Long-term follow-up results of PTMC treated by ultrasound-guided radiofrequency ablation: a retrospective study

Abstract

Objectives: To confirm the long-term efficacy and safety of radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC). Methods: We retrospectively reviewed data of 102 primary papillary thyroid carcinoma patients (82 women, 20 men; mean age: 43 [19] years) treated with radiofrequency ablation and thyroid-stimulating hormone (TSH) suppression therapy before December 2018. All patients were at high surgical risk or refused surgery. They were followed up at 1, 3, 6, 9, and 12 months and every 6-12 months thereafter using ultrasound and contrast-enhanced ultrasound. The volume and volume reduction ratio was calculated. Recurrence and lymph node or distant metastasis were evaluated. Results: The mean initial tumor diameter was 0.50 (0.29) cm; the mean initial volume was 0.06 (0.09) mL. At 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after RFA, complete resorption rates were 0, 0, 9.8 (10/ 102), 33.3 (34/102), 91.2 (93/102), 96.1 (98/102), 99 (101/102), 100, and 100%, respectively. Two patients had developed ipsilateral neck lymph node metastasis in regions IV and VI at 30-and 18month follow-ups, respectively. After RFA, 3/102 patients (2.9%) developed hoarseness-the main side effect. No life-threatening or delayed complications occurred. The TSH value in the initial period was 0.06 (0.02) mIU/mL; the rate of reaching the TSH target was 85.7%. The TSH value at follow-up was 1.47 (0.91) mIU/mL; the compliance rate was 99.3%. Conclusions: Ultrasound-guided RFA for PTMC is highly effective and safe. RFA can serve as a minimally invasive treatment for PTMC patients who refuse surgery or active surveillance.

Association of BRAFV600E Mutation with the Aggressive Behavior of Papillary Thyroid Microcarcinoma: A Meta-Analysis of 33 Studies

“…Radiofrequency ablation (RFA) is one treatment option that has demonstrated impressive safety and efficacy profiles [ 56 , 57 ]. A 2021 study of 102 patients with PTMC found 100% resorption rates at the 5-year follow-up [ 58 ]. Befittingly, minimally invasive ablative technology is generally more efficacious in nodules of smaller sizes [ 59 , 60 ], making them an attractive option for patients with PTMC.…”

Research Review of Thermal Ablation in the Treatment of Papillary Thyroid Carcinoma

“…A meta-analysis including 339 thermal ablation and 314 surgical patients (54) showed no statistically significant differences in the rates of local tumor recurrence, lymph node metastasis, distant metastasis, and salvage surgery between surgery and ablation. In a long-term follow-up study (27), two patients treated with thermal ablation developed ipsilateral cervical lymph node metastases; however, a study by Myung et al (55) showed a recurrence rate of 1.4% in patients followed for 5-6 years after surgery. By contrast, ablation does not affect the prognosis of patients treated with or without surgery, and it preserves at least one side of the thyroid gland in most patients.…”

“…Cho et al (26) reported complete disappearance rates of 98.8% and 100% at 24 and 60 months after RFA for PTMC, respectively, with no local tumor progression, lymph node metastasis, distant metastasis, delayed complications, surgery-related death, or delayed surgery. A 5-year retrospective study of RFA for PTMC was also conducted in China (27), and all nodes were completely absorbed at the end of follow-up, with only 2 patients developing ipsilateral lateral cervical lymph node metastasis. These studies confirm the effectiveness and safety of RFA for the treatment of PTMC.…”

“…In addition, the rich blood supply to the thyroid gland can lead to transient bleeding at the end of the ablation, although this can be relieved with compression. Finally, a small number of patients experience complications such as altered thyroid function (24,27,49,50,60,77) and cough (21,36,45) after thermal ablation, which normally resolve during the postoperative period.…”

The preliminary study on the microwave ablation of multifocal papillary thyroid microcarcinoma

“…In recent years, minimally invasive image-guide ablation techniques such as microwave ablation (MWA), radiofrequency ablation (RFA), laser ablation (LA) have been developed. The outcomes of thermal ablation for unifocal PTMC were proved to be promising according to the previous studies (9)(10)(11).However, the study on MWA of multifocal PTMC has seldom been reported.…”