Analysis And Evaluation Of The Efficacy Of Ultrasound-guided Microwave Ablation For Papillary Thyroid Microcarcinoma

Background:With the improvement of people’s health awareness and scientific and technological level,the detection rate of papillary thyroid microcarcinoma(PTMC)has been increasing year by year.However,how to choose the most appropriate treatment after PTMC was diagnosed remained controversial.Internationally,ultrasound-guided thermal ablation,as an emerging technique,has achieved satisfactory results in the treatment of thyroid microcarcinoma.The present study aimed to evaluate the efficacy of microwave ablation(MWA)for unifocal PTMC with a diameter of≤0.6 cm,and to provide a basis for further studies on the effectiveness of ultrasound-guided thermal ablation in the treatment of thyroid microcarcinoma.Methods:Patients with PTMC diagnosed in the Affiliated Hospital of Qingdao University from January 2016 to December 2018 were studied retrospectively.They were divided into MWA group(63 cases)and surgery group(83 cases)according to the final treatment method.MWA was performed using the hydrodissection technique and multidimensional fixed-needle principle.We analyzed the absorption of the lesion in the MWA area and evaluated the prognosis over a follow-up period of 24 months.At the same time,the operating room characteristics and procedural complications of the two groups were compared,operating room characteristics included thyroid tissue loss volume,operating room(OR)time and average hospital stayResults:In MWA group,the maximum diameter(MD)of ablation area,volume of ablation area(AVV)and volume reduction rate(VRR)changed significantly from immediately to 24months after MWA.Mean value of MD decreased from 1.76±0.27cm to 0.02±0.05cm(p<0.001),AAV decreased from 1.3413±0.6763 cm~3to 0.0001±0.0004cm~3(p<0.05),VRR was as high as 99.43±1.58%(p<0.05),and the volume reduction trend gradually slowed down after 12 months.The incidence of temporary reactive hyperplastic lymphadenectasis was higher(6%>2%)and that of other complications was lower in the MWA group than in the surgery group.Pain:mild pain in the MWA group was 98%,moderate pain in the surgery group was 48%,and severe pain was 3%.Hoarseness:11%temporary hoarseness in MWA group and 5%permanent hoarseness in surgery group.Thyroid function:temporary hyperthyroidism in MWA group was 32%,temporary hyperthyroidism in surgery group was 73%,and permanent decompensation of thyroid function was 4%.One percent of the patients in the surgery group had recurrence or metastasis,but none were detected in the MWA group.The MWA group is superior to the surgery group in thyroid tissue loss volume(1.35±0.72 cm~3<22.37±14.81 cm~3,p<0.001),OR time(29.71±6.55 min<69.13±29.57 min,p<0.001),average hospital stay(1.19±0.44 days<5.37±1.31 days,p<0.001).The loss of thyroid tissue volume(p<0.001),operating room time(p<0.001),and the mean length of hospital stay(p<0.001)were significantly lower in the MWA group than in the surgery group.Conclusion:Ultrasound-guided MWA is an effective treatment strategy for unifocal PTMC with a diameter of≤0.6 cm.It can become an alternative treatment for surgery for such diseases in the future.