| Objectives:(1)To evaluate the safety, efficacy of thermal ablation in thyroid benign nodules and get the reliable evidence-based medicine proof.(2)To evaluate the ability and clinical value of immediate contrast-enhanced ultrasound (CEUS) in the assessment of MWA of benign thyroid nodules.(3)To assess the safety and efficacy of ultrasound-(US) guided MWA for controlling papillary thyroid cancer (PTC).Methods:(1)A total of 788 patients with 1018 benign thyroid nodules received ultrasound (US) guided thermal ablation in 13 hospitals in China from February 2013 to March 2015. The mean diameter of tumors were 2.77±1.45cm(Range:1.0cm-8.3cm)and the mean volume of tumors were 8.55±15.43ml(Rage:0.11-210.87ml). All patients took radiofrequency ablation (RFA),microwave ablation (MWA) or laser ablation (LA) depend on the hospital they stayed in. All nodules’preoperative and postoperative size, and blood flow, volume reduction radio (VRR) were assessed with unified standards.(2) From January 2013 to March 2015, a total of 187 patients with benign thyroid nodules received US-guided thermal ablation and were divided into two groups by the ablation date. US group did not perform CEUS immediately, however, CEUS group perform CEUS immediately.(3)From July 2013 to February 2015, a total of 16 patients with 19 malignant thyroid nodules received US-guided MWA. The mean volume of tumors were 0.21±0.30ml (Rage:0.02-1.09ml),and mean diameter of nodules is 0.87±0.50cm (Range: 0.4-2.0cm).All nodules received completed ablation and achieved safe margin. After ablation all patients received chronic thyroid-stimulating hormone suppression.Results:(1)The totally follow-up duration was 1-24 months. There were 434 nodules performed MWA 578 nodules performed RFA and 6 nodules performed LA. Tumor volume decreased significantly from 8.55±15.43ml before ablation tol.92±3.29 (P<.005), with a volume reduction ratio of 40.2(35.8)%,73.6(35.8)%,94.1(31.5)% and 77.8(32.6)% in 1-,3-,6-,12-month, respectively. The overall complication rate was 9.77%.(22) There were totally 187 nodules performed MWA. One hundred and seventy-eight (95.2%) nodules were ablated in 1 session, and 9 nodules (4.8%) performed additional ablation. There were 2 patients in CEUS group and 7 patients in US group underwent additional ablation, respectively. The blood supply of ablation area in CEUS group is obviously better than the display in US group (P<0.001), all patients blood supply in CEUS group were showed exactly (121/121). The cases of blood supply of ablation area in US group showed indefinite accounted for 22.7%(15/66). Ablation area blood supply of US group showed no definite cases accounted for 22.7% of the group (15/66).(3) The mean volume increased from 0.21ml to 1.23ml and then reduced to 0.05ml in last follow-up visit. There were 4 tumors were disappeared,3 tumors showed puncture path coagulation necrosis in US in the last visit. One patient took additional ablation because of the suspicious new lesion, however no lymphatic and other metastasis.There were no complications during the ablation and follow-up period.Conclusion:(1) Thermal ablation can be effective to reduce the volume of thyroid nodule, even make nodules disappear completely. Compared with the surgical resection, thermal ablation is a technique not only minimally invasive, but also with the low incidence of complications and side effects. Large sample of prospective multicenter study can provide the thermal ablation of thyroid benign nodules standardized treatment guidelines and reliable evidence of evidence-based medicine.(2) Immediately CEUS after ablation to evaluate blood flow better than the US, showing the coagulation zone more clear and accurate, and can be used as a local curative effect to determine ablation zone of thyroid nodules after ablation immediately.(3) For small, classification stage earlier, not lymph node and distant metastasis and high degree of differentiation of thyroid papillary carcinoma, MWA ablation is safe, effective and repeatable. |
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