Bernardi Stella, Palermo Andrea, Grasso Rosario Francesco, Fabris Bruno, Stacul Fulvio, Cesareo Roberto
Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy.
U.C.O. Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, 34149 Trieste, Italy.
Cancers (Basel). 2021 Jun 1;13(11):2746. doi: 10.3390/cancers13112746.
US-guided minimally-invasive techniques, such as radiofrequency ablation (RFA) have emerged as an alternative treatment for benign and malignant thyroid nodules. This systematic review aims to provide an overview on the long-term outcomes of US-guided RFA in patients with benign and malignant thyroid nodules.
We systematically searched PubMed/MEDLINE, EMBASE, and Scopus to identify articles reporting the outcomes of thyroid RFA after a follow-up of at least 3 years.
A total of 20 studies met the inclusion criteria and were included in the review. In patients with benign thyroid nodules, RFA significantly reduced nodule volume and this was generally maintained for the following 5 years. However, a small but not negligible proportion of nodules regrew and some of them required further treatments over time. In patients with malignant nodules, RFA has been used not only to treat differentiated thyroid cancer (DTC) neck recurrences, but also to treat papillary thyroid microcarcinoma (PTMC). In most patients with PTMC, RFA led to complete disappearance of the tumor. When it was compared to surgery, RFA was not inferior in terms of oncologic efficacy but it had a lower complication rate. However, RFA did not allow for final pathology, disease staging and accurate risk stratification.
US-guided RFA significantly reduces benign thyroid nodules and destroys most PTMC, and this is generally maintained for at least 5 years after the initial treatment. Further studies addressing the risk of regrowths in patients with benign thyroid nodules, as well as the risk of recurrence in patients with PTMC are needed.
超声引导下的微创技术，如射频消融（RFA）已成为治疗良性和恶性甲状腺结节的一种替代方法。本系统评价旨在概述超声引导下RFA治疗良性和恶性甲状腺结节患者的长期疗效。
我们系统检索了PubMed/MEDLINE、EMBASE和Scopus，以确定报告甲状腺RFA随访至少3年后疗效的文章。
共有20项研究符合纳入标准并被纳入本评价。在良性甲状腺结节患者中，RFA显著减小了结节体积，且在随后5年中通常保持这一效果。然而，一小部分但不可忽略的结节会复发，其中一些随着时间推移需要进一步治疗。在恶性结节患者中，RFA不仅用于治疗分化型甲状腺癌（DTC）颈部复发，还用于治疗甲状腺微小乳头状癌（PTMC）。在大多数PTMC患者中，RFA导致肿瘤完全消失。与手术相比，RFA在肿瘤学疗效方面并不逊色，但并发症发生率较低。然而，RFA无法获得最终病理结果、疾病分期和准确的风险分层。
超声引导下RFA可显著减小良性甲状腺结节并破坏大多数PTMC，且在初始治疗后通常至少5年保持这一效果。需要进一步研究解决良性甲状腺结节患者的复发风险以及PTMC患者的复发风险。
