微波消融治疗伴有美容问题的良性甲状腺结节及消融后完全缓解的相关因素：一项双中心回顾性研究
Microwave ablation for benign thyroid nodules with cosmetic problems and related factors for post-ablative complete relief: a two-center retrospective study.
作者信息
Li Xiao-Long, Chen Zi-Tong, Jin Yun-Jie, Xu Ben-Hua, Xu Ya-Dan, Cao Qiong, Bo Xiao-Wan, Wen Jie-Xian, Ji Zheng-Biao, Fan Pei-Li, Xu Hui-Xiong
机构信息
Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China.
出版信息
Endocrine. 2025 Mar;87(3):1080-1089. doi: 10.1007/s12020-024-04103-9. Epub 2024 Nov 28.
PURPOSE
To investigate the efficacy of ultrasound (US)-guided percutaneous MWA for benign thyroid nodules with cosmetic problems and identify related factors contributing to post-ablative complete relief (CR).
METHODS
This retrospective study reviewed the efficacy of MWA in treating thyroid nodules in patients with cosmetic problems who underwent MWA from January 2021 to May 2023. Patients were followed up at 1, 3, and 6 months after MWA. Pre-treatment clinical characteristics, conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) features were analyzed to explore their correlation with cosmetic improvement, defined as a cosmetic score of 1 or 2 at the 6-month follow-up. Univariable and multivariable regression analyses were carried out to identify variables associated with CR, and the related nomogram was established. Calibration curve and decision curve analysis were used to evaluate the nomogram performance.
RESULTS
118 patients with 118 nodules were included in the study. During the 1-, 3- and 6-month follow-up, the mean volume reduction ratios (VRR) were 2%, 36% and 73%, respectively. 22.0% (26/118), 57.6% (68/118), and 89.8% (106/118) patients achieved CR of cosmetic problems at 1, 3, and 6 months after MWA. In multivariable analysis, three variables (i.e., non-hashimoto's thyroiditis [HT] [OR: 90.036, P = 0.001], nodule location not close to danger triangle area [OR: 66.812, P = 0.003], early hyperenhancement on CEUS [OR: 0.035, P = 0.024]) were found to be closely associated with CR of cosmetic problems at 6 months after MWA. A nomogram model was constructed, and its accuracy was well validated (i.e., C-index = 0.914).
CONCLUSION
MWA was effective and safe for treating benign thyroid nodules with cosmetic problems. Non-HT, nodule location not close to danger triangle area, and early hyperenhancement on CEUS were associated with CR of cosmetic problems after MWA.
目的
探讨超声（US）引导下经皮微波消融术（MWA）治疗有美容问题的良性甲状腺结节的疗效，并确定有助于消融后完全缓解（CR）的相关因素。
方法
这项回顾性研究评估了2021年1月至2023年5月期间接受MWA治疗的有美容问题的甲状腺结节患者中MWA的疗效。在MWA后1、3和6个月对患者进行随访。分析治疗前的临床特征、常规超声（US）和超声造影（CEUS）特征，以探讨它们与美容改善的相关性，美容改善定义为6个月随访时美容评分为1或2。进行单变量和多变量回归分析以确定与CR相关的变量，并建立相关的列线图。使用校准曲线和决策曲线分析来评估列线图的性能。
结果
该研究纳入了118例患者的118个结节。在1个月、3个月和6个月的随访期间，平均体积缩小率（VRR）分别为2%、36%和73%。在MWA后1个月、3个月和6个月，分别有22.0%（26/118）、57.6%（68/118）和89.8%（106/118）的患者美容问题得到CR。在多变量分析中，发现三个变量（即非桥本甲状腺炎[HT][比值比：90.036，P = 0.001]、结节位置不靠近危险三角区[比值比：66.812，P = 0.003]、CEUS上早期高增强[比值比：0.035，P = 0.024]）与MWA后6个月美容问题的CR密切相关。构建了一个列线图模型，其准确性得到了很好的验证（即C指数= 0.914）。
结论
MWA治疗有美容问题的良性甲状腺结节有效且安全。非HT、结节位置不靠近危险三角区以及CEUS上早期高增强与MWA后美容问题的CR相关。
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