Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Int J Hyperthermia. 2021;38(1):976-984. doi: 10.1080/02656736.2021.1942241.
An intrathoracic goiter (ITG) is defined as a thyroid extension below the sternal notch. Compared to cervical goiters, surgery for ITG is more challenging, with a higher risk of an extracervical approach. Ultrasound (US)-guided radiofrequency ablation (RFA) is a minimally invasive treatment modality. The purpose of this study was to prospectively evaluate the safety and efficacy of RFA in patients with ITG.
From a total of 324 patients who underwent thyroid RFA at a single medical center, 15 patients (mean age 52.2 years; 73.3% female) with 16 ITGs were included and classified into three grades and three types using the cross-section imaging CT system. Clinical features and demographics, degree of extension, RFA details, goiter volume, and complications were analyzed.
Mean pre- and post-RFA goiter volumes as measured by US were 106.62 ± 61.82 and 25.09 ± 14.22 mL respectively, with a volume reduction rate (VRR) of 75.5% ( < 0.001) at 6 months. The VRR as measured by CT/MRI was 57.0 ± 10.0% ( < 0.001) at 6 months. The intrathoracic length reduction rate at 6 months was 44.9 ± 39.2% ( = 0.001). In addition, 4 (25%) ITGs had total regression of the intrathoracic extension, with a downgrade from grade 1 to cervical goiter. Mean pre- and post-RFA symptom and cosmetic scores were 1.53 and 0.15 ( = 0.001), and 2.67 and 2.00 ( = 0.001), respectively. One patient had transient vocal cord palsy and another had perithyroidal and mediastinal hemorrhage.
US-guided RFA is an effective treatment for ITG in terms of both cervical and intrathoracic reductions with an acceptable complication rate.
胸腔内甲状腺肿（ITG）是指甲状腺在胸骨切迹以下的延伸。与颈部甲状腺肿相比，ITG 的手术更具挑战性，采用颈外入路的风险更高。超声（US）引导下的射频消融（RFA）是一种微创治疗方法。本研究的目的是前瞻性评估 RFA 治疗 ITG 的安全性和有效性。
从在一家医疗中心接受甲状腺 RFA 的 324 名患者中，共纳入 15 名（平均年龄 52.2 岁；女性占 73.3%）患有 16 个 ITG 的患者，并使用横断面成像 CT 系统将其分为三级和三型。分析了临床特征和人口统计学、延伸程度、RFA 细节、甲状腺肿体积和并发症。
US 测量的术前和术后 RFA 甲状腺肿体积分别为 106.62 ± 61.82 和 25.09 ± 14.22 mL，6 个月时体积减少率（VRR）为 75.5%（ < 0.001）。CT/MRI 测量的 6 个月时的 VRR 为 57.0 ± 10.0%（ < 0.001）。6 个月时胸腔内长度减少率为 44.9 ± 39.2%（ = 0.001）。此外，4 个（25%）ITG 完全消退，胸腔内延伸程度从 1 级降为颈内甲状腺肿。术前和术后 RFA 的症状和美容评分分别为 1.53 和 0.15（ = 0.001），2.67 和 2.00（ = 0.001）。1 例患者出现暂时性声带麻痹，另 1 例患者出现甲状腺周围和纵隔血肿。
US 引导下的 RFA 是一种有效的治疗 ITG 的方法，可同时减少颈部和胸腔内的病变，并发症发生率可接受。
