrate that US-guided MWA is a feasible, effective, and safe treatment option for selected patients with PTC located in the thyroid isthmus.

A feasibility study of microwave ablation for papillary thyroid cancer close to the thyroid capsule.

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.

Microwave ablation versus radiofrequency ablation for primary hyperparathyroidism: a multicenter retrospective study.

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.

Ultrasound-guided thermal ablation for papillary thyroid microcarcinoma: a multicenter retrospective study.

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.

Efficacy and safety of microwave ablation for cervical metastatic lymph nodes arising post resection of papillary thyroid carcinoma: a retrospective study.

Purpose: To evaluate the efficacy and safety of microwave ablation (MWA) for cervical metastatic lymph nodes (LNs) post resection of papillary thyroid cancer (PTC).Materials and methods: From November 2015 to November 2018, 14 patients with 38 cervical metastatic LNs treated by MWA were included in this retrospective study. Wilcoxon signed rank test was used to compare the changes of LN and serum thyroglobulin levels pre- and post-ablation.Results: The technical success rate in this study was 100% (38/38). The mean follow-up time was 23.6 ± 9.3 months. On pre-ablation contrast-enhanced ultrasound, 25 LNs showed high-enhancement, 8 LNs showed iso-enhancement, and 5 LNs showed low-enhancement. The median largest diameter of LNs at pre-ablation and 3, 6, 9, 12, 18, 24, and 36 months post-ablation was 11.5 mm and 9.5, 9.0, 8.0, 8.0, 8.0, 7.0, and 6.0 mm, respectively. The median volume of LNs at pre-ablation and 3, 6, 9, 12, 18, 24, and 36 months post-ablation were 251.2 mm3 and 206.7, 167.2, 166.2, 155.7, 153.9, 153.9, and 113.1 mm3, respectively. The largest diameter and the volume of the cervical metastatic LNs at the last post-ablation was significantly smaller than the pre-ablation level (p = .0016; p = .0018). Serum Tg level at the last post-ablation (median 1.25 ng/mL) was significantly lower than the pre-ablation level (median 8.35 ng/mL) (p = .001). There were no complications.Conclusion: MWA is a safe and effective novel treatment option for cervical metastatic LN that emerge post resection of PTC.

Efficacy and safety of microwave ablation treatment for secondary hyperparathyroidism: systematic review and meta-analysis.

Purpose: The present systematic review and meta-analysis was designed to evaluate the efficacy and safety of microwave ablation (MWA) treatment for secondary hyperparathyroidism (SHPT).Materials and methods: The study authors systematically searched the Web of Science, Cochrane Library, PubMed, Embase and Ovid databases for studies published in English prior to 7October 2019. All studies included in the meta-analysis measured levels of parathyroid hormone (PTH), calcium and phosphorus, and included data related to complications following MWA treatment for SHPT.Results: The meta-analysis ultimately included 233 patients from two retrospective cohort studies and six retrospective self-control studies. Compared to PTH level measurements obtained after MWA, measurements obtained at one day (weighted mean differences (WMD): 890.314, 95% confidence interval (CI): 767.121-1013.506, p < 0.01) , one week (WMD: 860.298, 95% CI: 759.401-961.194, p < 0.01), one month (WMD: 800.846, 95% CI: 687.709-913.983, p < 0.01) and six months (WMD: 860.847, 95% CI: 745.214-976.480, p < 0.01) after MWA were significantly lower. Calcium and phosphorus levels at one day and one week after MWA were also significantly lower than those measured before MWA. After MWA, the incidence of nerve injury was 1.2% (3/233; effect size (ES): 0.022, 95% CI: -0.003-0.048, p < 0.01). After MWA, the incidence of hypocalcemia was 15.8% (37/233; ES: 0.449, 95% CI: 0.341-0.556, p < 0.01).Conclusion: The preliminary results of this meta-analysis indicate that MWA may be effective and safe in treating patients with SHPT, and that future prospective research and randomized controlled trials (RCT) are necessary.

Hypocalcemia after ultrasound-guided microwave ablation and total parathyroidectomy for secondary hyperparathyroidism: a retrospective study.

OBJECTIVE: To compare the postoperative hypocalcemia between ultrasound-guided microwave ablation (MWA) and total parathyroidectomy (TPTX) for secondary hyperparathyroidism (SHPT). METHODS: The retrospective study reviewed 286 SHPT patients (171 received MWA and 115 underwent TPTX) between March 2018 and May 2019. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. A total of 184 SHPT patients (92 in each group) were finally enrolled, the occurrence and prognosis of postoperative hypocalcemia were compared. And the risk factors associated with severe hypocalcemia (SH) in each group were analyzed. RESULTS: Hypocalcemia encountered in 95cases (49 in the MWA group and 46 in the TPTX group). SH occurred in 76 cases (40 in the MWA group and 36 in the TPTX group). There were no statistically significant differences in the detection time, incidence, minimum value of serum calcium and symptomatic hypocalcemia between MWA and TPTX group (all p values > 0.05). Of patients developing hypocalcemia, serum calcium did not recover to normal range in 5 cases (10.2%) in the MWA group, while 13 cases (28.3%) were still hypocalcemia at 6 months follow-up in TPTX group (p = 0.035). The time to recovery from hypocalcemia in the TPTX group (mean 30 days, range 3-180 days) was longer than the WA group (mean 14 days, range 3-126 days) (p = 0.000). High serum alkaline phosphatase (ALP) level and low serum calcium level were the main risk factors of postoperative SH. CONCLUSION: There was no difference in hypocalcemia between MWA and TPTX group. Hypocalcemia in the TPTX group might need a longer time to recover.

Complications encountered in the treatment of primary and secondary hyperparathyroidism with microwave ablation - a retrospective study.

Purpose: To evaluate the complications encountered during microwave ablation (MWA) for primary and secondary hyperparathyroidism (HPT).Materials and methods: The retrospective study enrolled 213 secondary hyperparathyroidism (SHPT) and 51 primary hyperparathyroidism (PHPT) patients who received MWA between July 2015 and September 2018. The major and minor treatment-related complications were documented. The baseline data, clinical parameters, laboratory indices and characteristics of the parathyroid glands were analyzed to assess the risk factors associated with these complications.Results: The incidence of post-MWA complications in HPT patients was 12.1% (32/264). In total, five (5/264, 1.9%) patients with SHPT had major complications, including aphonia/hoarseness (n = 4) and Horner syndrome (n = 1). A total of 27 (10.2%, 27/264) HPT patients had minor complications, including neck hematoma (0.8%, 2/264), bucking (4.2%, 11/264) and phonasthenia (5.3%, 14/264). The incidence of severe hypocalcemia (SH) after MWA was 18.2%. Cutaneous necrosis occurred in two SH patients after intravenous calcium supplementation. There were no significant differences in the incidence of overall complications, major complications and minor complications between SHPT and PHPT patients (12.7% vs 9.8%, p = 0.811; 2.3% vs 0, p = 0.587; 10.3% vs 9.8%, p = 1.000). A history of parathyroidectomy (PTX) (p = 0.031) and multiple symptoms (p = 0.000) were risk factors for the occurrence of complications in SHPT patients. One patient sustained a permanent injury to a unilateral recurrent laryngeal nerve (RLN), and the two patients who experienced cutaneous necrosis underwent debridement plus autologous skin transplantation. The remaining patients recovered without sequelae.Conclusion: The incidence of major complications was low which only occurred in SHPT patients. Most of the patients with complications recovered spontaneously. MWA is safe for the treatment of HPT.

Propofol Suppresses Proinflammatory Cytokine Production by Increasing ABCA1 Expression via Mediation by the Long Noncoding RNA LOC286367.

We previously reported that propofol upregulated the expression of ATP-binding cassette transporter subfamily A member 1 (ABCA1) via peroxisome proliferator-activated receptor gamma/liver X receptor in macrophage-derived foam cells. Here, we provide evidence that in addition to inducing ABCA1 expression, propofol represses proinflammatory cytokine production by increasing ABCA1 expression in a LOC286367-dependent manner. Western blot analysis showed that ABCA1 expression was elevated in macrophages by propofol treatment and this effect was markedly reduced by LOC286367 overexpression. Moreover, propofol treatment downregulated the production of the proinflammatory cytokines interleukin-6, tumor necrosis factor, and interferon gamma in lipopolysaccharide-stimulated macrophages by enhancing ABCA1 expression. Notably, propofol achieved this effect in a LOC286367-dependent manner. To the best of our knowledge, this is the first report of the mechanism in which propofol represses proinflammatory cytokine production mediated by ABCA1.