A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis

Abstract

Purpose: To compare technique efficacy and safety of laser ablation (LA) and radiofrequency ablation (RFA) in treatment of benign thyroid nodules.

Materials and methods: Institutional review board approval was obtained, and patients’ consent was waived. 601 nodules were treated from May 2009 to December 2014 at eight centres, 449 (309 females, age 57?±?14?years) with LA and 152 (107 females, age 57?±?14?years) with RFA. A matched cohort composed of 138 patients from each group was selected after adjustment with propensity score matching. Factors influencing volume reduction at 6 and 12?months and complications were evaluated.

Results: No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. Mean nodule reduction at 6 and 12?months was ?67?±?19% vs. ?57?±?21% (p?<?0.001)???70?±?19% vs. ?62?±?22% (p =?0.001) in LA group and in RFA group, respectively. Nodules with volume?>30?mL had significantly higher percentage volume reduction at 6 and 12?months (?69?±?19 vs. ?50?±?21, p?=?0.001) and (?73?±?18 vs. ?54?±?23 8, p?=?0.001) in the LA group than in the RFA group, respectively. In both groups, operator’s skills affected the results. Major complications occurred in 4 cases in each group (p?=?0.116)

Conclusions: LA and RFA showed nearly similar outcome but LA was slightly more effective than RFA in large nodules. Operator’s skills could be crucial in determining the extent of nodule volume reduction regardless of the used technique.     

Safety of radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: a systematic review and meta-analysis

Abstract

Objective: We performed a systematic review and meta-analysis to evaluate the safety of radiofrequency ablation (RFA) for the treatment of benign thyroid nodules and recurrent thyroid cancers.

Materials and methods: Ovid-MEDLINE, EMBASE, and Library of Cochrane databases were searched up to 12 July 2016 for studies on the safety of RFA for treating benign thyroid nodules or recurrent thyroid cancers. Pooled proportions of overall and major complications were assessed using random-effects modelling. Heterogeneity among studies was determined using the χ² statistic for the pooled estimates and the inconsistency index I².

Results: A total of 24 eligible studies were included, giving a sample size of 2421 patients and 2786 thyroid nodules. 41 major complications and 48 minor complications of RFA were reported, giving a pooled proportion of 2.38% for overall RFA complications [95% confidence interval (CI): 1.42%–3.34%] and 1.35% for major RFA complications (95% CI: 0.89%–1.81%). There were no heterogeneities in either overall or major complications (I²?=?1.24%–21.79%). On subgroup analysis, the overall and major complication rates were significantly higher for malignant thyroid nodules than for benign thyroid nodules (p?=?0.0011 and 0.0038, respectively).

Conclusions: RFA was found to be safe for the treatment of benign thyroid nodules and recurrent thyroid cancers.     

Ethanol and thermal ablation for malignant thyroid tumours

Abstract

Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid malignancy and has a good prognosis and low mortality rate. Surgery is the standard treatment for patients with primary and recurrent thyroid cancer. Although patients with PTC usually exhibit excellent treatment outcome, the incidence of recurrence in the neck ranges from 20% to 59%. When a patient with thyroid cancer is contraindicated for surgery, ultrasound (US)-guided ablation techniques, including ethanol ablation (EA) and thermal ablations, are suggested alternatives. In this review, we evaluated the indications, devices, techniques, clinical outcomes, and complications associated with US-guided EA and thermal ablations based on available scientific evidence and expert opinions regarding the use of ablation for primary and recurrent thyroid cancers.     

Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA)

Purpose: To evaluate the reduction over time of benign thyroid nodules treated using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA) by the same equipe.

Materials and methods: Ninety patients (age 55.6?±?14.1 years) underwent ablation for benign thyroid nodule causing compression/aesthetic dissatisfaction from 2011. Fifty-nine (age 55.8?±?14.1 years) underwent RFA and 31 (age 55.2?±?14.2 years) PLA, ultrasound guided. Technical success, complications, duration of ablation and treatment, energy deployed, volumetric percentage reduction at 1, 6 and 12 months were derived. A regression model for longitudinal measurements was used with random intercept and random slope. Values are expressed as mean?±?standard deviation or N (%).

Results: Technical success was always obtained. No major complications occurred. Mean ablation time was 30.1?±?13.8 vs. 13.9?±?5.9?min (p?Conclusions: RFA and PLA are similarly feasible, safe and effective in treating benign thyroid nodules when performed by the same equipe. RFA is faster than PLA but require significantly higher energy.     

射频消融术和腹腔镜肝切除术治疗复发性肝癌的临床疗效及远期生存情况分析

目的探讨射频消融术(RFA)和腹腔镜肝切除术(LH)治疗复发性肝癌的临床疗效及远期生存情况。方法依据随机数字表法将58例复发性肝癌患者分为LH组(接受LH治疗)和RFA组(接受RFA治疗),每组29例。比较治疗前和治疗后4周两组患者的血清肝功能指标[总胆红素(TBIL)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)]和肿瘤标志物[癌胚抗原(CEA)、磷脂酰肌醇蛋白聚糖3(GPC3)、甲胎蛋白(AFP)]水平,比较两组患者术后并发症发生率及3年生存情况。结果治疗前,两组患者的血清TBIL、AST、ALT、CEA、GPC3、AFP水平比较,差异均无统计学意义(P﹥0.05)。治疗后4周,RFA组患者的血清ALT、AST水平均高于LH组,差异均有统计学意义(P﹤0.05)。LH组患者的并发症总发生率为20.69%,高于RFA组的3.45%,差异有统计学意义(P﹤0.05)。两组患者的3年无进展生存情况和总生存情况比较,差异均无统计学意义(P﹥0.05)。结论对于复发性肝癌,LH与RFA治疗具有相似的长期疗效,但RFA治疗的安全性较好。     

Management strategy for nerve damage during radiofrequency ablation of thyroid nodules

Objective: The aim of this study was to introduce a management strategy for nerve damage occurring during radiofrequency ablation (RFA).

Methods: From January 2016 to October 2017, 17 patients who experienced the symptoms of nerve damage during RFA were enrolled in this study. If damage to nerves was suspected during RFA, ablation was stopped immediately, and a cold solution of 5% dextrose was injected directly into the space where the nerves were located until symptoms improved. Patients were followed up after the procedure until symptoms had resolved. The clinical data of patients who received a cold dextrose solution injection for nerve damage were compared with those who did not receive such an injection.

Results: Of 17 patients who experienced nerve damage, 12 received an injection of cold dextrose solution shortly after the emergence of symptoms. While resolution of symptoms was seen in all 17 patients, the mean time to recovery was significantly faster in the 12 patients who received treatment with an injection of cold dextrose solution than in those patients who did not receive such a treatment (p value = .041).

Conclusions: In the event of thermal damage to adjacent nerve structures during RFA, the direct injection of a cold dextrose solution is a simple and effective treatment that can result in rapid symptom resolution.     

Bipolar radiofrequency ablation of benign thyroid nodules using a multiple overlapping shot technique in a 3-month follow-up

Purpose The aim of this study was to evaluate the decrease of benign thyroid nodules after bipolar radiofrequency ablation (RFA) in a 3-month follow-up using a multiple overlapping shot technique (‘MOST’).

Methods A total of 18 patients with 20 symptomatic benign thyroid nodules (17 cold nodules, 3 hyperfunctioning nodules) were treated in one single session by bipolar RFA. Bipolar ablation was performed using MOST. The nodule volumes were measured prior to ablation and 3 months after the procedure using ultrasound. The population consisted of either solid (>80% solid tissue within the volume of interest), complex, or cystic nodules (<20% solid tissue within the volume of interest).

Results Bipolar RFA resulted in a highly significant (p?<?0.0001) decrease of nodule volume (ΔV), median 5.3?mL (range 0.13–43.1?mL), corresponding to a relative reduction in mean of 56?±?17.9%. Median initial volume was 8?mL (range 0.48–62?mL); 3 months after ablation a median volume of 2.3?mL (range 0.3–32?mL) was measured. Nodule growth ≥50% occurred in 70% (14 nodules). At the follow-up no complications such as infections, persisting pain, nerve injuries or immunogen stimulation occurred. Patients with cold nodules (15) remained euthyroid, with hyperfunctioning nodules either euthyroid (2) or latent hypofunctional (1).

Conclusion The use of bipolar RFA is an effective, safe and suitable thermoablative technique to treat benign thyroid nodules. Combined with the multiple overlapping shot technique it allows sufficient ablation.     

Locoregional control of recurrent papillary thyroid carcinoma by ultrasound-guided percutaneous microwave ablation: A prospective study

Abstract

Purpose: The aim of this study was to evaluate the safety and efficiency of ultrasound-guided percutaneous microwave (MW) ablation for the control of locally recurrent papillary thyroid carcinoma (LR-PTC) in patients for whom surgery is not viable. Materials and methods: The inclusion criteria for MW ablation were three or fewer LR-PTCs and no recurrence beyond the neck, with ineligibility or refusal to undergo surgery. MW ablation was carried out using a 16-gauge MW antenna under local anaesthesia. Patients were then followed at 1, 3, 6 and 12 months after treatment and every 6 months thereafter. Technical success usually meant volume reduction more than 50%. Results: Between October 2010 to March 2013?a total of 17 patients (14 women, 3 men; average age 54.1 years) with 23 LR-PTCs, were treated with MW ablation in our department. All the LR-PTCs were technical successes with the number of treatment sessions for one tumour ranging from 1 to 4 (mean, 2.3?±?0.9). The mean volume reduction ratio of the LR-PTCs was 1?±?86%, 47?±?12%, 70?±?33%, 91?±?14% at the 1, 3, 6 and 18 months follow-up visit respectively (all p?<?0.05). All treated nodules decreased in size: 30.4% nodules (7/23) had completely disappeared, 52.2% nodules (12/23) remained as small scar-like lesions. One patient experienced transient dysphonia immediately after MW ablation. No other severe and permanent complications occurred. Conclusion: Although with some limitations, our preliminary results are encouraging and show MW ablation may be an alternative treatment option for the control of LR-PTCs in selected patients for whom surgery is not viable.     

集束电极射频治疗肺癌手术并发症及其处理

目的 探讨集束电极射频热凝固治疗肺癌的手术并发症及其发生的原因、处理方法和预防措施。方法 肺癌54例，62个病灶，CT引导下经皮肺穿刺将射频电极插入肺癌病灶行热凝固治疗。术中及术后密切观察，对并发症发生者予以积极处理。结果 54例患者的术中并发症：咳嗽ll例，气胸9例，血压下降7例，贴电极处皮肤灼伤4例，穿刺点持续渗血2例，呃逆2例及寒战l例，经处理后均不需中断手术。术后的常见并发症为发热，l例出现术后气胸。结论 集束电极射频热凝固治疗术中最常见并发症为咳嗽，最严重并发症为气胸：术后常出现发热。应采取积极的防治措施，才能保证手术的顺利进行。     

Feasibility of percutaneous radiofrequency ablation for intrathoracic malignancies: a large single-center experience

BACKGROUND: Radiofrequency ablation (RFA) has become an accepted alternative for treating intrathoracic malignancies; however, the incidence and characteristics of peri- and postprocedural complications are not well described. The purpose of the study was to assess the safety and technical feasibility of percutaneous RFA in unresectable intrathoracic malignancies. METHODS: Percutaneous RFA was performed in patients with intrathoracic malignancies between June 2001 and December 2004. In total, 366 tumors were treated in 137 patients in 211 sessions. All patients were nonsurgical candidates or had refused surgery. Three hundred and thirty-six lesions were subjected to RFA for the treatment of metastases and 30 lesions for primary lung carcinoma. RESULTS: Although no procedural mortality occurred, 2 patients died during the course of the study because of intractable pneumothorax and massive hemoptysis (0.9%). The overall major complication rate was 17.1% (pneumothoraces requiring tube drainage in 25, pleuritis in 6, pleural effusion requiring tube drainage in 4, lung abscess in 1, and intrapulmonary hemorrhage with hemothorax in 1). Minor complications included pneumothoraces not requiring tube drainage in 108 sessions, pleural effusion without drainage in 34, hemosputum in 9, nausea and/or vomiting in 3, subcutaneous emphysema in 3, cough in 2, skin burn in 2, atelectasis in 1, and subileus in 1. High fever and/or chest pain were seen in 33.8% and 39.3% of patients, respectively. CONCLUSIONS: With over 200 procedures, RFA appears to be a safe and minimally invasive option with negligible mortality and little morbidity in selected patients with unresectable intrathoracic malignancies.     

高强度聚焦超声和射频消融治疗子宫腺肌瘤的临床对比研究

目的:对比分析高强度聚焦超声（HIFU）和射频消融（RFA）两种方法治疗子宫腺肌瘤患者的临床疗效。方法:回顾性分析2014年3月至2016年3月于我院就诊的250例子宫腺肌瘤患者临床资料,其中接受HIFU治疗患者136例、RFA 治疗患者114例。根据子宫腺肌瘤直径将患者分为3组（2~4 cm组、＞4~6 cm组、＞6~8 cm组）,对比两种治疗方法的疗效及并发症。结果:HIFU及RFA组间患者一般情况比较及2~4 cm、＞4~6 cm、＞6~8 cm腺肌瘤组内两组间病例数分布、年龄、不同位置肌瘤构成比比较无统计学差异（P>0.05）,两种治疗组总有效率分别为83.09%、93.86%,两组比较差异有统计学意义（P＜0.05）。对于2~4 cm的子宫腺肌瘤患者,HIFU及RFA治疗组总有效率比较差异无统计学意义（P>0.05）。对于＞4~6 cm、＞6~8 cm的子宫腺肌瘤患者,HIFU及RFA治疗组总有效率比较差异均有统计学意义（P＜0.05）,RFA治疗组总有效率明显高于HIFU治疗组。HIFU治疗组并发症发生率显著低于RFA治疗组,差异具有统计学意义（P＜0.05）。结论:对于直径小于4 cm的子宫腺肌瘤患者建议选择HIFU,因其疗效与RFA相当,但并发症发生率低;而对于大于4 cm的子宫腺肌瘤,建议选择RFA治疗。两种治疗方法对于子宫腺肌瘤患者来说均是有效的治疗方法,值得临床推广。     

Ultrasound-guided percutaneous microwave ablation of solitary T1N0M0 papillary thyroid microcarcinoma: Initial experience

Purpose: The aim of this study was to evaluate the feasibility, safety and efficacy of ultrasound-guided percutaneous microwave (MW) ablation for solitary T1N0M0 papillary thyroid microcarcinoma. Materials and methods: A total of 21 patients (six men and 15 women; age range, 29–81 years; mean, 52.1?±?13.6 years) with 21 nodules of pathologically proven solitary papillary carcinoma 3.7 to 10.0?mm in diameter without clinically apparent lymph node, or distant metastasis at diagnosis (T1N0M0) were treated with MW ablation in our department. Microwaves were emitted at 40?W for 400?s and prolonged as necessary to attain confluent ablation zones. All patients were treated with levothyroxine after MW ablation to maintain thyroid stimulating hormone (TSH) levels below 0.1?mU/L. Follow-up consisted of ultrasound in 21 patients, biopsy in five patients, and surgical treatment in three patients. Results: Four patients complained of hoarseness immediately after the MW ablation procedure, and all of them recovered within 3 months spontaneously. All tumours were completely ablated at a single session and no serious or permanent complications occurred. No recurrence at the treatment site and no distant metastases were detected, with a mean follow-up of 11 months. Histological examination showed no evidence of a tumour in the treated lesions in eight patients. Follow-up ultrasound examinations showed disappearance of previously detected colour Doppler flow, as well as mass shrinkage, or both. Conclusion: During the short-term follow-up period, ultrasound-guided percutaneous MW ablation appears to be a safe and effective technique for solitary T1N0M0 papillary thyroid microcarcinoma.     

Radiofrequency ablation of primary thyroid carcinoma: efficacy according to the types of thyroid carcinoma

Objective: To evaluate the efficacy of ultrasound (US)-guided radiofrequency ablation (RFA) according to the types of thyroid carcinoma, particularly in patients with a high-surgical risk.

Materials and methods: Eight patients with nine tumours of pathologically proven papillary and anaplastic carcinoma were treated by US-guided RFA. Patients with primary thyroid carcinoma were divided into three groups; group (1) Anaplastic carcinoma, group (2) papillary macrocarcinoma, and group (3) papillary microcarcinoma. We evaluated changes in clinical symptoms, tumour volume and local tumour recurrence/metastasis after RFA. Patients were followed up at 1, 6 and 12 months and annually thereafter.

Results: Among nine tumours, one anaplastic carcinoma was treated three times and the other anaplastic carcinoma and one papillary macrocarcinoma were treated twice. Group 3 were treated once. The initial mean tumour volume was 107.9?±?78.6 (with neck bulging), 126.9 (with neck bulging) and 0.16?±?0.08?mL (without cosmetic or symptomatic problems) in groups 1–3, respectively. Group 1 showed no improvement in clinical symptoms or neck bulging after RFA, whereas group 2 demonstrated a decreased tumour volume measuring 0.7?mL with improved neck bulging. In group 3, mean volume decreased measuring 0.07?±?0.12?mL. No local tumour recurrence or metastatic lesion was detected during the mean follow-up of 19.3 months in papillary carcinomas. No major complications were encountered.

Conclusions: In patients with primary thyroid carcinoma, RFA achieved excellent local tumour control for papillary macro- and microcarcinoma; however, its clinical effect on anaplastic carcinoma was questionable.     

Vocal cord paresis following single-session high intensity focused ablation (HIFU) treatment of benign thyroid nodules: incidence and risk factors

Abstract

Background: Vocal cord paresis (VCP) may occur following high intensity focused ultrasound (HIFU) of thyroid nodules. We hypothesised its occurrence relates to the distance of the focus point (FP) of the HIFU beams from the recurrent laryngeal nerve (RLN) and the thermal power that this point received. Their relationships were examined.

Methods: One hundred and three patients who underwent HIFU for symptomatic benign thyroid nodule from October 2015 to March 2017 were analysed. All treatment images were captured and were later watched by 2 reviewers to identify three FPs closest to the tracheoesophageal groove (TEG) on transverse sonographic view. TEG was taken as the RLN position. After identifying these FPs, their distance (mm) from the TEG, thermal power (W) used and depth from skin (mm) were recorded. These parameters were compared between those with and without VCP. VCP was defined as a cord with reduced or no movement.

Results: Four (3.9%) patients suffered from a unilateral VCP afterwards but they all recovered fully within 6?weeks. There were no significant differences in baseline characteristics and treatment efficacy between the two groups. The distance from TEG (OR?=?1.706, 95%CI?=?1.001 to 2.915, p?=?0.050) was the only significant factor for VCP. None of the other variables including thermal power were significant.

Conclusions: The incidence of VCP was 3.9% (4/103) and they completely recovered within 6?weeks. The distance between the FP and the TEG was the only related factor for VCP. The safe distance between FP and TEG should be ≥1.1?cm.     

Local thyroid tissue ablation by high-intensity focused ultrasound: Effects on thyroid function and first human feasibility study with hot and cold thyroid nodules

Objective: The aim of this study was to assess whether high-intensity focused ultrasound (HIFU), a new and promising method for the treatment of benign hot and cold thyroid nodules using thermal ablation, has an impact on thyroid function, and to evaluate its feasibility in outpatient settings. Additionally, a possible difference in the treatment of solid and complex thyroid nodules was evaluated. Method: Ten patients with one thyroid nodule each (six cold and four hot nodules) underwent HIFU in January 2014. Four nodules were solid and six nodules were complex. Serum levels of triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyroglobulin (hTg) and additionally antibodies against hTg (TAK), TSH receptors (TRAK) and thyroid peroxidase (TPO) were measured at enrolment and 24?h after the HIFU treatment. The pre- and post-thyroglobulin reduction was measured to evaluate the scale of ablation. In addition, patients’ pain was recorded on a numeric rating scale from 0 to 10. Results: The HIFU treatment did not affect thyroid function, since hormone levels stayed stable (p?p?p?Conclusion: HIFU is a safe and effective method to treat benign, solid, complex, hot and cold thyroid nodules preserving thyroid function. Further developments of the system are needed to gain suitability for daily use.     

CT引导下经皮肺射频消融术治疗晚期肺癌的疗效及并发症分析

目的 评价CT引导下经皮肺射频消融治疗晚期肺癌的疗效和安全性,总结并发症情况及并发症的处理经验.方法 回顾性分析29例接受CT引导下经皮肺射频消融术晚期肺癌患者的临床资料,评价疗效,总结并发症发生情况并分析并发症发生的诱因.结果 29例(共35个病灶)接受CT引导下经皮肺射频消融术晚期肺癌患者3、6个月局部控制率分别为77.1%、25.7%.16例患者在术中或术后出现并发症,其中疼痛5例(17.2%),发热5例(17.2%),咯血5例(17.2%),气胸5例(17.2%),皮下气肿3例(10.3%),感染3例(10.3%),纵隔气肿1例(3.4%),嗜睡1例(3.4%),窦性心动过缓1例(3.4%).皮下气肿发生在消融病灶靠近胸膜的患者.无操作相关的死亡.结论 对于多数晚期肺癌患者,CT引导下经皮肺射频消融术安全有效,并发症可防、可控.     

左、右半结肠癌肝转移患者射频消融治疗疗效及生存的对比分析

目的:探讨原发部位分别位于左、右半结肠的结肠癌肝转移患者行超声引导下肝转移瘤射频消融术后的生存差异及预后影响因素分析。方法:回顾性分析2010年1月至2015年12月于我科行射频消融治疗的结肠癌肝转移患者100例,其中左半结肠癌62例,右半结肠癌38例,分析原发部位不同的结肠癌肝转移患者在进行超声引导下射频消融治疗后的生存情况。结果:左半结肠癌肝转移患者射频消融术后1、3、5年总体生存率及中位生存期均高于右半结肠癌肝转移患者（88.71% vs 73.68%、62.90% vs 30.02%、49.72% vs 26.33%、55个月 vs 23个月）,且二者生存曲线差异具有统计学意义（P＜0.05）。经Log-rank检验及COX多因素分析,左、右半结肠癌肝转移患者射频消融治疗术后的生存情况存在差异。此外,原发灶淋巴结转移情况、患者术前CA199水平及原发灶分化程度是患者射频消融治疗术后生存情况的影响因素。结论:左半结肠癌肝转移患者射频消融术后整体生存率明显高于右半结肠癌肝转移患者,左半结肠癌与右半结肠癌肝转移患者在射频消融治疗术后生存状况存在明显差异。     

Comparison of microwave ablation and radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis

Background: Microwave ablation (MWA) has several advantages over radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). We aimed to compare the efficacy and safety of MWA with those of RFA for HCC from the perspectives of percutaneous and laparoscopic approaches.

Methods: PubMed/MEDLINE, Embase, the Cochrane library, and China Biology Medicine databases were searched. Studies comparing the efficacy and safety of MWA with those of RFA in patients with HCC were considered eligible. Complete ablation (CA), local recurrence (LR), disease-free survival (DFS), overall survival (OS), and the major complication rate were compared between MWA and RFA.

Results: Four randomized controlled trials and 10 cohort studies were included. For percutaneous ablation, no significant difference was found between MWA and RFA regarding CA, LR, DFS, OS, and the major complication rate. A subgroup analysis of tumors measuring ≥3?cm revealed no difference in CA and LR for percutaneous ablation. For laparoscopic ablation, a significantly lower LR rate and a non-significant trend toward a higher major complication rate were observed for the MWA group (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.16–4.02, p?=?.01 for LR; OR 0.21, 95% CI 0.04–1.03, p?=?.05 for major complication rate). CA, DFS, and OS were similar between the two groups.

Conclusions: Percutaneous (P)-MWA had similar therapeutic effects compared with P-RFA for HCC. Patients undergoing laparoscopic MWA had a lower LR rate; however, their major complication rate appeared to be higher. The superiority of MWA over RFA remains unclear and needs to be confirmed by high-quality evidence.     

微波消融治疗甲状腺乳头状癌术后淋巴结转移的临床研究和疗效观察

目的 为了提高对超声引导下经皮微波消融术治疗甲状腺乳头状癌术后颈部淋巴结转移癌的认识,并评价其疗效性和安全性。方法 选择84例甲状腺乳头状癌术后复发的患者,接受微波消融治疗后,通过超声造影增强检查,评估消融区内的肿瘤活性,在1、3、6个月以及12个月对患者进行肿瘤大小、体积和血清甲状腺球蛋白的测量临床评估。结果 103个颈部淋巴结转移癌全部成功接受了微波消融治疗,治疗后超声造影增强检查未检测到不完全消融,在最后一次随访中,平均最大直径从10.5±5.7mm减小到0.8±1.5mm(P＜0.05),平均体积从285.9±245.7mm³减小到4.0±8.0mm³(P＜0.05)。治疗后既未检测到已治疗的肿瘤发生进展,也没有新增可疑的淋巴结。结论 超声引导下经皮微波消融术可能成为某些不适合或拒绝进行手术治疗的甲状腺乳头状癌术后淋巴结转移患者的替代疗法,这种手术安全有效,并发症发生率低。     

CT-guided radiofrequency ablation of spinal osteoblastoma: treatment and long-term follow-up

Objective: Osteoblastoma (OB) is a painful, rare, benign bone tumour usually observed in young populations, and this condition involves the spine in up to one-third of cases. We sought to focus on the minimally invasive treatment of spinal OB with radiofrequency ablation (RFA) under computed tomography (CT) guidance. When performed near the spinal cord, surgery can lead to instability of the spine, sometimes requiring additional interventions to stabilise the segments involved, and can cause the precocious onset of arthrosis or other degenerative diseases.

The results were evaluated both clinically and with the aid of diagnostic imaging techniques during a 5-year follow-up study.

Materials and methods: Eleven patients affected by spinal OB were treated in a single session with biopsy and CT-guided RFA. Pre- and post-evaluations of the patients were performed both clinically and with CT and magnetic resonance imaging (MRI).

Results: Complete success in terms of pain relief was achieved in all patients. Additional treatments were not required in any patients. There were no complications. During follow-up, neither complications nor pathological findings related to the treatment were observed.

Conclusions: Our experience demonstrates that RFA for spinal OB is safe and effective. One of the main advantages of this technique is represented by its lower grade of invasiveness compared with that for potentially hazardous surgical manoeuvres.