1 Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center , Shanghai, People's Republic of China .
2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai, People's Republic of China .
Thyroid. 2018 Sep;28(9):1134-1142. doi: 10.1089/thy.2017.0558. Epub 2018 Aug 14.
Recently, thermal ablation has been proposed for treating primary papillary thyroid carcinoma (PTC), triggering an extensive debate. This study aimed to analyze surgical outcomes of post-ablation cases to investigate the effectiveness and safety of thermal ablation in primary PTC.
Primary PTC patients treated with thermal ablation were retrospectively searched for from the authors' medical record database prior to August 2017. The surgical patients met the following criteria: (i) primary PTC treated with thermal ablation, (ii) findings suspicious for malignancy of the post-ablation lesions on ultrasound or malignancy confirmed by cytology, or with clinical evidence of cervical lymph node metastasis (LNM), (iii) written informed consent for surgery, (iv) preference for definite diagnosis of the post-ablation lesions for the patients without evidence for malignant findings, and (v) tolerance of a thyroidectomy and without severe illness. Moreover, a systematic review of the literature was made to analyze relevant cases.
Twelve patients with an average age of 41.0 ± 13.6 years constituted the Fudan University Shanghai Cancer Center cohort in this study. Twenty-two foci with a mean size of 1.3 ± 0.7 cm were ablated percutaneously under ultrasound guidance. Residual PTCs were confirmed in all cases by histopathology, and LNM was present in 66.7% (8/12) of the patients. Intraoperatively, adhesion of the post-ablation lesions with the strap muscles was observed in six cases. Strap muscles were found to be cauterized in five cases, and notably the recurrent laryngeal nerve was involved in one case. Furthermore, seven relevant studies from Korea, Italy, and China were retrospectively reviewed, and incomplete ablation of primary PTC and omission of LNM by thermal ablation were observed frequently.
Surgical therapy demonstrated incomplete ablation of primary PTC and omission of LNM by thermal ablation in this cohort of patients. Thermal ablation should be recommended with caution as treatment of operable patients with primary PTC.
最近，热消融被提议用于治疗原发性甲状腺乳头状癌（PTC），引发了广泛的争论。本研究旨在分析消融后的手术结果，以研究热消融治疗原发性 PTC 的有效性和安全性。
回顾性地从作者的病历数据库中搜索 2017 年 8 月之前接受热消融治疗的原发性 PTC 患者。手术患者符合以下标准：（i）接受热消融治疗的原发性 PTC，（ii）消融后病变的超声表现疑似恶性或细胞学证实为恶性，或有颈部淋巴结转移（LNM）的临床证据，（iii）有手术的书面知情同意书，（iv）对于没有恶性发现证据的患者，首选消融后病变的明确诊断，（v）能够耐受甲状腺切除术且没有严重疾病。此外，还进行了文献系统综述，以分析相关病例。
本研究纳入了 12 例平均年龄为 41.0±13.6 岁的复旦大学附属肿瘤医院患者。经超声引导经皮消融 22 个病灶，平均大小为 1.3±0.7cm。所有病例均通过组织病理学证实存在残余 PTC，66.7%（8/12）的患者存在 LNM。术中发现 6 例消融后病变与颈阔肌粘连。5 例发现颈阔肌被烧灼，其中 1 例明显累及喉返神经。此外，还回顾性分析了来自韩国、意大利和中国的 7 项相关研究，发现热消融常导致原发性 PTC 消融不完全和 LNM 遗漏。
本研究队列中，手术治疗显示热消融治疗原发性 PTC 存在不完全消融和 LNM 遗漏。因此，对于可手术的原发性 PTC 患者，应谨慎推荐热消融治疗。
