Hay Ian D, Lee Robert A, Reading Carl C, Pittock Siobhan T, Sharma Animesh, Thompson Geoffrey B, William Charboneau J
Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
J Endocr Soc. 2023 May 17;7(7):bvad065. doi: 10.1210/jendso/bvad065. eCollection 2023 Jun 5.
Childhood papillary thyroid carcinoma (CPTC), despite bilateral thyroidectomy, nodal dissection and radioiodine remnant ablation (RRA), recurs within neck nodal metastases (NNM) in 33% within 20 postoperative years. These NNM are usually treated with reoperation or further radioiodine. Ethanol ablation (EA) may be considered when numbers of NNM are limited.
We studied the long-term results of EA in 14 patients presenting with CPTC during 1978 to 2013 and having EA for NNM during 2000 to 2018.
Cytologic diagnoses of 20 NNM (median diameter 9 mm; median volume 203 mm) were biopsy proven. EA was performed during 2 outpatient sessions under local anesthesia; total volume injected ranged from 0.1 to 2.8 cc (median 0.7). All were followed regularly by sonography and underwent volume recalculation and intranodal Doppler flow measurements. Successful ablation required reduction both in NNM volume and vascularity.
Post EA, patients were followed for 5 to 20 years (median 16). There were no complications, including postprocedure hoarseness. All 20 NNM shrank (mean by 87%) and Doppler flow eliminated in 19 of 20. After EA, 11 NNM (55%) disappeared on sonography; 8 of 11 before 20 months. Nine ablated foci were still identifiable after a median of 147 months; only one identifiable 5-mm NNM retained flow. Median serum Tg post EA was 0.6 ng/mL. Only one patient had an increase in Tg attributed to lung metastases.
EA of NNM in CPTC is effective and safe. Our results suggest that for CPTC patients who do not wish further surgery and are uncomfortable with active surveillance of NNM, EA represents a minimally invasive outpatient management option.
儿童乳头状甲状腺癌（CPTC），尽管进行了双侧甲状腺切除术、淋巴结清扫术和放射性碘残留消融（RRA），但在术后20年内仍有33%的患者出现颈部淋巴结转移（NNM）复发。这些NNM通常采用再次手术或进一步放射性碘治疗。当NNM数量有限时，可考虑乙醇消融（EA）。
我们研究了1978年至2013年期间出现CPTC并于2000年至2018年期间接受NNM乙醇消融治疗的14例患者的长期结果。
对20个NNM（中位直径9毫米；中位体积203立方毫米）进行细胞学诊断，并经活检证实。EA在局部麻醉下的2次门诊手术中进行；注射的总体积为0.1至2.8立方厘米（中位值0.7）。所有患者均定期接受超声检查，并进行体积重新计算和淋巴结内多普勒血流测量。成功消融需要NNM体积和血管减少。
EA术后，患者随访5至20年（中位值16年）。无并发症发生，包括术后声音嘶哑。所有20个NNM均缩小（平均缩小87%），20个中有19个的多普勒血流消失。EA后，11个NNM（55%）在超声检查中消失；11个中有8个在2个月内消失。中位147个月后，9个消融灶仍可识别；只有1个可识别的5毫米NNM仍有血流。EA后血清Tg的中位值为0.6纳克/毫升。只有1例患者的Tg升高归因于肺转移。
CPTC中NNM的EA有效且安全。我们的结果表明，对于不希望进一步手术且对NNM主动监测感到不适的CPTC患者，EA是一种微创的门诊治疗选择。
