Skip to main content

Advertisement

SpringerLink
Log in

Clinical outcomes of radiofrequency ablation for multifocal papillary thyroid microcarcinoma versus unifocal papillary thyroid microcarcinoma: a propensity-matched cohort study

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To investigate and compare the clinical outcomes of radiofrequency ablation (RFA) for multifocal papillary thyroid microcarcinoma (PTMC) versus unifocal PTMC in a large cohort.

Methods

Patients with low-risk PTMC (n = 487) who underwent RFA were included in this retrospective study and divided into the unifocal group (U group) (n = 432) and the multifocal group (M group) (n = 55) according to the number of lesions. After 1:1 propensity score matching (PSM), volume, volume reduction ratio (VRR), the development of local tumor progression including lymph node metastasis (LNM), recurrent PTMC and persistent lesions, and recurrence-free survival (RFS) rate were evaluated and compared between the two groups. The different impacts of multifocality on recurrence after RFA for PTMC were investigated by Cox analysis.

Results

During a mean follow-up time of 49.25 ± 12.98 months, the overall VRR was 99.40 ± 4.43% and the overall incidence of local tumor progression was 3.70% (18/487). No complications occurred after RFA. After PSM, no significant differences were found in volume (0.11 ± 0.69 mm3 vs 0 mm3, p = 0.441), VRR (99.87 ± 0.78% vs 100%, p = 0.441), complete disappearance rate (95.61% vs 89.09%, p = 0.201), incidence of local tumor progression (5.45% vs 5.45%, p = 1.000), LNM (1.82% vs 0%, p = 0.317), recurrent PTMC (1.82% vs 5.45%, p = 0.611), persistent lesions (1.82% vs 0%, p = 0.317), and RFS rate (96.36% vs 94.55%, p = 0.632) between the M group and U group. The association between multifocality and local tumor recurrence also remained nonsignificant (p = 0.619). No distant metastasis or delayed surgery occurred.

Conclusions

The impact of multifocality on the prognosis after RFA for low-risk PTMC was little. RFA might be a promising treatment for both unifocal and multifocal PTMC in properly selected patients after sufficient preoperative evaluation.

Key Points

• No significant differences are found in the local tumor progression between the unifocal PTMC and multifocal PTMC.

• Multifocality is not associated with higher recurrence after RFA for low-risk PTMC.

• RFA is a promising alternative for both unifocal and multifocal PTMC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

AS:

Active surveillance

CEUS:

Contrast-enhanced ultrasound

CLT:

Chronic lymphocytic thyroiditis

CNB:

Core-needle biopsy

ETE:

Extrathyroidal extension

FNA:

Fine-needle aspiration

LNM:

Lymph node metastasis

M group:

Multifocal group

PSM:

Propensity score matching

PTMC:

Papillary thyroid microcarcinoma

RFA:

Radiofrequency ablation

RFS:

Recurrence-free survival

U group:

Unifocal group

VRR:

Volume reduction rate

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424

    Article  PubMed  Google Scholar 

  2. Haugen BR, Alexander EK, Bible KC et al (2015) 2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26:1–133

    Article  Google Scholar 

  3. Miyauchi A, Ito Y, Oda H (2017) Insights into the management of papillary microcarcinoma of the thyroid. Thyroid 28:23–31

    Article  PubMed  CAS  Google Scholar 

  4. Zheng WH, Wang KJ, Wu JZ, Wang WD, Shang JB (2018) Multifocality is associated with central neck lymph node metastases in papillary thyroid microcarcinoma. Cancer Manag Res 10:1527–1533

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Zanocco KA, Hershman JM, Leung AM (2019) Active surveillance of low-risk thyroid cancer. JAMA 321:2020–2021

    Article  PubMed  Google Scholar 

  6. Sugitani I, Ito Y, Takeuchi D et al (2021) Indications and strategy for active surveillance of adult low-risk papillary thyroid microcarcinoma: consensus statements from the Japan Association of Endocrine Surgery Task Force on Management for Papillary Thyroid Microcarcinoma. Thyroid 31:183–192

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zhang M, Luo Y, Zhang Y, Tang J (2016) Efficacy and safety of ultrasound-guided radiofrequency ablation for treating low-risk papillary thyroid microcarcinoma: a prospective study. Thyroid 26:1581–1587

    Article  PubMed  Google Scholar 

  8. Teng DK, Li WH, Du JR, Wang H, Yang DY, Wu XL (2020) Effects of microwave ablation on papillary thyroid microcarcinoma: a five-year follow-up report. Thyroid 30:1752–1758

    Article  CAS  PubMed  Google Scholar 

  9. Zhou W, Jiang S, Zhan W, Zhou J, Xu S, Zhang L (2017) Ultrasound-guided percutaneous laser ablation of unifocal T1N0M0 papillary thyroid microcarcinoma: Preliminary results. Eur Radiol 27:2934–2940

    Article  PubMed  Google Scholar 

  10. Cho SJ, Baek SM, Lim HK, Lee KD, Son JM, Baek JH (2020) Long-term follow-up results of ultrasound-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma: more than 5-year follow-up for 84 tumors. Thyroid 30:1745–1751

    Article  CAS  PubMed  Google Scholar 

  11. Teng DK, Li HQ, Sui GQ et al (2019) Preliminary report of microwave ablation for the primary papillary thyroid microcarcinoma: a large-cohort of 185 patients feasibility study. Endocrine 64:109–117

    Article  CAS  PubMed  Google Scholar 

  12. Wu R, Luo YK, Tang J et al (2020) Ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma: a retrospective analysis of 198 patients. Int J Hyperth 37:168–174

    Article  Google Scholar 

  13. Lim HK, Cho SJ, Baek JH et al (2019) US-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma: efficacy and safety in a large population. Korean J Radiol 20:1653–1661

    Article  PubMed  PubMed Central  Google Scholar 

  14. Yan L, Luo Y, Zhang Y et al (2020) The clinical application of core-needle biopsy after radiofrequency ablation for low-risk papillary thyroid microcarcinoma: a large cohort of 202 patients study. J Cancer 11:5257–5263

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ji L, Wu Q, Gu J et al (2019) Ultrasound-guided percutaneous laser ablation for papillary thyroid microcarcinoma: a retrospective analysis of 37 patients. Cancer Imaging 19:16

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zhang Y, Zhang MB, Luo YK, Li J, Zhang Y, Tang J (2019) Effect of chronic lymphocytic thyroiditis on the efficacy and safety of ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma. Cancer Med 8:5450–5458

    Article  PubMed  PubMed Central  Google Scholar 

  17. Yue W, Wang S, Yu S, Wang B (2014) Ultrasound-guided percutaneous microwave ablation of solitary T1N0M0 papillary thyroid microcarcinoma: initial experience. Int J Hyperth 30:150–157

    Article  Google Scholar 

  18. J-h K, Baek JH, Sung JY et al (2017) Radiofrequency ablation of low-risk small papillary thyroidcarcinoma: preliminary results for patients ineligible for surgery. Int J Hyperth 33:212–219

    Article  Google Scholar 

  19. Li J, Liu Y, Liu J, Qian L (2018) Ultrasound-guided percutaneous microwave ablation versus surgery for papillary thyroid microcarcinoma. Int J Hyperth 34:653–659

    Article  CAS  Google Scholar 

  20. Zhou W, Ni XF, Xu SY, Zhang L, Chen YD, Zhan WW (2019) Ultrasound-guided laser ablation versus surgery for solitary papillary thyroid microcarcinoma: a retrospective study. Int J Hyperth 36:897–904

    Article  Google Scholar 

  21. Yue WW, Qi L, Wang DD et al (2020) US-guided microwave ablation of low-risk papillary thyroid microcarcinoma: longer-term results of a prospective study. J Clin Endocrinol Metab 105

  22. Zhang M, Tufano RP, Russell JO et al (2020) Ultrasound-guided radiofrequency ablation versus surgery for low-risk papillary thyroid microcarcinoma: results of over 5 years' follow-up. Thyroid 30:408–417

    Article  PubMed  Google Scholar 

  23. Zhang L, Zhou W, Zhan W, Peng Y, Jiang S, Xu S (2018) Percutaneous laser ablation of unifocal papillary thyroid microcarcinoma: utility of conventional ultrasound and contrast-enhanced ultrasound in assessing local therapeutic response. World J Surg 42:2476–2484

    Article  PubMed  Google Scholar 

  24. Choi Y, Jung SL (2020) Efficacy and safety of thermal ablation techniques for the treatment of primary papillary thyroid microcarcinoma: a systematic review and meta-analysis. Thyroid 30:720–731

    Article  PubMed  Google Scholar 

  25. Tong M, Li S, Li Y, Li Y, Feng Y, Che Y (2019) Efficacy and safety of radiofrequency, microwave and laser ablation for treating papillary thyroid microcarcinoma: a systematic review and meta-analysis. Int J Hyperth 36:1278–1286

    Article  Google Scholar 

  26. Jeon YW, Gwak HG, Lim ST, Schneider J, Suh YJ (2019) Long-term prognosis of unilateral and multifocal papillary thyroid microcarcinoma after unilateral lobectomy versus total thyroidectomy. Ann Surg Oncol 26:2952–2958

    Article  PubMed  Google Scholar 

  27. Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202

    Article  PubMed  Google Scholar 

  28. Cho SJ, Suh CH, Baek JH et al (2019) Active surveillance for small papillary thyroid cancer: a systematic review and meta-analysis. Thyroid 29:1399–1408

    Article  PubMed  Google Scholar 

  29. Oh HS, Ha J, Kim HI et al (2018) Active surveillance of low-risk papillary thyroid microcarcinoma: a multi-center cohort study in Korea. Thyroid 28:1587–1594

    Article  PubMed  Google Scholar 

  30. Ito Y, Miyauchi A, Oda H (2018) Low-risk papillary microcarcinoma of the thyroid: a review of active surveillance trials. Eur J Surg Oncol 44:307–315

    Article  CAS  PubMed  Google Scholar 

  31. Nickel B, Brito JP, Barratt A, Jordan S, Moynihan R, McCaffery K (2017) Clinicians' views on management and terminology for papillary thyroid microcarcinoma: a qualitative study. Thyroid 27:661–671

    Article  PubMed  Google Scholar 

  32. Oh H S, Kwon H, Song E et al (2019) Tumor volume doubling time in active surveillance of papillary thyroid carcinoma. Thyroid 29(5):642–649

  33. Kim JH, Baek JH, Lim HK et al (2018) 2017 Thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology. Korean J Radiol 19:632–655

    Article  PubMed  PubMed Central  Google Scholar 

  34. Li J, Liu Y, Liu J, Yang P, Hu X, Qian L (2019) A comparative study of short-term efficacy and safety for thyroid micropapillary carcinoma patients after microwave ablation or surgery. Int J Hyperth 36:640–646

    Article  Google Scholar 

  35. Cho S J, Baek S M, Na D G, Lee K D, Shong Y K and Baek J H (2021) Five-year follow-up results of thermal ablation for low-risk papillary thyroid microcarcinomas: systematic review and metaanalysis. Eur Radiol. https://doi.org/10.1007/s00330-021-07808-x

  36. Ding M, Tang X, Cui D et al (2019) Clinical outcomes of ultrasound-guided radiofrequency ablation for the treatment of primary papillary thyroid microcarcinoma. Clin Radiol 74:712–717

    Article  CAS  PubMed  Google Scholar 

  37. So YK, Kim MW, Son YI (2015) Multifocality and bilaterality of papillary thyroid microcarcinoma. Clin Exp Otorhinolaryngol 8:174–178

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kaliszewski K, Diakowska D, Wojtczak B, Migon J, Kasprzyk A, Rudnicki J (2019) The occurrence of and predictive factors for multifocality and bilaterality in patients with papillary thyroid microcarcinoma. Medicine (Baltimore) 98:e15609

    Article  Google Scholar 

  39. W Z, K W, J W, W W, J S (2018) Multifocality is associated with central neck lymph node metastases in papillary thyroid microcarcinoma. Cancer Manag Res 10:1527–1533

    Article  Google Scholar 

  40. Karatzas T, Vasileiadis I, Charitoudis G, Karakostas E, Tseleni-Balafouta S, Kouraklis G (2013) Bilateral versus unilateral papillary thyroid microcarcinoma: predictive factors and associated histopathological findings following total thyroidectomy. Hormones (Athens) 12:529–536

  41. Connor MP, Wells D, Schmalbach CE (2011) Variables predictive of bilateral occult papillary microcarcinoma following total thyroidectomy. Otolaryngol Head Neck Surg 144:210–215

    Article  PubMed  Google Scholar 

  42. Kim KJ, Kim SM, Lee YS, Chung WY, Chang HS, Park CS (2015) Prognostic significance of tumor multifocality in papillary thyroid carcinoma and its relationship with primary tumor size: a retrospective study of 2,309 consecutive patients. Ann Surg Oncol 22:125–131

    Article  PubMed  Google Scholar 

  43. Choi WR, Roh JL, Gong G et al (2019) Multifocality of papillary thyroid carcinoma as a risk factor for disease recurrence. Oral Oncol 94:106–110

    Article  PubMed  Google Scholar 

  44. Zhou YL, Gao EL, Zhang W et al (2012) Factors predictive of papillary thyroid micro-carcinoma with bilateral involvement and central lymph node metastasis: a retrospective study. World J Surg Oncol 10:67

    Article  PubMed  PubMed Central  Google Scholar 

  45. Iacobone M, Jansson S, Barczynski M, Goretzki P (2014) Multifocal papillary thyroid carcinoma-a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg 399:141–154

  46. Feng JW, Qu Z, Qin AC, Pan H, Ye J, Jiang Y (2020) Significance of multifocality in papillary thyroid carcinoma. Eur J Surg Oncol

  47. Ito Y, Miyauchi A, Inoue H et al (2010) An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg 34:28–35

    Article  PubMed  Google Scholar 

  48. Tuttle RM, Haugen B, Perrier ND (2017) Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): what changed and why? Thyroid 27:751–756

    Article  PubMed  PubMed Central  Google Scholar 

  49. Lee DY, Kwon TK, Sung MW, Kim KH, Hah JH (2014) Prediction of extrathyroidal extension using ultrasonography and computed tomography. Int J Endocrinol 2014:351058

    Article  PubMed  PubMed Central  Google Scholar 

  50. Liu Y, Liu H, Qian CL, Lin MS, Li FH (2017) Utility of quantitative contrast-enhanced ultrasound for the prediction of extracapsular extension in papillary thyroid carcinoma. Sci Rep 7:1472

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. Wei X, Li Y, Zhang S, Gao M (2014) Prediction of thyroid extracapsular extension with cervical lymph node metastases (ECE-LN) by CEUS and BRAF expression in papillary thyroid carcinoma. Tumour Biol 35:8559–8564

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No funding

Author information

Authors and Affiliations

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

    Lin Yan, Mingbo Zhang, Qing Song, Fang Xie & Yukun Luo

Authors
  1. Lin Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mingbo Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qing Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fang Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yukun Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yukun Luo.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Yukun Luo.

Conflict of interest

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.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yan, L., Zhang, M., Song, Q. et al. Clinical outcomes of radiofrequency ablation for multifocal papillary thyroid microcarcinoma versus unifocal papillary thyroid microcarcinoma: a propensity-matched cohort study. Eur Radiol 32, 1216–1226 (2022). https://doi.org/10.1007/s00330-021-08133-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-08133-z

Keywords

Search

Navigation