Cho Uiju, Jung So Lyung, Jung Chan Kwon
Department of Pathology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Ann Diagn Pathol. 2025 Aug;77:152479. doi: 10.1016/j.anndiagpath.2025.152479. Epub 2025 Apr 5.
Radiofrequency ablation (RFA) therapy is a minimally invasive treatment option for benign thyroid nodules and metastatic papillary thyroid carcinoma (PTC). This study investigated the cytomorphological changes induced by RFA in thyroid nodules. The study included patients who received RFA for benign thyroid nodules (n = 6) or recurrent PTC (n = 14), in the thyroid bed or lymph nodes following thyroidectomy. Patients underwent fine-needle aspiration (FNA) or core needle biopsy (CNB) to evaluate therapeutic responses. Most benign thyroid nodules showed acellular or hypocellular cellularity and coagulative necrosis. Thermal artifacts, fibrosis, and foreign body reactions were also noted. All cases were successfully treated, showing reduced nodule size with no recurrence during follow-up. In patients with recurrent PTC, post-RFA biopsies diagnosed 12 out of 14 samples as PTC, with most displaying degenerated tumor cells. Cytomorphological changes included acellular necrosis, nuclear pyknosis, or karyorrhexis. The second biopsy group showed lower cellularity, fewer degenerated cells, and fewer viable PTC cells than the first biopsy group. Two patients with persistent viable PTC cells after repeated RFA underwent surgical treatment. FNA and CNB effectively evaluate the response to RFA and detect residual tumors. Acellular specimens, total necrosis, and severely degenerated tumor cells indicate successful RFA, while viable cells with preserved PTC features suggest incomplete treatment.
射频消融（RFA）疗法是治疗良性甲状腺结节和转移性甲状腺乳头状癌（PTC）的一种微创治疗选择。本研究调查了RFA对甲状腺结节诱导产生的细胞形态学变化。该研究纳入了因良性甲状腺结节（n = 6）或复发性PTC（n = 14）接受RFA治疗的患者，这些患者在甲状腺切除术后于甲状腺床或淋巴结接受治疗。患者接受细针穿刺抽吸活检（FNA）或粗针穿刺活检（CNB）以评估治疗反应。大多数良性甲状腺结节表现为无细胞或细胞减少以及凝固性坏死。还观察到热效应伪像、纤维化和异物反应。所有病例均成功治疗，结节大小减小，随访期间无复发。在复发性PTC患者中，RFA术后活检将14份样本中的12份诊断为PTC，大多数样本显示肿瘤细胞退变。细胞形态学变化包括无细胞坏死、核固缩或核碎裂。第二次活检组的细胞数量、退变细胞数量和存活的PTC细胞数量均低于第一次活检组。两名经反复RFA后仍有存活PTC细胞的患者接受了手术治疗。FNA和CNB能有效评估对RFA的反应并检测残留肿瘤。无细胞标本、完全坏死和严重退变的肿瘤细胞表明RFA成功，而具有PTC特征的存活细胞提示治疗不完全。
