Department of Endocrinology, Regina Apostolorum Hospital, Albano, Rome, Italy.
Thyroid. 2011 Aug;21(8):917-20. doi: 10.1089/thy.2010.0447. Epub 2011 May 19.
Incidental papillary thyroid microcarcinoma (PTMC), a frequent clinical problem, is usually associated with a favorable outcome. During long-term follow-up, only a minority of cases show aggressive behavior with either lymph node or distant metastases. Recently, we had an opportunity to evaluate the efficacy of nonsurgical, ultrasound (US)-guided percutaneous laser ablation (PLA) for local treatment of PTMC in an otherwise inoperable patient.
Neck US examination revealed an incidental, solitary, 8 × 7 × 7 mm hypoechoic nodule with microcalcifications of the right thyroid lobe. The patient suffered from decompensated liver cirrhosis, renal failure, and recent surgery followed by external beam radiation therapy for breast cancer. Cytologic diagnosis showed papillary thyroid carcinoma, but the patient declined surgery because of high risk of thyroid surgery. After local anesthesia with 2% xylocaine, PLA was performed according to the previously reported procedure with an Nd:YAG laser.
The procedure was well tolerated, without side effects, and the patient required no analgesics. US-guided fine-needle aspiration biopsy and core-needle biopsy were performed at 1 and 12 months after PLA, which demonstrated necrotic material and inflammatory cells with no viable neoplastic cell. At the 24 months US follow-up examination, the area of necrosis further decreased, demonstrating a 4 × 4 mm hypoechoic zone and a small hyperechoic area due to fibrotic changes. A fine-needle aspiration biopsy confirmed the absence of malignant cells.
Laser-induced thermal ablation was a safe and effective ablative treatment for a patient with PTMC confined to the thyroid gland who was at high surgical risk. This approach should be considered only in elderly patients and/or in those with comorbidities that might expose the patients to an undue high surgical risk and only after the evaluation by neck US, computed tomography, magnetic resonance imaging, or positron emission tomography/computed tomography rules out lymph-node involvement or metastatic disease.
偶然发现的甲状腺微小乳头状癌（PTMC）是一种常见的临床问题，通常预后良好。在长期随访中，只有少数病例表现出侵袭性行为，出现淋巴结或远处转移。最近，我们有机会评估非手术性、超声（US）引导下经皮激光消融（PLA）治疗无法手术的甲状腺微小乳头状癌患者局部病变的疗效。
颈部 US 检查发现右甲状腺叶单发、8×7×7mm 低回声结节，伴有微钙化。患者患有代偿性肝硬化、肾衰竭，近期因乳腺癌接受手术及外照射放疗。细胞学诊断为甲状腺乳头状癌，但由于甲状腺手术风险高，患者拒绝手术。在 2%的利多卡因局部麻醉下，按照先前报道的方法，用 Nd:YAG 激光进行 PLA。
该过程耐受良好，无副作用，患者无需使用镇痛药。PLA 后 1 个月和 12 个月进行 US 引导下细针抽吸活检和核心针活检，显示坏死物质和炎症细胞，无存活的肿瘤细胞。PLA 后 24 个月的 US 随访检查显示，坏死区域进一步缩小，表现为 4×4mm 的低回声区和由于纤维化改变导致的小高回声区。细针抽吸活检证实无恶性细胞。
激光诱导热消融是一种安全有效的治疗方法，适用于局限于甲状腺的、手术风险高的甲状腺微小乳头状癌患者。这种方法仅应考虑用于老年患者和/或存在可能使患者面临过度手术风险的合并症的患者，并且仅在通过颈部 US、计算机断层扫描、磁共振成像或正电子发射断层扫描/计算机断层扫描排除淋巴结受累或转移疾病后才考虑。
