Hegedüs Laszlo, Frasoldati Andrea, Negro Roberto, Papini Enrico
Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.
Division of Endocrinology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Eur Thyroid J. 2020 Jul;9(4):194-204. doi: 10.1159/000506513. Epub 2020 Mar 27.
Image-guided interventional ultrasound (US) techniques represent diagnostic and therapeutic tools for non-surgical management of thyroid nodular disease. We sought to investigate the attitude of European Thyroid Association (ETA) members towards the use of minimally invasive techniques (MIT) in diagnosis/therapy of symptomatic nodular goitre.
ETA members were invited to participate in an online survey investigating the use of MIT in benign and malignant thyroid nodular disease. Of 865 invited members, 221 (25.5%) completed the survey. The respondents were from 40 countries; 139 (74.7%) were from European countries.
Respondents personally performed thyroid US (91.6%), Fine needle aspiration (FNA; 75.3%), ethanol ablation (EA; 22.1%), core needle biopsy (CNB; 11%) and thermal treatments (4.8%). When skills and/or technology were unavailable, only 13.4% referred patients "often" or "always" to other centres with specific expertise in this field. Surgery was the preferred first option in patients with recurrent cysts, 4.0 cm benign nodules, local (radioiodine-avid or non-avid) lymph node metastases, or papillary cancers <1.0 cm. For autonomously functioning nodules radioactive iodine treatment was the preferred choice, followed by surgery. Thermal ablation (TA) was the preferred option only for a 4 cm benign nodule in old patients with comorbidities.
US, US-guided FNA and surgery were available to nearly all respondents, while MIT was not. CNB and EA were employed only by about 1/3 of the respondents and TA procedures were available and personally performed only by a minority. For most thyroid lesions, surgery was the preferred option versus thermal therapies. The ETA needs to develop guidelines and establish teaching to overcome geographic inequality and promote the use of MIT as a valid therapy option in appropriate cases.
图像引导下的介入性超声（US）技术是甲状腺结节性疾病非手术治疗的诊断和治疗工具。我们旨在调查欧洲甲状腺协会（ETA）成员对在有症状的结节性甲状腺肿诊断/治疗中使用微创技术（MIT）的态度。
邀请ETA成员参与一项关于MIT在良性和恶性甲状腺结节性疾病中应用的在线调查。在865名受邀成员中，221名（25.5%）完成了调查。受访者来自40个国家；139名（74.7%）来自欧洲国家。
受访者个人进行甲状腺超声检查（91.6%）、细针穿刺抽吸（FNA；75.3%）、乙醇消融（EA；22.1%）、粗针活检（CNB；11%）和热治疗（4.8%）。当缺乏相关技能和/或技术时，只有13.4%的人“经常”或“总是”将患者转诊至该领域有特定专业知识的其他中心。对于复发性囊肿、4.0 cm良性结节、局部（放射性碘亲和或不亲和）淋巴结转移或直径<1.0 cm的乳头状癌患者，手术是首选的第一治疗方案。对于自主功能性结节，放射性碘治疗是首选，其次是手术。热消融（TA）仅在合并症老年患者的4 cm良性结节中是首选方案。
几乎所有受访者都能进行超声检查、超声引导下FNA和手术，而MIT则不然。只有约1/3的受访者采用CNB和EA，只有少数人能够进行TA且亲自操作。对于大多数甲状腺病变，与热疗相比，手术是首选方案。ETA需要制定指南并开展教学，以克服地域不平等，促进在适当情况下将MIT作为一种有效的治疗选择。
