Hay Ian D, Lee Robert A, Kaggal Suneetha, Morris John C, Stan Marius N, Castro M Regina, Fatourechi Vahab, Thompson Geoffrey B, Charboneau J William, Reading Carl C
Departments of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Departments of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
J Endocr Soc. 2020 Sep 15;4(11):bvaa135. doi: 10.1210/jendso/bvaa135. eCollection 2020 Nov 1.
Currently acceptable management options for patients with adult papillary thyroid microcarcinoma (APTM) range from immediate surgery, either unilateral lobectomy or bilateral lobar resection, to active surveillance (AS). An alternative minimally invasive approach, originally employed for eliminating neck nodal metastases, may be ultrasound-guided percutaneous ethanol ablation (EA). Here we present our experience of definitively treating with EA 15 patients with APTM.
During 2010 through 2017, the 15 cT1aN0M0 patients selected for EA were aged 36 to 86 years (median, 45 years). Tumor volumes (n = 17), assessed by sonography, ranged from 25 to 375 mm (median, 109 mm). Fourteen of 15 patients had 2 ethanol injections on successive days; total volume injected ranged from 0.45 to 1.80 cc (median, 1.1 cc). All ablated patients were followed with sonography and underwent recalculation of tumor volume and reassessment of tumor perfusion at each follow-up visit.
The ablated patients have now been followed for 10 to 100 months (median, 64 months). There were no complications and no ablated patient developed postprocedure recurrent laryngeal nerve dysfunction. All 17 ablated tumors shrank (median 93%) and Doppler flow eliminated. Median tumor volume reduction in 9 identifiable avascular foci was 82% (range, 26%-93%). After EA, 8 tumors (47%) disappeared on sonography after a median of 10 months. During follow-up no new PTM foci and no nodal metastases have been identified.
Definitive treatment of APTM by EA is effective, safe, and inexpensive. Our results suggest that, for APTM patients who do not wish neck surgery and are uncomfortable with AS, EA represents a well-tolerated and minimally invasive outpatient management option.
目前，成人甲状腺微小乳头状癌（APTM）患者可接受的治疗方案包括立即手术（单侧叶切除术或双侧叶切除术）以及主动监测（AS）。一种最初用于消除颈部淋巴结转移的替代微创方法可能是超声引导下经皮乙醇消融术（EA）。在此，我们介绍我们使用EA对15例APTM患者进行确定性治疗的经验。
在2010年至2017年期间，选择接受EA治疗的15例cT1aN0M0患者年龄在36至86岁之间（中位数为45岁）。通过超声检查评估的肿瘤体积（n = 17）范围为25至375立方毫米（中位数为109立方毫米）。15例患者中有14例连续两天接受了两次乙醇注射；注射的总体积范围为0.45至1.80立方厘米（中位数为1.1立方厘米）。所有接受消融治疗的患者均接受超声检查随访，每次随访时重新计算肿瘤体积并重新评估肿瘤灌注情况。
接受消融治疗的患者现已随访10至100个月（中位数为64个月）。未出现并发症，且没有接受消融治疗的患者出现术后喉返神经功能障碍。所有17个接受消融的肿瘤均缩小（中位数为93%），且多普勒血流消失。9个可识别的无血管病灶的肿瘤体积中位数减少了82%（范围为26% - 93%）。EA治疗后，中位数为10个月时，8个肿瘤（47%）在超声检查中消失。在随访期间，未发现新的PTM病灶和淋巴结转移。
通过EA对APTM进行确定性治疗是有效、安全且廉价的。我们的结果表明，对于不希望进行颈部手术且对主动监测感到不适的APTM患者，EA是一种耐受性良好的微创门诊治疗选择。
