中国一项回顾性单中心研究：超声引导激光消融治疗老年甲状腺微小乳头状癌的 5 年疗效和安全性随访。

A 5-year follow-up study on the efficacy and safety of ultrasound-guided laser ablation in elderly patients with papillary thyroid microcarcinoma: A retrospective, single-center study from China.

机构信息

Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China.

Department of Ultrasound, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China.

出版信息

Front Endocrinol (Lausanne). 2022 Nov 3;13:972589. doi: 10.3389/fendo.2022.972589. eCollection 2022.

DOI:10.3389/fendo.2022.972589

PMID:36407301

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9671076/

Abstract

OBJECTIVE

The aim of this study is to evaluate the long-term efficacy and safety of ultrasound-guided percutaneous laser ablation (PLA) for the treatment of elderly patients with papillary thyroid microcarcinoma (PTMC).

METHODS

From September 2015 to April 2017, 38 elderly patients with PTMC confirmed through fine-needle aspiration biopsy (FNAB) were treated with PLA. Before the treatment, the location and volume of the nodule together with the patients' symptoms were evaluated. Twenty-four hours after the treatment, contrast-enhanced ultrasound (CEUS) was performed to evaluate the completeness of the ablation. To evaluate the volume of the ablation area and recurrence or metastasis, ultrasound examination was performed at 1, 3, 6, and 12 months after the treatment and every 6 months thereafter. FNAB was performed for any suspicious recurrence or metastasis lesions.

RESULT

The ablation of all the 38 patients was all achieved completely as confirmed by CEUS. No obvious complications were found. The success rate of single ablation was 100%. The average follow-up time was 64.58 ± 5.29 months (60-78 months). By the time of the last follow-up, 31 (81.58%) ablation lesions disappeared completely and seven (18.42%) ablation lesions showed scar-like changes. The volume of nodules was 40.69 ± 16.45 mm before operation, which decreased to 0.22 ± 0.76 mm by the end of 42 months, and all nodules disappeared 4 years after ablation ( < 0.01). At 6, 12, 18, 24, 30, 36, and 42 months after ablation, the average volume reduction rates (VRRs) were 12.09%, 31.21%, 50.9%, 72.06%, 84.79%, 95.65%, and 100%, respectively. Of all the patients enrolled, one patient (2.6%) had local recurrence and was treated with PLA again. No regrowth of treated nodule or lymph node metastasis and distant metastases was detected.

CONCLUSION

Ultrasound-guided PLA is effective and safe for the treatment of elderly patients with PTMC who are ineligible for surgery.

摘要

目的

本研究旨在评估超声引导下经皮激光消融（PLA）治疗老年甲状腺微小乳头状癌（PTMC）的长期疗效和安全性。

方法

2015 年 9 月至 2017 年 4 月，对 38 例经细针穿刺活检（FNAB）证实的老年 PTMC 患者行 PLA 治疗。治疗前，评估结节的位置、体积以及患者的症状。治疗后 24 小时，行超声造影（CEUS）评估消融的完全性。为评估消融面积的体积和复发或转移情况，治疗后 1、3、6、12 个月及此后每 6 个月进行超声检查。对任何可疑的复发或转移病灶进行 FNAB。

结果

38 例患者的消融均完全通过 CEUS 证实。未发现明显并发症。单次消融的成功率为 100%。平均随访时间为 64.58±5.29 个月（60-78 个月）。末次随访时，31 例（81.58%）消融病灶完全消失，7 例（18.42%）消融病灶呈瘢痕样改变。术前结节体积为 40.69±16.45mm，42 个月时降至 0.22±0.76mm，消融后 4 年所有结节均消失（<0.01）。消融后 6、12、18、24、30、36 和 42 个月时，平均体积减少率（VRR）分别为 12.09%、31.21%、50.9%、72.06%、84.79%、95.65%和 100%。所有患者中，1 例（2.6%）出现局部复发，再次行 PLA 治疗。未发现治疗结节或淋巴结转移和远处转移的再生长。