Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.
J Clin Endocrinol Metab. 2023 Nov 17;108(12):3230-3238. doi: 10.1210/clinem/dgad360.
Ultrasound (US)-guided radiofrequency ablation (RFA) has been considered as an alternative to surgery or active surveillance for papillary thyroid microcarcinoma (PTMC). However, little is known about the long-term outcomes of RFA in comparison with surgery for unilateral multifocal PTMC.
This work aims to report the comparison between RFA vs surgery for unilateral multifocal PTMC over a more than 5-year follow-up period.
This was a retrospective study at a primary care center with a median follow-up period of 72.9 months. A total of 97 patients with unilateral multifocal PTMC were treated with RFA (RFA group, n = 44) or surgery (surgery group, n = 53). In the RFA group, patients were treated by a bipolar RFA generator and an 18-gauge bipolar RF electrode with a 0.9-cm active tip. In the surgery group, patients underwent thyroid lobectomy with prophylactic central neck dissection.
During the follow-up, no statistically significant differences were found in disease progression (4.5% vs 3.8%; P = ≥.999), lymph node metastasis (2.3% vs 3.8%; P = ≥.999), persistent lesion (2.3% vs 0%; P = .272), and RFS rates (97.7% vs 96.2%; P = .673) in the RFA and surgery groups. Patients undergoing RFA had a shorter hospitalization (0 vs 8.0 [3.0] d; P < .001), shorter procedure time (3.5 [2.4] vs 80.0 [35.0] min; P < .001), lower estimated blood loss (0 vs 20.0 [15.0] mL; P < .001), and lower costs ($1768.3 [0.1] vs $2084.4 [1173.8]; P = .001) than those in the surgery group. The complication rate in the surgery group was 7.5%, whereas none of the RFA-treated patients experienced any complications (P = .111).
This study revealed 6-year comparable outcomes between RFA and surgery for unilateral multifocal PTMC. RFA may be a safe and effective alternative to surgery in selected patients with unilateral multifocal PTMC.
超声引导下射频消融术（RFA）已被认为是甲状腺微小乳头状癌（PTMC）手术或主动监测的替代方法。然而，与手术相比，对于单侧多灶性 PTMC，关于 RFA 的长期结果知之甚少。
本研究旨在报告超过 5 年随访期间 RFA 与手术治疗单侧多灶性 PTMC 的比较。
这是一项在基层医疗中心进行的回顾性研究，中位随访时间为 72.9 个月。共有 97 例单侧多灶性 PTMC 患者接受 RFA（RFA 组，n=44）或手术（手术组，n=53）治疗。在 RFA 组中，患者使用双极 RFA 发生器和 18G 双极 RF 电极（带有 0.9cm 有效尖端）进行治疗。在手术组中，患者接受甲状腺叶切除术和预防性中央颈部清扫术。
在随访期间，RFA 组和手术组的疾病进展（4.5% vs 3.8%；P≥.999）、淋巴结转移（2.3% vs 3.8%；P≥.999）、持续性病变（2.3% vs 0%；P=.272）和 RFS 率（97.7% vs 96.2%；P=.673）无统计学差异。RFA 组患者的住院时间（0 与 8.0[3.0]d；P<.001）、手术时间（3.5[2.4]与 80.0[35.0]min；P<.001）、估计出血量（0 与 20.0[15.0]mL；P<.001）和费用（$1768.3[0.1]与 $2084.4[1173.8]；P=.001）均低于手术组。手术组的并发症发生率为 7.5%，而 RFA 治疗组无任何并发症（P=.111）。
本研究揭示了 RFA 与单侧多灶性 PTMC 手术治疗 6 年的结果相当。对于单侧多灶性 PTMC 患者，RFA 可能是手术的一种安全有效的替代方法。
