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Microwave ablation vs. surgery for papillary thyroid carcinoma with minimal sonographic extrathyroid extension: a multicentre prospective study

  • Oncology
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Abstract

Objectives

Minimal extrathyroid extension (mETE) was removed from the TNM staging system. This study was designed prospectively to compare the safety and efficacy of microwave ablation (MWA) versus surgery for treating T1N0M0 papillary thyroid carcinomas (PTC) with sonographically detected mETE.

Methods

From December 2019 to April 2021, 198 patients with T1N0M0 mETE-PTCs evaluated by preoperative ultrasound from 10 hospitals were included. Ninety-two patients elected MWA, and 106 patients elected surgery for treatment. MWA was performed using extensive ablation with hydrodissection. Surgery consisted of lobectomy with ipsilateral central lymph node dissection (CLD), lobe and isthmus excision with ipsilateral CLD and total thyroidectomy with ipsilateral CLD. The rates of technical success, cost, oncologic outcomes, complications and quality of life of the two groups were assessed.

Results

The follow-up times for the MWA and surgery groups were 12.7 ± 4.1 and 12.6 ± 5.0 months, respectively. The technical success rate was 100% for both groups. Oncological outcomes of the two groups were similar during the follow-up (all p > 0.05). The MWA group had a shorter operation time, less blood loss and lower costs (all p < 0.001). Three complications (3.3%) were reported in the MWA group and 4 (3.8%) in the surgery group (p = 0.846). The surgery group had higher scores for scar problems and anxiety (p < 0.001 and p = 0.003, respectively).

Conclusions

Microwave ablation was comparable in the short term to surgery in terms of treatment safety and efficacy in selected patients with T1N0M0 mETE-PTC detected by ultrasound.

Key Points

• Microwave ablation is comparable to surgery in the safety and short-term efficacy for PTCs with sonographically detected mETE.

• Thermal ablation is technically feasible for mETE-PTC treatment.

• Patients with mETE-PTC have similar quality of life in the two groups, except for worse scar problems and anxiety in the surgery group.

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Abbreviations

CLD :

Central lymph node dissection

gETE :

Gross extrathyroid extension

HADS:

Hospital Anxiety and Depression Scale

LNMs:

Lymph node metastasis

LTP :

Local tumour progression

mETE :

Minimal extrathyroid extension

MWA :

Microwave ablation

PTC :

Papillary thyroid carcinoma

TA :

Thermal ablation

THYCA-QoL:

Thyroid Cancer-specific Quality of Life

US :

Ultrasound

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Acknowledgements

All authors contributed to the idea, gathered the information, interpreted the data, and wrote and approved the final version of the manuscript.

Funding

The authors state that this work has not received any funding.

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Author notes

  1. Lin Zheng and Jian-ping Dou contributed equally to this work.

Authors and Affiliations

  1. Department of Interventional Ultrasound, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China

    Lin Zheng, Jian-ping Dou, Fang-yi Liu, Jie Yu, Zhi-gang Cheng, Xiao-ling Yu, Zhi-yu Han & Ping Liang

  2. Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, China

    Hui Wang

  3. Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250013, People’s Republic of China

    Cun Liu

  4. Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, 100029, China

    Ming-an Yu

  5. Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China

    Zhi-bin Cong & Xue Wang

  6. Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China

    Shu-rong Wang & Ying Liu

  7. Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China

    Ying Che

  8. First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China

    Zhi-feng Xu & Ying Zhou

  9. Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China

    Ying Hao

  10. Department of Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, China

    Nan Bai

  11. Department of Medical Ultrasound, Chengwu County People’s Hospital, 66 Bole Dajie, Chengwu County, Heze City, Shandong Province, China

    Jing Shi

  12. Department of Medical Ultrasound, The Third Hospital of Xingtai City, 108 Gangtai North Road, Xingtai City, HeBei Province, China

    Zhao-hu Fu

  13. Department of Ultrasonography, The Fourth People’s Hospital of Jinan, 50 Normal Road, Jinan City, Shandong Province, China

    Hong-yan Zhan

Authors
  1. Lin Zheng
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Corresponding authors

Correspondence to Zhi-yu Han or Ping Liang.

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The scientific guarantor of this publication is Ping Liang.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• prospective

• diagnostic or prognostic study

• multicentre study performed at one institution

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Zheng, L., Dou, Jp., Liu, Fy. et al. Microwave ablation vs. surgery for papillary thyroid carcinoma with minimal sonographic extrathyroid extension: a multicentre prospective study. Eur Radiol 33, 233–243 (2023). https://doi.org/10.1007/s00330-022-08962-6

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  • DOI: https://doi.org/10.1007/s00330-022-08962-6

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