微波消融治疗伴有和不伴有超声检测到的甲状腺包膜侵犯的甲状腺微小乳头状癌：一项多中心前瞻性队列研究。
Microwave Ablation for Papillary Thyroid Microcarcinoma with and without US-detected Capsule Invasion: A Multicenter Prospective Cohort Study.
机构信息
From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.).
出版信息
Radiology. 2023 May;307(3):e220661. doi: 10.1148/radiol.220661. Epub 2023 Mar 7.
Background Microwave ablation (MWA) has achieved favorable results in the treatment of papillary thyroid microcarcinoma (PTMC) confined in glandular parenchyma. However, studies on the outcome of MWA for PTMC with US-detected capsular invasion remain unclarified in the literature. Purpose To compare the feasibility, effectiveness, and safety of MWA in the treatment of PTMC with and without US-detected capsular invasion. Materials and Methods Participants from 12 hospitals with a PTMC maximal diameter of 1 cm or less without US- or CT-detected lymph node metastasis (LNM) who planned to undergo MWA were enrolled in this prospective study between December 2019 and April 2021. All tumors were evaluated with preoperative US and were divided into those with and those without capsular invasion. The participants were observed until July 1, 2022. The primary end points, including technical success and disease progression, and the secondary end points, including treatment parameters, complications, and tumor shrinkage during follow-up, were compared between the two groups, and multivariable regression was performed. Results After exclusion, 461 participants (mean age, 43 years ± 11 [SD]; 337 women) were included: 83 with and 378 without capsular invasion. After one participant with capsular invasion aborted MWA because of technical failure, 82 participants with and 378 participants without capsular invasion (mean tumor volume, 0.1 mL ± 0.1 vs 0.1 mL ± 0.1; = .07) were analyzed with a mean follow-up period of 20 months ± 4 (range, 12-25 months) and 21 months ± 4 (range, 11-26 months), respectively. In those with and those without capsular invasion, comparable technical success rates were achieved (99% [82 of 83] vs 100% [378 of 378], = .18), with one and 11 complications, respectively (1% [one of 82] vs 3% [11 of 378], = .38). There was no evidence of differences in disease progression (2% [one of 82] vs 1% [four of 378]; = .82) or tumor shrinkage (mean, 97% ± 8 [SD] vs 96% ± 13; = .58). Conclusion Microwave ablation was feasible in the treatment of papillary thyroid microcarcinoma with US-detected capsular invasion and showed comparable short-term efficacy with or without the presence of capsular invasion. © RSNA, 2023 Clinical trial registration no. NCT04197960
背景 微波消融 (MWA) 在治疗局限于腺实质的甲状腺微小乳头状癌 (PTMC) 方面取得了良好的效果。然而，关于超声检测到包膜侵犯的 PTMC 的 MWA 治疗结果的研究在文献中仍不明确。目的 比较 MWA 治疗超声检测到包膜侵犯和无包膜侵犯的 PTMC 的可行性、有效性和安全性。材料与方法 2019 年 12 月至 2021 年 4 月，12 家医院的参与者计划行 MWA 治疗，最大直径为 1 cm 或以下的 PTMC，无超声或 CT 检测到的淋巴结转移 (LNM)，纳入本前瞻性研究。所有肿瘤均行术前超声检查，并分为包膜侵犯组和无包膜侵犯组。参与者随访至 2022 年 7 月 1 日。比较两组的主要终点(包括技术成功率和疾病进展)和次要终点(包括治疗参数、并发症和随访期间肿瘤缩小情况)，并进行多变量回归分析。结果 排除后，461 名参与者(平均年龄 43 岁±11[标准差];337 名女性)纳入研究：83 名包膜侵犯，378 名无包膜侵犯。1 名包膜侵犯的参与者因技术失败而中止 MWA 后，对 82 名包膜侵犯和 378 名无包膜侵犯的参与者(平均肿瘤体积分别为 0.1 mL±0.1 和 0.1 mL±0.1; =.07)进行分析，平均随访时间分别为 20 个月±4(范围，12-25 个月)和 21 个月±4(范围，11-26 个月)。包膜侵犯组和无包膜侵犯组的技术成功率相当(99%[82/83]与 100%[378/378]， =.18)，分别有 1 例和 11 例并发症(1%[82/83]与 3%[378/378]， =.38)。无疾病进展差异(2%[82/83]与 1%[4/378]; =.82)或肿瘤缩小差异(平均，97%±8[标准差]与 96%±13; =.58)。结论 MWA 治疗超声检测到包膜侵犯的甲状腺微小乳头状癌是可行的，且与无包膜侵犯的甲状腺微小乳头状癌相比，短期疗效相当。
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