热消融技术治疗甲状腺微小乳头状癌的现况

doi:10.16139/j.1007-9610.2023.05.14

摘要/Abstract

摘要：

热消融是一项发展迅速的微创治疗技术，包含激光消融、射频消融和微波消融，其应用于肝细胞癌和肾细胞腺癌等恶性疾病的治疗已获得显著性成功。近年来，该技术已逐渐被引入甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）的治疗中。越来越多研究表明，热消融运用于PTMC的治疗有效且安全，与传统外科手术相比，具有独特的优势，但是否作为一线治疗仍有许多争议。目前，陆续有指南和共识提出热消融治疗PTMC的适应证和禁忌证，在临床上也相继有许多PTMC热消融治疗后的相关随访报道。本文就热消融技术治疗PTMC的原理、适应证与禁忌证、有效性及安全性、与传统外科手术比较等进行总结。

关键词: 甲状腺癌, 甲状腺微小乳头状癌, 热消融, 影像学

Abstract:

Thermal ablations are rapidly developing techniques for minimally invasive treatment, including laser ablation, radiofrequency ablation, and microwave ablation. Such remarkable success has been achieved in treatment malignant neoplasms, for instance, hepatocellular carcinoma and renal cell adenocarcinoma. In recent years, the practice has been gradually adopted into the treatment of papillary thyroid microcarcinoma (PTMC). Many reports have stated that thermal ablations have distinctive advantages over traditional thyroidectomy owing to its efficacy and safety for treatment primary PTMC, meanwhile there are many controversial issues which hotly debated regarding to first-line treatments. Recently, indications and contraindications of thermal ablation for PTMC have been successively proposed by guidelines and consensuses. Many follow-up reports related to thermal ablation in the treatment of PTMC have been reported in clinical practice as well. In this review, we summarized the principles, indications and contraindications, and the efficacy and safety of thermal ablation in the treatment of PTMC, and compared it with traditional surgery.

Key words: Thyroid cancer, Papillary thyroid microcarcinoma, Thermal ablation, Imaging

中图分类号:

R736.1

林庭伃综述, 赵艳娜, 费健审校. 热消融技术治疗甲状腺微小乳头状癌的现况[J]. 外科理论与实践, 2023, 28(05): 477-482.

LIN Tingyu, ZHAO Yanna, FEI Jian. The current status of thermal ablation in the treatment of papillary thyroid microcarcinoma[J]. Journal of Surgery Concepts & Practice, 2023, 28(05): 477-482.

参考文献 11

[12]	WANG L, XU D, YANG Y, et al. Safety and efficacy of ultrasound-guided percutaneous thermal ablation in treating low-risk papillary thyroid microcarcinoma: a pilot and feasibility study[J]. J Cancer Res Ther, 2019, 15(7): 1522-1529. doi: 10.4103/jcrt.JCRT_214_19 pmid: 31939432
[13]	DING M, TANG X, CUI D, et al. Clinical outcomes of ultrasound-guided radiofrequency ablation for the treatment of primary papillary thyroid microcarcinoma[J]. Clin Radiol, 2019, 74(9):712-717. doi: S0009-9260(19)30252-1 pmid: 31253420
[14]	ZHANG L, ZHOU W, ZHAN W, et al. Percutaneous laser ablation of unifocal papillary thyroid microcarcinoma: utility of conventional ultrasound and contrast-enhanced ultrasound in assessing local therapeutic response[J]. World J Surg, 2018, 42(8):2476-2484. doi: 10.1007/s00268-018-4500-6 pmid: 29488064
[15]	MIN Y, WANG X, CHEN H, et al. Thermal ablation for papillary thyroid microcarcinoma: how far we have come?[J]. Cancer Manag Res, 2020, 12:13369-13379. doi: 10.2147/CMAR.S287473 pmid: 33380841
[16]	MAURI G, NICOSIA L, DELLA VIGNA P, et al. Percutaneous laser ablation for benign and malignant thyroid di-seases[J]. Ultrasonography, 2019, 38(1):25-36. doi: 10.14366/usg.18034 URL
[17]	ZHOU W, NI X, XU S, et al. Ultrasound-guided laser ablation versus surgery for solitary papillary thyroid microcarcinoma: a retrospective study[J]. Int J Hyperthermia, 2019, 36(1):897-904.
[18]	赵艳娜, 柳俊, 黄莉, 等. 生理盐水隔离带在激光、射频和微波甲状腺热消融术中安全性的实验研究[J]. 外科理论与实践, 2020, 25(5):432-436.
	ZHAO Y N, LIU J, HUANG L, et al. Safety of normal saline isolation zone: an experimental study on laser, radiofrequency and microwave thyroid thermal ablation[J]. J Surg Concepts Pract, 2020, 25(5):432-436.
[19]	RIDOUANI F, TUTTLE R M, GHOSN M, et al. Ultrasound-guided percutaneous laser ablation of the thyroid gland in a swine model: comparison of ablation para-meters and ablation zone dimensions[J]. Cardiovasc Intervent Radiol, 2021, 44(11):1798-1806. doi: 10.1007/s00270-021-02915-0
[20]	彭晓琳. 超声引导下热消融治疗甲状腺疾病的研究进展[J]. 中国微创外科杂志, 2022, 28(2):170-174.
	Peng X L. Advances in ultrasound-guided thermal ablation for the treatment of thyroid diseases[J]. Chin J Min Inv Surg, 2022, 28(2):170-174.
[21]	MAURI G, GENNARO N, LEE M K, et al. Laser and radiofrequency ablations for benign and malignant thyroid tumors[J]. Int J Hyperthermia, 2019, 36(2):13-20. doi: 10.1080/02656736.2019.1622795 URL
[22]	TUFANO R P, PACE-ASCIAK P, RUSSELL J O, et al. Update of radiofrequency ablation for treating benign and malignant thyroid nodules. The future is now[J]. Front Endocrinol (Lausanne), 2021, 12:698689. doi: 10.3389/fendo.2021.698689 URL
[23]	KIM C. Understanding the nuances of microwave ablation for more accurate post-treatment assessment[J]. Future Oncol, 2018, 14(17):1755-1764. doi: 10.2217/fon-2017-0736 pmid: 29441813
[24]	HONGLEI G, SHAHBAZ M, FARHAJ Z, et al. Ultrasound guided microwave ablation of thyroid nodular goiter and cystadenoma: a single center, large cohort study[J]. Medicine(Baltimore), 2021, 100(34):e26943.
[25]	CAO X J, YU M A, ZHU Y L, et al. Ultrasound-guided thermal ablation for papillary thyroid microcarcinoma: a multicenter retrospective study[J]. Int J Hyperthermia, 2021, 38(1):916-922. doi: 10.1080/02656736.2021.1936218 URL
[26]	JI-HOON K, HWAN B J, KYUNG L H, et al. 2017 Thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology[J]. Korean J Radiol,2018, 19(4):632-655. doi: 10.3348/kjr.2018.19.4.632 URL
[27]	中国医师协会甲状腺肿瘤消融治疗技术专家组, 中国抗癌协会甲状腺癌专业委员会, 中国医师协会介入医师分会超声介入专业委员会, 等. 甲状腺良性结节、微小癌及颈部转移性淋巴结热消融治疗专家共识(2018版)[J]. 中国肿瘤, 2018, 27(10):768-773.
	The Technical Expert Group of Thyroid Tumor Ablation Treatment of Chinese Medical Doctor Association, Chinese Association of Thyroid Oncology, Thyroid Tumor Committee of Oncology Branch of Chinese Medical Association, the Ultrasound Intervention Professional Committee of Interventional Physician Branch of Chinese Medical Doctor Association, et al. Expert consensus on thermal ablation for thyroid benign nodes,microcarcinoma and metastatic cervical lymph nodes(2018 edition)[J]. Chin Oncol, 2018, 27(10):768-773.
[28]	中国医师协会超声医师分会. 甲状腺微小乳头状癌热消融诊疗指征专家共识[J]. 中华医学超声杂志(电子版), 2019, 16(8):571-574.
	Ultrasound Society of Physicians of Chinese Medical Doctor Association. Expert consensus on the indications for the diagnosis and treatment of micropapillary thyroid cancer by thermal ablation[J]. Chin J Med Ultrasound(Electronic Edition), 2019, 16(8):571-574.
[29]	MAURI G, HEGEDÜS L, BANDULA S, et al. European thyroid association and cardiovascular and interventional radiological society of Europe 2021 clinical practice guideline for the use of minimally invasive treatments in malignant thyroid lesions[J]. Eur Thyroid J, 2021, 10(3):185-197. doi: 10.1159/000516469 pmid: 34178704
[30]	ORLOFF L A, NOEL J E, Stack B C Jr, et al. Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: an international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association[J]. Head Neck, 2022, 44(3):633-660. doi: 10.1002/hed.v44.3 URL
[31]	中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)分化型甲状腺癌诊疗指南2021[J]. 肿瘤预防与治疗, 2021, 34(12):1164-1200.
	Guidelines Working Committee of Chinese Society of Clinical Oncology. Guidelines of Chinese Society of Clinical Oncology (CSCO) differentiated thyroid cancer[J]. J Cancer Control Treat, 2021, 34(12):1164-1200.
[32]	上海市中西医结合学会甲状腺疾病专业委员会, 全国甲状腺疾病中西医结合诊治专家组. 甲状腺结节及相关疾病热消融中西医结合诊疗指南(2021版)[J]. 中国卫生标准管理, 2022, 13(7):1-7.
	Thyroid Committee of Shanghai Association of Chinese Integrative Medicine, Thyroid Tumor Ablation Experts Croup of Chinese Medical Doctor Association. Chinese guidelines for the diagnosis and operational of combined thermal ablation and traditional Chinese medicine for thyroid nodules and related diseases (2021 edition)[J]. China Health Standard Manage, 2022, 13(7):1-7.
[33]	TONG M, LI S, LI Y, et al. Efficacy and safety of radiofrequency, microwave and laser ablation for treating papillary thyroid microcarcinoma: a systematic review and meta-analysis[J]. Int J Hyperthermia, 2019, 36(1):1278-1286.
[34]	CHOI Y, JUNG S L. Efficacy and safety of thermal ablation techniques for the treatment of primary papillary thyroid microcarcinoma: a systematic review and meta-analysis[J]. Thyroid, 2020, 30(5):720-731. doi: 10.1089/thy.2019.0707 pmid: 31801432
[35]	CUI T, JIN C, JIAO D, et al. Safety and efficacy of microwave ablation for benign thyroid nodules and papillary thyroid microcarcinomas: a systematic review and meta-analysis[J]. Eur J Radiol, 2019, 118:58-64. doi: S0720-048X(19)30231-1 pmid: 31439259
[36]	CHO S J, BAEK S M, LIM H K, et al. Long-term follow-up results of ultrasound-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma: more than 5-year follow-up for 84 tumors[J]. Thyroid, 2020, 30(12):1745-1751. doi: 10.1089/thy.2020.0106 URL
[37]	CHO S J, BAEK S M, NA D G, et al. Five-year follow-up results of thermal ablation for low-risk papillary thyroid microcarcinomas: systematic review and meta-analysis[J]. Eur Radiol, 2021, 31(9):6446-6456. doi: 10.1007/s00330-021-07808-x pmid: 33713168
[38]	AGYEKUM E A, FU J H, XU F J, et al. Ultrasound-guided thermal ablation of thyroid nodules: technicalities progress and clinical applications, especially in malignant thyroid nodules[J]. Front Oncol, 2021, 11:761005. doi: 10.3389/fonc.2021.761005 URL
[39]	SHEN K, XUE S, XIE Y, et al. Comparison of thermal ablation and routine surgery for the treatment of papillary thyroid microcarcinoma: a systematic review and meta-analysis[J]. Int J Hyperthermia, 2020, 37(1):913-924. doi: 10.1080/02656736.2020.1777331 URL
[40]	KIM H J, CHO S J, BAEK J H. Comparison of thermal ablation and surgery for low-risk papillary thyroid microcarcinoma: a systematic review and meta-analysis[J]. Korean J Radiol, 2021, 22(10):1730-1741. doi: 10.3348/kjr.2020.1308 pmid: 34585542
[41]	YAN L, ZHANG M, SONG Q, et al. Ultrasound-guided radiofrequency ablation versus thyroid lobectomy for low-risk papillary thyroid microcarcinoma: a propensity-matched cohort study of 884 patients[J]. Thyroid, 2021, 31(11):1662-1672. doi: 10.1089/thy.2021.0100 URL
[1]	李昌金, 胡薇. 微波消融与传统开放手术治疗甲状腺微小乳头状癌的安全性及近期疗效Meta分析[J]. 中华介入放射学电子杂志, 2020, 8(4):339-345.
	LI C J, HU W. Meta-analysis of the safety and short-term efficacy of microwave ablation and traditional open surgery in the treatment of papillary thyroid microcarcinomas[J]. Chin J Inter Rad (Electronic Edition), 2020, 8(4):339-345.
[42]	MAURI G, ORSI F, CARRIERO S, et al. Image-guided thermal ablation as an alternative to surgery for papillary thyroid microcarcinoma: preliminary results of an Italian experience[J]. Front Endocrinol(Lausanne), 2020, 11:575152.
[43]	RUSSELL J, SINCLAIR C F. Future considerations and directions for thermal ablative technologies[J]. Curr Otorhinolaryngology Rep, 2021, 9(2):210-214.
[2]	CHO S J, BAEK J H, CHUNG S R, et al. Thermal ablation for small papillary thyroid cancer: a systematic review[J]. Thyroid, 2019, 29(12):1774-1783. doi: 10.1089/thy.2019.0377 pmid: 31739738
[3]	岳林先, 陈琴. 甲状腺微小乳头状癌的诊治进展[J]. 实用医院临床杂志, 2020, 17(5):243-248.
	YUE L X, CHEN Q. The progress in the diagnosis and management of papillary thyroid microcarcinoma[J]. Pract J Clin Med, 2020, 17(5):243-248.
[4]	HAUGEN B R, ALEXANDER E K, BIBLE K C, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer[J]. Thyroid,2016, 26(1):1-133. doi: 10.1089/thy.2015.0020 URL
[5]	陈杭军, 张超, 黄品同. 甲状腺微小乳头状癌经微波消融与手术切除的疗效、安全性及经济性比较[J]. 中华医学超声杂志(电子版), 2018, 15(4):275-280.
	Chen H J, Zhang C, Huang P T. Microwave ablation and surgical resection of papillary thyroid microcarcinoma: comparative analysis of clinical efficacy, safety and economy[J]. Chin J Med Ultrasound(Electronic Edit), 2018, 15(4):275-280.
[6]	OH H S, HA J, KIM H I, et al. Active surveillance of low-risk papillary thyroid microcarcinoma: a multi-center cohort study in Korea[J]. Thyroid, 2018, 28(12):1587-1594. doi: 10.1089/thy.2018.0263 URL
[7]	JEONG S Y, BAEK J H, CHOI Y J, et al. Radiofrequency ablation of primary thyroid carcinoma: efficacy according to the types of thyroid carcinoma[J]. Int J Hyperthermia, 2018, 34(5):611-616. doi: 10.1080/02656736.2018.1427288 URL
[8]	JI L, WU Q, GU J, et al. Ultrasound-guided percutaneous laser ablation for papillary thyroid microcarcinoma:a retrospective analysis of 37 patients[J]. Cancer Imaging, 2019, 19(1):16. doi: 10.1186/s40644-019-0204-x
[9]	TENG D K, LI H Q, SUI G Q, et al. Preliminary report of microwave ablation for the primary papillary thyroid microcarcinoma:a large-cohort of 185 patients feasibility study[J]. Endocrine, 2019, 64(1):109-117. doi: 10.1007/s12020-019-01868-2
[10]	LIM H K, CHO S J, BAEK J H, et al. US-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma: efficacy and safety in a large population[J]. Korean J Radiol, 2019, 20(12):1653-1661. doi: 10.3348/kjr.2019.0192 pmid: 31854153
[11]	CHEN J, CAO J, QIU F, et al. The efficacy and the safety of ultrasound-guided ablation therapy for treating papillary thyroid microcarcinoma[J]. J Cancer, 2019, 10(21):5272-5282. doi: 10.7150/jca.36289 pmid: 31602278