Department of Interventional Ultrasound, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China.
Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, China.
Eur Radiol. 2023 Jan;33(1):233-243. doi: 10.1007/s00330-022-08962-6. Epub 2022 Jun 30.
Minimal extrathyroid extension (mETE) was removed from the TNM staging system. This study was designed prospectively to compare the safety and efficacy of microwave ablation (MWA) versus surgery for treating T1N0M0 papillary thyroid carcinomas (PTC) with sonographically detected mETE.
From December 2019 to April 2021, 198 patients with T1N0M0 mETE-PTCs evaluated by preoperative ultrasound from 10 hospitals were included. Ninety-two patients elected MWA, and 106 patients elected surgery for treatment. MWA was performed using extensive ablation with hydrodissection. Surgery consisted of lobectomy with ipsilateral central lymph node dissection (CLD), lobe and isthmus excision with ipsilateral CLD and total thyroidectomy with ipsilateral CLD. The rates of technical success, cost, oncologic outcomes, complications and quality of life of the two groups were assessed.
The follow-up times for the MWA and surgery groups were 12.7 ± 4.1 and 12.6 ± 5.0 months, respectively. The technical success rate was 100% for both groups. Oncological outcomes of the two groups were similar during the follow-up (all p > 0.05). The MWA group had a shorter operation time, less blood loss and lower costs (all p < 0.001). Three complications (3.3%) were reported in the MWA group and 4 (3.8%) in the surgery group (p = 0.846). The surgery group had higher scores for scar problems and anxiety (p < 0.001 and p = 0.003, respectively).
Microwave ablation was comparable in the short term to surgery in terms of treatment safety and efficacy in selected patients with T1N0M0 mETE-PTC detected by ultrasound.
• Microwave ablation is comparable to surgery in the safety and short-term efficacy for PTCs with sonographically detected mETE. • Thermal ablation is technically feasible for mETE-PTC treatment. • Patients with mETE-PTC have similar quality of life in the two groups, except for worse scar problems and anxiety in the surgery group.
微小甲状腺外延伸（mETE）已从 TNM 分期系统中删除。本研究旨在前瞻性比较微波消融（MWA）与手术治疗超声检测到 mETE 的 T1N0M0 甲状腺乳头状癌（PTC）的安全性和疗效。
2019 年 12 月至 2021 年 4 月，来自 10 家医院的 198 例 T1N0M0 mETE-PTC 患者接受术前超声评估，纳入本研究。92 例患者选择 MWA 治疗，106 例患者选择手术治疗。MWA 采用广泛消融联合水分离进行。手术包括腺叶切除术伴同侧中央淋巴结清扫术（CLD）、腺叶和峡部切除术伴同侧 CLD 和全甲状腺切除术伴同侧 CLD。评估两组的技术成功率、费用、肿瘤学结果、并发症和生活质量。
MWA 组和手术组的随访时间分别为 12.7±4.1 和 12.6±5.0 个月。两组的技术成功率均为 100%。在随访期间，两组的肿瘤学结果相似（均 P>0.05）。MWA 组的手术时间更短、出血量更少、费用更低（均 P<0.001）。MWA 组报告了 3 例（3.3%）并发症，手术组报告了 4 例（3.8%）并发症（P=0.846）。手术组的疤痕问题和焦虑评分更高（均 P<0.001 和 P=0.003）。
在超声检测到的 T1N0M0 mETE-PTC 患者中，选择微波消融与手术相比，在治疗安全性和疗效方面短期结果相当。
微波消融在安全性和短期疗效方面与手术相当，适用于超声检测到微小甲状腺外延伸的 PTC 治疗。
热消融技术可用于 mETE-PTC 治疗。
除手术组患者的疤痕问题和焦虑评分更差外，两组患者的生活质量相似。
