Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Ultrasound, Zibo Central Hospital, Zibo, China.
Front Endocrinol (Lausanne). 2022 Aug 22;13:967044. doi: 10.3389/fendo.2022.967044. eCollection 2022.
To evaluate the safety and efficacy of radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) for the treatment of cervical metastatic lymph nodes (CMLNs) of papillary thyroid carcinoma (PTC).
The Pubmed, EMBASE, Web of Science, and Cochrane Library databases were searched for studies on the safety and efficacy of thermal ablations (RFA, MWA, and LA) for the treatment of CMLNs of PTC until March 30, 2022. A review of 334 potential papers identified 17 eligible papers including 312 patients. Fixed-effects model or random-effects model was used to evaluate the pooled proportions of volume reduction rate (VRR), complete disappearance, and recurrence, and pooled estimates of changes in the largest diameter, volume, and serum after ablation. The pooled proportions of overall and major complications were calculated. Subgroup analysis based on treatment modalities. The heterogeneity among studies was analyzed by using statistics and inconsistency index . MINORS scale was used to evaluate the quality of the studies.
17 eligible studies were finally identified, including 312 patients and 559 CMLNs. The pooled proportions of VRR, complete disappearance and recurrence of CMLNs were 91.28% [95% confidence interval : 86.60-95.97%], 67.9% [95% : 53.1-81.1%] and 7.8% [95%: 3.0-14.1%], respectively. The pooled estimates of changes in the largest diameter, volume and serum were 8.12 mm [95%: 6.78-9.46 mm], 338.75 mm [95%: 206.85 -470.65 mm] and 5.96 ng/ml [95%: 3.68-8.24 ng/ml], respectively. The pooled proportions of overall and major complications were 2.9% [95%: 0.3-7.1%] and 0.3% [95%: 0-1.9%], respectively. Significant between-study heterogeneity was observed for complete disappearance (<0.01, 88.6%), VRR (<0.001, 99.9%), recurrence (=0.02, 47.76%), overall complications (<0.02, 44.8%), and changes in the largest diameter ( < 0.001, 82.6%), volume (<0.001, 97.0%), and serum ( < 0.001, 93.7%). Subgroup analysis showed heterogeneity of the VRR among the treatment modality ( range: 84.4-100%). The VRR of MWA was the highest (97.97%), followed by RFA (95.57%) and LA (84.46%) ( < 0.001).
All thermal ablations were safe and effective for the treatment of CMLNs of PTC. However, each treatment had significant heterogeneity in VRR. Compared with RFA and MWA, LA was less effective in reducing the volume of CMLNs of PTC.
评估射频消融（RFA）、微波消融（MWA）和激光消融（LA）治疗甲状腺乳头状癌（PTC）颈部转移性淋巴结（CMLN）的安全性和疗效。
检索 Pubmed、EMBASE、Web of Science 和 Cochrane Library 数据库，以评估热消融（RFA、MWA 和 LA）治疗 PTC 的 CMLN 的安全性和疗效，截至 2022 年 3 月 30 日。通过对 334 篇潜在论文的综述，确定了 17 篇符合条件的论文，其中包括 312 名患者。使用固定效应模型或随机效应模型评估体积减少率（VRR）、完全消失和复发的汇总比例，以及消融后最大直径、体积和血清 的变化的汇总估计值。计算了总并发症和主要并发症的汇总比例。基于治疗方式的亚组分析。使用 统计量和不一致指数 分析研究之间的异质性。使用 MINORS 量表评估研究的质量。
最终确定了 17 项符合条件的研究，包括 312 名患者和 559 个 CMLN。CMLN 的 VRR、完全消失和复发的汇总比例分别为 91.28%（95%置信区间：86.60-95.97%）、67.9%（95%：53.1-81.1%）和 7.8%（95%：3.0-14.1%）。最大直径、体积和血清 变化的汇总估计值分别为 8.12mm（95%：6.78-9.46mm）、338.75mm（95%：206.85-470.65mm）和 5.96ng/ml（95%：3.68-8.24ng/ml）。总并发症和主要并发症的汇总比例分别为 2.9%（95%：0.3-7.1%）和 0.3%（95%：0-1.9%）。完全消失（<0.01，88.6%）、VRR（<0.001，99.9%）、复发（=0.02，47.76%）、总并发症（<0.02，44.8%）和最大直径变化（<0.001，82.6%）的汇总比例存在显著的研究间异质性。体积（<0.001，97.0%）和血清 （<0.001，93.7%）。亚组分析显示，治疗方式的 VRR 存在异质性（范围：84.4-100%）。MWA 的 VRR 最高（97.97%），其次是 RFA（95.57%）和 LA（84.46%）（<0.001）。
所有热消融术均安全有效，可用于治疗 PTC 的 CMLN。然而，每种治疗方法在 VRR 方面均存在显著异质性。与 RFA 和 MWA 相比，LA 降低 PTC 的 CMLN 体积的效果较差。
