Percutaneous Laser Ablation of Metastatic Lymph Nodes in the Neck From Papillary Thyroid Carcinoma: Preliminary Results
Percutaneous Laser Ablation of Metastatic Lymph Nodes in the Neck From Papillary Thyroid Carcinoma: Preliminary Results
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DOI：
10.1210/jc.2013-1140
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发表时间：
2013-07-01
影响因子：
5.8
通讯作者：
Solbiati, L.
中科院分区：
文献类型：
--
作者：
Mauri, G.;Cova, L.;Solbiati, L.
内容：经皮激光消融（PLA）可能是有用的治疗患者异时性转移淋巴结在neck.Objective：我们的目的是评估PLA作为一种治疗难治性异时性颈部淋巴结转移的甲状腺乳头状癌。设计和设置：我们进行了一项回顾性分析，前瞻性收集的数据在公立医院。患者：在2010年9月至2012年4月期间，对15例甲状腺乳头状癌切除术后血清甲状腺球蛋白（Tg）或抗Tg抗体（TgAbs）水平升高的患者和24例异时性淋巴结转移患者进行了[F-18]氟脱氧葡萄糖（（18）FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）和对比增强超声（CEUS）。干预：干预是PLA。在6个月和12个月时评估Tg/TgAb血清水平和（18）FDG-PET/CT和CEUS外观，并与基线进行比较。结果：PLA始终是可行的，所有患者都取得了技术成功。6个月时，15例患者中有11例（73%）实现了局部控制，其中6例（40%）血清Tg/TgAb正常化（P = 0.017 vs基线）。而24个淋巴结中有20个（83%）在18个FDG-PET/CT和CEUS中呈阴性（P <0.001 vs基线），4个为18个FDG-PET/CT阳性（3个也为CEUS阳性）。在12个月随访时，14例患者中有10例（71.4%）实现了局部控制。20个淋巴结中有16个（80%）在18FDG-PET/CT和CEUS中呈阴性（P < .001 vs基线），4个（18）FDG-PET/CT阳性（2个也为CEUS阳性）。10例患者中有4例（40%）血清Tg/TgAb恢复正常（与基线相比，P = 0.098）。结论：PLA治疗甲状腺乳头状癌异时性颈淋巴结转移是可行、安全、有效的。该手术可减少或延迟大量高侵袭性重复颈清扫术。
Context: Percutaneous laser ablation (PLA) may be useful in treating patients with metachronous metastatic lymph nodes in the neck.Objective: Our objective was to assess PLA as a treatment of difficult-to-treat metachronous cervical lymph node metastases from papillary thyroid carcinoma.Design and Setting: We conducted a retrospective analysis of prospectively collected data at a public hospital.Patients: Fifteen patients with previous resection of papillary thyroid carcinoma with elevated serum levels of thyroglobulin (Tg) or anti-Tg antibodies (TgAbs) and 24 metachronous nodal metastases treated between September 2010 and April 2012 were followed with [F-18] fluorodeoxyglucose ((18)FDG) positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced ultrasound (CEUS).Intervention: Intervention was PLA.Outcome Measures: Technique feasibility and technical success were evaluated. Tg/TgAb serum levels and (18)FDG-PET/CT, and CEUS appearance were assessed at 6 and 12 months and compared with baseline. Complications were recorded.Results: PLA was always feasible, and technical success was achieved in all patients. At 6 months, local control was achieved in 11 of 15 patients (73%), with 6 (40%) having serum Tg/TgAb normalized (P = .017 vs baseline). Whereas 20 of 24 (83%) nodes were negative at (18)FDG-PET/CT and CEUS (P < .001 vs baseline), 4 were (18)FDG-PET/CT-positive (3 also CEUS-positive). At the 12-month follow-up, local control was achieved in 10 of 14 patients (71.4%). Sixteen of 20 nodes (80%) were negative at 18FDG-PET/CT and CEUS (P < .001 vs baseline), 4 were (18)FDG-PET/CT-positive (2 also CEUS-positive). Four of 10 (40%) patients had normalization of serum Tg/TgAb (P = .098 vs baseline). No major complications occurred.Conclusions: PLA is potentially feasible, safe, and effective for the treatment of metachronous cervical nodal metastases from papillary thyroid carcinoma. This procedure may reduceor delay a large number of highly invasive repeat neck dissections.