Preoperative Diagnosis And Microwave Ablation Of Thyroid Follicular Neoplasm

Objective:To investigate the clinical efficacy of ultrasound-guided core needle biopsy(CNB)for thyroid nodules with indeterminate cytology or Bethesda Ⅳ result.To compare the diagnostic efficiencies for follicular neoplasm achieved by five ultrasound-based malignancy risk stratification system.To evaluate the effectiveness and safety of microwave ablation(MWA)for Bethesda category Ⅳ thyroid nodules.Methods:From December 2013 to December 2021,a total of 491 consecutive nodules were tested using fine needle aspiration cytology(FNAC)and CNB the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine.Analysing the diagnostic efficacy of CNB for thyroid nodules with Bethesda Ⅳ result.From January 2013 to October 2021,we recruited 223 patients with follicular thyroid adenoma or follicular thyroid carcinoma(249 thyroid nodules)examined by pathological examination in 3 centers(The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine,The First Affiliated Hospital of Xiamen University and Suqian People’s Hospital of Jiangsu Province).Receiver operating characteristic(ROC)curves illustrating the diagnostic ability of 5 malignancy risk stratification systems(ACR-TIRADS、K-TIRADS、C-TIRADS、ATA、AACE/ACE/AME)in diagnosing benign/malignant thyroid follicular neoplasms were depicted.the best diagnostic cut-off was selected according to the Youden index to compare their diagnostic performance.A total of 133 patients undergo fine-needle aspiration FNAC in the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine,47 patients elected MWA and 85 patients elected surgery for treatment of Bethesda category Ⅳ thyroid nodules.Patients were followed up at 1,3,6,and 12 months after intervention,the change of nodule volume was observed.Postoperative complications,operation time,hospitalization time,and incision length were recorded.Results:(1)The rate of indeterminate results reported by FNAC and CNB was 44.20%(217/491)and 24.85%(122/491),respectively.Among the 34 Bethesda Ⅳ nodules,17 were Ⅱ results in the CNB pathology reporting system,12(44.12%)were still Ⅱ results in the CNB pathology reporting system.(2)Among the 249 follicular thyroid adenoma or follicular thyroid carcinoma,nodules with characteristics of solid,hypoechoic,irregular margin and aspect ratio>1 have a higher rate of malignancy.(3)There was significant difference in the malignancy rate between categories of thyroid nodules graded by 5 thyroid imaging reporting and data system(P<0.001).The areas under the curves(AUCs)of ACR-TIRADS、K-TIRADS、C-TIRADS、ATA、AACE/ACE/AME were 0.787、0.772、0.802、0.637 and 0.735 with their own best diagnostic cut-off,respectively.(4)84 patients underwent surgery,postoperative pathology was benign lesions,borderline tumors,papillary thyroid carcinoma,follicular variant papillary thyroid carcinoma,follicular thyroid carcinoma,medullary carcinoma,44 cases,4 cases,27 cases,6 cases,3 cases,1 case,respectively.Compared to benign lesions,Preoperative ultrasonographic features of thyroid carcinoma were solid(86.11%vs.72.72%),hypoechoic(55.56%vs.13.63),and irregular margin(47.22%vs.13.63%).(5)In MWA group,there was no significant difference in ultrasound characteristics of 47 cases of thyroid nodules before ablation and after.The mean follow-up time was 10.05±3.06 months in MWA group.Immediate MWA and at 1,3,6,12 months postoperatively,the volume was 10.85±10.18 ml,5.82±4.55 ml,3.73±3.38 ml,2.50±2.63 ml,1.42±1.27 ml,respectively,VRR was 37.90%±22.54%、58.59%±20.34%、73.84%±17.24%、85.01%±10.86%,No recurrences,no metastatic lymph node,and no distant metastases were detected during follow-up.(6)The TA group had fewer complications,shorter operation time,smaller incision length,shorter hospitalization time,and lower treatment costs compared to the surgery group(all P<0.001).Conclusion:(1)CNB can significantly reduce the rate of nondiagnostic or indeterminate cytology,furthering clarify the benign and malignant of Bethesda Ⅳ nodules,rather than identified carcinoma effectively.(2)All the five ultrasound models have value for benign/malignant thyroid follicular neoplasms.C-TIRADS has the best diagnostic performance,ACR-TIRADS with a high sensitivity,and the specificity of K-TIRADS is higher.(3)MWA can significantly reduce the tumor volume for FN,with high safety.Compared witih surgery,MWA can significantly reduce the length of surgery and hospital stay,reduce medical costs,and have fewer adverse reactions.