Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, 21204, USA.
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
Endocrine. 2021 Jun;72(3):619-632. doi: 10.1007/s12020-020-02598-6. Epub 2021 Jan 15.
In the thyroid gland, radiofrequency ablation (RFA) is being applied to both benign nodules and cancers internationally, while interest is also growing in the West. Benign thyroid nodules (BTNs) may be candidates for intervention when symptoms develop. For differentiated thyroid cancers (DTC), surgery is currently the first-line treatment. However, for candidates with high surgical risk or those who refuse to undergo repeated surgery, newer techniques such as RFA are an option. Surgery is associated with complications including hypothyroidism, voice change, hypocalcemia, and a scar. RFA has been used in Asian and European institutions as an alternative to surgery, but is relatively new in North America. Although RFA is not associated with significant complications, few randomized control trials have assessed its efficacy. The studies to date suggest a low rate of severe complications and a small need for thyroid hormone replacement following RFA. Further large-scale studies focusing on a Western population are needed. The aim of this review is to evaluate the evidence with respect to the current studies and data about the safety and efficacy of radiofrequency ablation for the management of BTNs and DTC.
We systematically searched the PubMed/MEDLINE, EMBASE, Clinical Queries, and Web of Science databases, for articles published up to April 30th, 2020.
Total of 75 studies that met the inclusion criteria were included in the review. Thirty-five studies focused on RFA use for solid nodules, 12 studies on predominantly cystic nodules, 10 for autonomously functioning thyroid nodules, and 18 studied were published on differentiated thyroid cancer.
RFA seems to be an effective and safe alternative to surgery in high-risk surgical patients with thyroid cancers and for selected BTNs. Additional trials with longer follow-up in North American patients are needed to validate its full role in the armamentarium of thyroid ologists.
在甲状腺中，射频消融（RFA）在国际上既用于良性结节又用于癌症，而西方对此也越来越感兴趣。当出现症状时，良性甲状腺结节（BTN）可能是干预的候选者。对于分化型甲状腺癌（DTC），手术目前是一线治疗方法。但是，对于手术风险高的患者或拒绝重复手术的患者，RFA 等新技术是一种选择。手术与包括甲状腺功能减退，声音改变，低钙血症和疤痕在内的并发症有关。RFA 已在亚洲和欧洲的机构中用作手术的替代方法，但在北美相对较新。尽管 RFA 与重大并发症无关，但很少有随机对照试验评估其疗效。迄今为止的研究表明，RFA 后严重并发症发生率低，需要甲状腺激素替代治疗的病例少。需要进行进一步的针对西方人群的大规模研究。本综述的目的是评估当前研究的证据以及有关 RFA 治疗 BTN 和 DTC 的安全性和有效性的现有数据。
我们系统地搜索了 PubMed/MEDLINE、EMBASE、Clinical Queries 和 Web of Science 数据库，以获取截至 2020 年 4 月 30 日发表的文章。
共有 75 项符合纳入标准的研究纳入了本综述。其中 35 项研究集中于 RFA 在实性结节中的应用，12 项研究主要针对囊性结节，10 项研究针对自主功能性甲状腺结节，18 项研究则研究了分化型甲状腺癌。
在高风险手术患者中，RFA 似乎是一种有效的安全替代手术方法，适用于甲状腺癌患者，也适用于某些 BTN。需要在北美患者中进行具有更长随访时间的额外试验，以验证其在甲状腺科医生的武器库中的全部作用。
