Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China.
J Clin Endocrinol Metab. 2023 Oct 18;108(11):e1298-e1305. doi: 10.1210/clinem/dgad269.
To date there is no study on the feasibility of radiofrequency ablation (RFA) for papillary thyroid microcarcinomas (PTMCs) with BRAF V600E mutation.
This study was designed to evaluate the efficiency, safety, and prognosis of ultrasound (US)-guided percutaneous RFA for unifocal PTMCs with BRAF V600E mutation.
Sixty patients with 60 unifocal BRAF V600E mutation-positive PTMCs who received US-guided RFA between January 2020 and December 2021 were retrospectively analyzed. The mean maximum PTMC tumor diameter was 5.8 ± 1.7 mm (range, 2.5-10.0 mm). All PTMCs were pathologically confirmed by fine needle aspiration or core needle biopsy, and BRAF V600E mutation was confirmed to be positive by real-time fluorescent quantitative polymerase chain reaction. Contrast-enhanced ultrasound (CEUS) was performed immediately after RFA to evaluate whether PTMCs were extendedly ablated. Ultrasound was performed 1, 3, 6, and 12 months after RFA and every 6 months thereafter to evaluate the changes in the ablation zone, local recurrence, and cervical lymph node metastasis (LNM). The complications were recorded and evaluated.
Extended ablation was achieved in all enrolled patients. The ablation zone sizes increased immediately after RFA compared with those of tumors before treatment. One month later, the ablation zone sizes were smaller than immediately after RFA. At the last follow-up assessment, 42 nodules (70.0%) completely disappeared and the ablation zones of 18 nodules (30.0%) showed fissure-like changes. No local recurrence or cervical LNM was detected. Voice change (1.7%) was the only major complication.
RFA is effective and safe in treating unifocal PTMCs with BRAF V600E mutation, especially when surgery is not feasible or refused by patients who are unwilling to continue active surveillance.
目前尚无关于 BRAF V600E 突变的甲状腺微小乳头状癌（PTMC）行射频消融（RFA）可行性的研究。
本研究旨在评估超声引导下经皮 RFA 治疗单发 BRAF V600E 突变阳性 PTMC 的疗效、安全性和预后。
回顾性分析 2020 年 1 月至 2021 年 12 月期间接受超声引导下 RFA 的 60 例单发 BRAF V600E 突变阳性 PTMC 患者，最大肿瘤直径平均值为 5.8±1.7mm（范围，2.5-10.0mm）。所有 PTMC 均经细针抽吸或核心针活检病理证实，实时荧光定量聚合酶链反应证实 BRAF V600E 突变阳性。RFA 后即刻行超声造影（CEUS）评估 PTMC 是否广泛消融。RFA 后 1、3、6、12 个月及此后每 6 个月行超声检查，评估消融区变化、局部复发及颈淋巴结转移（LNM）。记录并评估并发症。
所有入组患者均实现了广泛消融。RFA 后即刻消融区大小较治疗前肿瘤增大，1 个月后较 RFA 后即刻缩小，末次随访时 42 个（70.0%）结节完全消失，18 个（30.0%）结节的消融区呈裂隙样改变。未发现局部复发或颈 LNM。仅 1 例（1.7%）发生声音改变等严重并发症。
RFA 治疗单发 BRAF V600E 突变的 PTMC 有效且安全，尤其适用于手术不可行或不愿继续主动监测的患者。
