超声引导下经皮射频和微波消融治疗甲状腺乳头状癌颈部淋巴结转移：临床疗效和安全性的系统评价与Meta分析

Ultrasound‑guided Percutaneous Radiofrequency and Microwave Ablation for Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma: A Systematic Review and Meta‑analysis of Clinical Efficacy and Safety.

作者信息

Upadhyaya Arun, Upadhyaya Sadhana Acharya, Chang Luchen, Li Yuanyuan, Wei Xi

机构信息

Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (A.U., L.C., Y.L., X.W.).

Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China (S.A.U.).

出版信息

Acad Radiol. 2025 May;32(5):2533-2544. doi: 10.1016/j.acra.2024.12.064. Epub 2025 Jan 11.

DOI:10.1016/j.acra.2024.12.064

PMID:39800601

Abstract

AIM

To evaluate the efficacy and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) for treating cervical lymph node metastasis (CLNM) from papillary thyroid carcinoma (PTC).

METHODS

Medline, EMBASE, Web of Science, and Cochrane Library were searched for studies on the efficacy and safety of thermal ablations for treating CLNM from PTC until July 2024. Among 544 papers, 11 articles were reviewed involving 233 patients and 432 CLNM cases. Random- or fixed-effects models assessed pooled proportions of volume reduction rate (VRR), complete disappearance, recurrence, major and minor or other complications. Similarly, pooled estimates of changes in the largest diameter, volume, and serum thyroglobulin (Tg) were evaluated post-ablation. Subgroup analysis by treatment modality was performed. Study heterogeneity was analyzed using Q statistics and inconsistency index (I). The quality of the studies was assessed using the MINORS scale.

RESULTS

Eleven studies with 233 patients and 432 CLNM were analyzed. The pooled VRR was 95.24% [95% Confidence Interval (CI): 91.97- 98.51%], complete disappearance was 63.1%, and recurrence was 1.6%. Changes in largest diameter, volume, and serum Tg were 8.36 mm (95%CI: 6.46-10.26mm), 216.09mm³, and 6.12ng/ml, respectively. Major complications occurred at 3.0%, while minor complications were 25.6%. Significant heterogeneity was found for diameter, volume, VRR, Tg, and minor complications. Subgroup analysis showed that MWA had a higher VRR (97.18%) than RFA (93.84%) (P < 0.001).

CONCLUSION

Both RFA and MWA were effective and safe for treating CLNM from PTC. However, RFA showed lower volume reduction than MWA with significant heterogeneity in VRR.

DATA AVAILABILITY STATEMENT

The original contributions revealed in the study are included in the article/Supplemental Material. Further inquiries can be made to the corresponding author.

摘要

目的

评估射频消融（RFA）和微波消融（MWA）治疗甲状腺乳头状癌（PTC）颈部淋巴结转移（CLNM）的疗效和安全性。

方法

检索Medline、EMBASE、科学网和Cochrane图书馆，查找截至2024年7月关于热消融治疗PTC的CLNM的疗效和安全性的研究。在544篇论文中，对11篇文章进行了综述，涉及233例患者和432例CLNM病例。采用随机或固定效应模型评估体积缩小率（VRR）、完全消失、复发、主要和次要或其他并发症的合并比例。同样，在消融后评估最大直径、体积和血清甲状腺球蛋白（Tg）变化的合并估计值。按治疗方式进行亚组分析。使用Q统计量和不一致指数（I）分析研究异质性。使用MINORS量表评估研究质量。

结果

分析了11项研究，共233例患者和432例CLNM。合并VRR为95.24%[95%置信区间（CI）：91.97 - 98.51%]，完全消失率为63.1%，复发率为1.6%。最大直径、体积和血清Tg的变化分别为8.36毫米（95%CI：6.46 - 10.26毫米）、216.09立方毫米和6.12纳克/毫升。主要并发症发生率为3.0%，次要并发症发生率为25.6%。在直径、体积、VRR、Tg和次要并发症方面发现显著异质性。亚组分析显示，MWA的VRR（97.18%）高于RFA（93.84%）（P < 0.001）。