| ObjectiveTo explore the clinical effect and feasibility of ultrasound-guided percutaneous thermal ablation for metastatic cervical lymph nodes in thyroid carcinoma,and to compare the application of radiofrequency ablation and microwave ablation in the treatment of cervical lymph node metastasis of thyroid cancer.MethodRetrospective analysis of clinical data of 43 patients with metastatic cervical lymph nodes treated with ultrasound-guided percutaneous thermal ablation in thyroid surgery department in the China-Japan union Hospital of Jilin University from September 2012 to July 2018.All patients underwent radical resection of thyroid cancer and cervical lymph node dissection,and were diagonosed as cervical lymph node recurrence by comprehensive evaluation with ultrasonography,FNA pathology,and FNA-Tg.Total lymph nodes were 49(two patients and three lymph nodes underwent twice thermal ablation).The pathological type of 42patients was papillary thyroid carcinoma and 1 case was medullary thyroid carcinoma.6 paitients were treated with microwave ablation,and36 paitients choosed radiofrequency ablation.Patients regularly followed up for 1 month,3 months,6 months,9 months,12 months,18 months,24months.Statistical method:Using SPSS 23.0 software,the measurement data conforming to the normal distribution was expressed as mean±standard deviation,and analyzed by t test.Lymph node volume and Tg levels before and after thermal ablation did not conform to the normal distribution,expressed as median±quartile,using Wilcoxon test.and the count data was expressed as a percentage,using the?~2 test.P<0.05indicates that the difference was statistically significant.ResultsOnly one of the 43 patients was lost to follow-up.The overall follow-up rate was 97.67%(42/43),and the mean follow-up time was44.5±18.86 months.The average maximum diameter of 49 lymph nodes before ablation was 9.69±4.67mm,and the average volume was117.81±72.78mm~3,the average Tg level is 3.28±1.00 ng/ml.Three patients had recurrence after ablation,accounting for 7.14%(3/42),and one of them was a patient with medullary carcinoma.In the last follow-up,the ablated lymph node areas of 34 patients had completely disappeared,which was 80.95%(34/42),and the remaining 5 ablation lesions still existed,accounting for 11.90%(5/42).The average volume of the 39patients before thermal ablation was 117.34±67.02 mm~3,the average volume after ablation was 0±0mm~3(P<0.01),the mean value of preoperative serum Tg was 4.39±1.03 ng/ml,and the mean postoperative Tg was 0.39±0.04ng/ml(P<0.01).In the radiofrequency treatment group and the microwave treatment group,there was a significant decline of lymph node volume(P<0.01,P=0.02),but the comparison between the two groups showed no significant difference in preoperative Tg levels and postoperative Tg levels and lymph node volume(P>0.05).Conclusions(1)Ultrasound-guided thermal ablation is feasible,safe,and effective for the treatment of metastatic cervical lymph nodes in papillary thyroid carcinoma.(2)For patients with metastatic cervical lymph nodes of medullary thyroid carcinoma,surgery should still be the main choice.(3)Before ablation,multiple methods should be used for accurate diagnosis.Ultrasound,serum Tg and TgAb are selected for postoperative follow-up.For some patients,other imaging examinations such as CT and PET-CT can be used selectively.(4)Radiofrequency ablation and microwave ablation both have effectiveness and safety in the treatment of cervical lymph nodes in thyroid cancer. |
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