Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Otolaryngology-Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Front Endocrinol (Lausanne). 2022 Jul 26;13:915303. doi: 10.3389/fendo.2022.915303. eCollection 2022.
Radiofrequency ablation (RFA) has been widely applied in patients with benign thyroid nodules (BTNs), and complete ablation in a single-session treatment brings great benefits to patients. While how the ablation should be planned and performed to achieve complete ablation in a single-session treatment in large BTNs remains unknown.
To determine a more suitable ablation strategy for sufficient treatment in a single-session treatment.
This retrospective study included 108 BTNs receiving RFA treatment. These patients were divided into two groups: group A using one insertion point with a fan-shaped overlapping mode and group B using multiple insertion points with a novel parallel overlapping mode. All the treatments used a hydrodissection approach and moving-shot technique. Contrast-enhanced ultrasonography (CEUS) was used to guide the supplementary ablation. Follow-ups were performed at 1, 3, 6 and 12 months. The rates of supplementary ablation, initial ablation ratio (IAR), the rates of complete ablation (CAR), treatment effects and complications between the two groups were compared.
The group B had larger treated nodules (10.2ml vs 6.4ml, <0.001) than group A, while group B had a lower rate of supplementary ablation (21.6% vs 75.4%, <0.001), especially in the BTNs with craniocaudal diameters ≥30mm (22.0% vs 100%, <0.001). With the assistance of supplementary ablation, both groups achieved similar IAR (100% vs 100%, =0.372) and CAR (94.7% vs 94.1%, =1.000). Two groups showed similar VRRs at 12-month follow-up (77.9% vs 77.5%, =0.894) and similar rates of complications (3.5% vs 2.0%, =1.000).
Needle placement using the multiple insertion points with a novel parallel overlapping mode would be easier to achieve complete ablation with less supplementary ablation, especially in large nodules.
射频消融（RFA）已广泛应用于良性甲状腺结节（BTN）患者，单次治疗的完全消融可为患者带来极大的获益。然而，对于较大 BTN 单次治疗中如何规划和进行消融以实现完全消融仍不清楚。
确定更适合单次治疗中充分治疗的消融策略。
本回顾性研究纳入 108 例接受 RFA 治疗的 BTN 患者。这些患者分为两组：A 组采用一个插入点的扇形重叠模式，B 组采用多个插入点的新型平行重叠模式。所有治疗均采用水分离法和移动射击技术。对比增强超声（CEUS）用于指导补充消融。随访时间为 1、3、6 和 12 个月。比较两组间补充消融率、初始消融比（IAR）、完全消融率（CAR）、治疗效果和并发症。
B 组治疗的结节较大（10.2ml 比 6.4ml，<0.001），但 B 组补充消融率较低（21.6% 比 75.4%，<0.001），尤其是在头尾径≥30mm 的 BTN 中（22.0% 比 100%，<0.001）。在补充消融的辅助下，两组 IAR（100%比 100%，=0.372）和 CAR（94.7%比 94.1%，=1.000）相似。两组在 12 个月随访时的 VRR 相似（77.9%比 77.5%，=0.894），并发症发生率也相似（3.5%比 2.0%，=1.000）。
采用新型平行重叠模式的多个插入点放置更容易实现完全消融，且补充消融较少，尤其在大结节中。
