Abstract
Objective To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous laser ablation (PLA) for the treatment of low-risk papillary thyroid microcarcinoma (PTMC). Methods From June 2012 to May 2015, 105 patients with solitary, pathologically confirmed PTMC lesions were treated with ultrasound-guided PLA. Nodule location, nodule volume, thyroid function, and clinical symptoms were evaluated before ablation. Contrast-enhanced ultrasound (CEUS) was performed 1 h after treatment to evaluate whether the ablation was complete. Ultrasound examination was performed at 1, 3, 6, and 12 months after ablation and every 6 months thereafter to determine the size of the ablation area and search for recurrence in the thyroid parenchyma and lymph node metastasis. Thyroid function was examined before and 1 month after ablation. Fine needle aspiration biopsy was performed for any suspicious metastatic lymph nodes and recurrent lesions in the thyroid. Results All 105 lesions were completely inactivated after one ablation, making the success rate for single ablation 100%. The average ablation time was 2.78 ± 1.05 min, and the average ablation energy was 505 ± 185 J. All patients could tolerate and complete the ablation. No serious complications occurred during the treatment; only minor side effects such as pain and local discomfort were reported. The volume reduction rates were −781.14 ± 653.29% at 1 h posttreatment and −268.65 ± 179.57%, −98.39 ± 76.58%, 36.78 ± 30.32%, 75.55 ± 21.81%, 96.79 ± 10.57%, and 100% at 1, 3, 6, 12, 18, and 24 months after ablation, respectively. This rate remained 100% at the later follow-up times. Overall, 28 (26.67%), 74 (70.48%), 96 (91.43%), and 103 (100%) were completely absorbed by 6, 12, 18, and 24 months after PLA. One patient developed another lesion 12 months after ablation, and two patients had central cervical lymph node metastasis 24 months after ablation. Conclusion PLA is a safe and effective alternative clinical treatment for low-risk PTMC.
Highlights
In recent years, due to the wide application of highresolution ultrasound and ultrasound-guided fine needle aspiration biopsy (FNAB), the detection rate of papillary thyroid microcarcinoma (PTMC) has increased [1, 2]
A total of 105 patients with solitary PTMC lesion treated by ultrasoundguided percutaneous laser ablation (PLA) in our department from June 2012 to May 2015 were enrolled in this study
Over the past few years, several investigators have applied PLA as an alternative therapy to surgery in the treatment of PTMC, either as the only therapy applied or in combination with other treatments
Summary
Due to the wide application of highresolution ultrasound and ultrasound-guided fine needle aspiration biopsy (FNAB), the detection rate of papillary thyroid microcarcinoma (PTMC) has increased [1, 2]. More than 50% of new cases of thyroid cancer are PTMC [3]. It rarely progresses to thyroid cancer with clinical significance, and some patients can live a lifetime with PTMC without symptoms. Even the presence of clinical symptoms or regional lymph node metastasis has been shown to have little impact on the survival rate among PTMC patients [8, 9]. Active surveillance rather than treatment is recommended for asymptomatic and nonmetastatic PTMC cases. Active surveillance has some drawbacks: first, PTMC has a good prognosis, some cases will not maintain a subclinical status without progression, and some
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