School of Medicine, Nankai University, Tianjin, China.
Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2021 Aug 24;12:674970. doi: 10.3389/fendo.2021.674970. eCollection 2021.
The purpose of our study was to evaluate the effectiveness of thermal ablation (TA) for Bethesda IV thyroid nodules, and to compare TA and surgery in terms of treatment outcomes, complications, and costs.
This study was approved by the local ethics committee. From January 2017 to December 2019, 30 patients elected TA and 31 patients elected surgery for treatment of Bethesda IV thyroid nodules. Demographics information and conventional ultrasound before treatment for each patient was obtained. For the TA group, the ablation extent was 3 mm beyond the edge of the tumor to prevent marginal residual and recurrence. Patients were followed up at 1, 3, and 6 months after intervention, and every 6 months thereafter. Postoperative complications, operation time, hospitalization time, blood loss, and incision length were recorded.
In the TA group, the volume reduction ratio (VRR) was 94.63 ± 8.99% (range:76%-100%) at the final follow-up. The mean follow-up time was 16.4 ± 5.2months (range:12-24 months). No recurrences, no metastatic lymph node, and no distant metastases were detected during follow-up. The TA group had fewer complications, shorter operation time, smaller incision length, less blood loss, shorter hospitalization time, and lower treatment costs compared to the surgery group (all <0.001).
TA is technically feasible for the complete destruction of Bethesda IV thyroid nodules, and also safe and effective during the follow-up period, with high VRR and low complication rates, especially in patients who were ineligible for or refused surgery.
本研究旨在评估热消融（TA）治疗 Bethesda IV 甲状腺结节的有效性，并比较 TA 和手术在治疗效果、并发症和成本方面的差异。
本研究获得了当地伦理委员会的批准。从 2017 年 1 月至 2019 年 12 月，30 例患者选择 TA 治疗，31 例患者选择手术治疗 Bethesda IV 甲状腺结节。获得每位患者治疗前的人口统计学信息和常规超声检查结果。对于 TA 组，消融范围超出肿瘤边缘 3mm，以防止边缘残留和复发。患者在干预后 1、3 和 6 个月以及此后每 6 个月进行随访。记录术后并发症、手术时间、住院时间、出血量和切口长度。
在 TA 组，最终随访时的体积缩小率（VRR）为 94.63±8.99%（范围：76%-100%）。平均随访时间为 16.4±5.2 个月（范围：12-24 个月）。随访期间未发现复发、转移性淋巴结或远处转移。与手术组相比，TA 组并发症更少，手术时间更短，切口更小，出血量更少，住院时间更短，治疗费用更低（均<0.001）。
TA 技术上可行，可完全破坏 Bethesda IV 甲状腺结节，在随访期间安全有效，VRR 高，并发症发生率低，尤其适用于不适合手术或拒绝手术的患者。
