Dionísio Teresa, Lajut Leando, Sousa Filipa, Violante Liliana, Sousa Pedro
Department of Radiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia 4430-000, Portugal.
Department of Sugery, Centro Hospitalar de Tras-os-Montes e Alto Douro, Vila Real 5000-508, Portugal.
World J Clin Cases. 2023 Jul 16;11(20):4883-4889. doi: 10.12998/wjcc.v11.i20.4883.
The gold standard treatment for papillary thyroid carcinoma is total thyroidectomy and indications for microwave thermal ablation for primary thyroid cancers have not yet been clearly established However, some patients refuse surgery and others have no indication for it, for example patients under palliative care as in this case, or cannot undergo surgery, based on their comorbidities. These indications are described in the most recent Korean, North American and European guidelines. Laser ablation, radiofrequency ablation, and microwave ablation are similarly safe and effective, so the choice should be based on the specific competences and resources of the pertaining centers. These indications are Percutaneous minimally-invasive techniques; they can be useful to stop disease progression and as an alternative to surgery in patients with contraindication or who refuse surgery. We present a case of a thyroid papillary carcinoma with 17 mm effectively treated with microwave thermal ablation and without recurrence after one year of follow up.
The authors present a case of a 71-years-old patient with a left lobe papillary thyroid carcinoma with 13 mm × 17 mm × 13 mm, with no indication for thyroid surgery given the context of another cancer in palliative treatment. Microwave thermoablation was performed on December 2021. Four months later he repeated computed tomography (CT) scan, which showed that the tumor had disappeared. Six months after ablation he underwent a positron emission tomography/CT-fluorodeoxyglucose scan, which didn't show any evidence of hypermetabolic tumor lesions.
This case shows microwave thermoablation can be a safe and effective alternative to surgery in patients with no conditions to undergo surgery or when they refuse it. By treating the tumor, with this minimally invasive technique, we are stopping its growth and avoiding disease progression.
甲状腺乳头状癌的金标准治疗方法是全甲状腺切除术，而原发性甲状腺癌微波热消融的适应证尚未明确确立。然而，一些患者拒绝手术，另一些患者则不具备手术指征，例如像本病例中处于姑息治疗的患者，或者由于合并症而无法接受手术。这些适应证在最新的韩国、北美和欧洲指南中有所描述。激光消融、射频消融和微波消融同样安全有效，因此选择应基于相关中心的特定能力和资源。这些适应证为经皮微创技术；它们可用于阻止疾病进展，并作为有禁忌证或拒绝手术患者手术的替代方法。我们报告一例17毫米的甲状腺乳头状癌患者，经微波热消融有效治疗，随访一年后无复发。
作者报告一例71岁患者，左叶甲状腺乳头状癌，大小为13毫米×17毫米×13毫米，鉴于其处于另一种癌症的姑息治疗背景下，不具备甲状腺手术指征。2021年12月进行了微波热消融。四个月后他复查计算机断层扫描（CT），显示肿瘤已消失。消融六个月后，他接受了正电子发射断层扫描/CT-氟脱氧葡萄糖扫描，未显示任何高代谢肿瘤病变的证据。
本病例表明，对于无条件接受手术或拒绝手术的患者，微波热消融可以是一种安全有效的手术替代方法。通过这种微创技术治疗肿瘤，我们正在阻止其生长并避免疾病进展。
