| Thyroid nodules are a kind of thyroid diseases with the highest incidence of 19%～67%,among which malignant nodules account for 5%～15%[1].Many small thyroid nodules have been found through CT,MR scan,high resolution ultrasound,and so on.For thyroid nodules and micropapillary thyroid carcinoma with indications for treatment,the traditional treatment is surgery or drug therapy.Surgical treatment affects thyroid function because of large trauma,high incidence of complications,permanent scar in the neck,and removal of non-pathological thyroid tissue.Therefore,some patients need to take drugs for a long time which is difficult for patients to follow.Thyroxine replacement therapy for hypothyroidism caused by excision of excessive thyroid tissue,but the effectiveness of drug therapy is also controversial.As a safe and effective minimally invasive treatment technology,benign thyroid nodules or recurrent thyroid cancer can be treated by radiofrequency ablation[2].Due to its advantages of minimally invasive,effective,safe and aesthetic,in 2012,South Korean agencies recommended radiofrequency ablation as the preferred treatment for benign thyroid nodules[3].In the Chinese Expert Consensus and Operational Guidelines on thermal ablation for thyroid benign nodules,microcarcinoma and metastatic cervical lymph nodes(2018 Edition),benign thyroid nodules and minimal thyroid papillary carcinoma have been included in the indications of thermal ablation surgery[4].Radiofrequency ablation technology treatment of benign thyroid nodules,thyroid papillary carcinoma of thyroid disease,need to establish and perfect a set of the diagnosis and surgical treatment was different from traditional pretreatment system,through the system after diagnosis and pretreatment,so that the thyroid disease radiofrequency ablation technology is more safely and effectively.The system includes:firstly,benign and malignant thyroid nodules’ pathological diagnosis by ultrasound-guided fine needle aspiration cytology;secondly,to improve the success rate of subsequent radiofrequency ablation by aspirating and replacing some capsular(solid)thyroid nodules;thirdly,the risk of grading assessment of thyroid nodules in different positions was conducted to clarify the risk degree of ablation and make corresponding pretreatment with relevant protective measures.Compared with the currently developed and mature surgical system,the clinical application of non-vascular interventional technology in thyroid diseases started late,and the exploration and development time is relatively short.At present,no such system has been established in the above aspects at home and abroad[5].In view of the above situation,this paper made some improvements on the puncture diagnosis and pretreatment system which is different from traditional surgical treatment for thyroid diseases such as benign thyroid nodule and thyroid micropapillary carcinoma by non-vascular interventional technique.On this basis,by analyzing the clinical application of radiofrequency ablation technology in thyroid diseases such as benign thyroid nodules and small thyroid papillary carcinoma,the effectiveness and safety of the clinical key indicators are evaluated and provided some help and new ideas for further improving the minimally invasive interventional diagnosis and treatment system of thyroid diseases.Part 1 Preliminary feasibility study of a new cell collector for fine needle aspiration cytology of thyroid glandObjective:To conduct a preliminary feasibility study on the application of the new cell collector in fine needle aspiration cytology of thyroid gland,judge the rationality and convenience of the design of the new cell collector,and evaluate the application value of the new cell collector in clinical work.Materials and methods:Through the form of patent implementation license to obtain the right to use the existing domestic patents,manufacturing a new type of cell collector.Thirty thyroid glands of fresh pigs slaughtered for less than 4 hours were examined by ultrasound-guided fine needle aspiration cytology.The experimental group was assisted with a new cell collector to establish negative pressure suction,while the control group was assisted with a common syringe to establish negative pressure suction.Two interventional physicians participated in the experiment.Among them,one physician has been engaged in ultrasound-guided interventional therapy for more than 5 years.The doctor performed fine needle aspiration cytology on 30 thyroid glands using instruments of the experimental group and the control group respectively.Each fine needle aspiration cytology examination produced 2 cytological smears,with a total of 60 smears for the experimental group and the same for the control group.During the physician’s operation,a senior physician specializing in ultrasound interventional therapy for more than 10 years determined the operating range of thyroid cell sampling by ultrasound images(the range diameter ≤5mm).The experimental group and the control group were compared in the time to complete the operation(needle tip entering thyroid gland to needle tip exiting thyroid gland),cytological smear quality and pathological diagnostic value,and the number of times the needle tip exceeded the specified range of activity under ultrasound during the operation.Results:The cytological examination of 30 thyroid glands by fine needle aspiration was successfully performed by the operator using the instruments of experimental group and control group.The experimental group spent less time in operation than the control group(experimental group vs control group:55±10 seconds vs 67±12 seconds,P<0.05).There were no statistically significant differences in cytological smear quality and pathological diagnostic value between the experimental group and the control group(undiagnosed or unsatisfactory specimens:experimental group vs control group:5%(3/60)vs 6.67%(4/60),P>0.05).The number of times the needle tip exceeded the range of activity specified under ultrasound was much less in the experimental group than in the control group(experimental group vs control group:5 times vs 45 times,P<0.05).Conclusion:Using new cells collector for thyroid fine needle suction cytology,short operation time,cytological smear and pathological diagnosis value of good quality,stable operation,strong controllability,adopt the new collector in the clinical work in the future can play high use value,assist clinicians more efficient,safe and convenient suction cytology of thyroid fine needle.Part 2 Series of improvements in preconditioning systems for the treatment of thyroid diseases by non-vascular interventional techniques1.Double needle flushing aspiration:an effective method of replacing the contents of the cystic(solid)thyroid nodulesObjective:To investigate the safety and effectiveness of double needle flushing aspiration for the replacement of intracapsular substances in thyroid refractory cystic(solid)nodule,and to provide convenience for clinical follow-up treatment.Materials and methods:Based on the single-center,prospective,randomized and controlled principle,a total of 111 patients with refractory cystic(solid)thyroid nodules who received interventional therapy at our center from September 2018 to December 2020 were enrolled in this study.There were 43 patients in group A and 68 patients in group B.In group A,A single needle was used to aspirate the substance in the capsule.In group B,two ordinary syringes were used to wash and aspirate the substance in the replacement capsule.In group B,patients were divided into 34 patients in B1 subgroup and 34 patients in B2 subgroup by simple random sampling in a 1:1 ratio according to the randomization principle.In subgroup B1,the needles were at the same ultrasound plane during the operation,and in subgroup B2,the needles were at the upper and lower extremes of cystic(solid)nodules,respectively.The drainage rate of the substance in the capsule after treatment was observed.Results:There were 6 cases in group A who failed to use A single needle to aspirate intracapsular substance and were transferred to group B for stratification.There were no bleeding,infection,recurrent laryngeal nerve injury and other complications in group A and group B during the treatment,which proved that both single-needle aspiration and double-needle flushing aspiration were very safe.In group B,the rate of extractive material in the sac after operation(A vs B,90±6.43%vs 98.42±1.67%,P<0.01)and the reduction rate of postoperative total nodule volume(A vs B,87.89±7.43%vs 95.32±3.23%,P<0.01),indicating that double-needle rinsing aspiration can effectively replace the substance in the thyroid refractory cystic(solid)nodule,which can provide great convenience for subsequent chemical ablation and radiofrequency ablation.Intracapsular volume of postoperative nodules in B2 subgroup(B1 vs B2,0.24±0.3mL vs 0.08±0.04ml,P<0.05)was significantly lower than that of B1 subgroup,indicating that when double-needle flushing aspiration was performed,if the double needle was located at the upper and lower extremes of cystic(solid)nodule,the capsular material in the nodule could be extracted better.Further,patients with nodule diameter≥3 cm in B1 and B2 subgroups were separately divided into B1#subgroup and B2#subgroup,respectively.After further comparison,it was found that in B2#subgroup,the volume of material in the capsule of postoperative nodule(B1#vs B2#,0.56±0.4ml vs 0.13±0.11ml,P<0.01),the drainage rate of postoperative material in the sac(B1#vs B2#,94.58± 1.35%vs 98.98± 1.32%,P<0.01)were significantly better than B1#subgroup.Conclusion:Compared with traditional single needle aspiration,double needle flushing aspiration can more effectively replace the cystic substances in thyroid refractory cystic(solid)nodules with the same safety,providing great convenience for subsequent treatment.On larger thyroid hard suction capsule(solid)nodules(maximum diameter 3 cm or higher)during operation,the operator in the use of double needle flushing suction technique,can choose priority will double needle respectively in capsule(solid),the two extremes of the nodule to wash suction to further reduce postoperative nodules within the internal capsule material volume,liquid usage and increase the rate of postoperative exhaust the pouch material.The method is simple,safe and reliable.2.Risk assessment of radiofrequency ablation of thyroid nodule and application of water separation techniqueObjective:The purpose of this study was to investigate the risk assessment of radiofrequency ablation for thyroid nodules and the importance of pretreatment with water separation technology,and to establish the concept and standard of risk assessment for thyroid nodules ablation.Materials and methods:According to the specific location of thyroid nodules,the risk assessment and corresponding preventive measures of thyroid ablation were formulated.A retrospective analysis was performed on 764 patients who underwent radiofrequency ablation for thyroid nodules in our center from January 2016 to December 2020,and the safety,effectiveness and corresponding preventive measures of ablation were compared and evaluated for patients with risk.Results:Of the 764 patients,376 underwent risk assessment and preventive measures before ablation and 388 did not.There were no significant differences in characteristics,risk grade and so on between the two groups(P>0.05).Complications of extremely high-risk nodules were significantly reduced in the group that underwent risk assessment and preventive measures before ablation.Conclusions:Radiofrequency ablation of thyroid nodules pretreated with water separation based on risk assessment is a safe and effective method to reduce the incidence of complications.Part 3 Clinical application of radiofrequency ablation in thyroid diseases 1.Safety and efficacy of radiofrequency ablation for benign thyroid nodulesObjective:To analyze the safety and efficacy of radiofrequency ablation in the treatment of benign thyroid nodules,and to provide help for the further clinical application of this technique.Materials and methods:Clinical data of 60 PTMC nodules from 60 patients who received radiofrequency ablation in our center from September 2018 to September 2020 were retrospectively analyzed.Before radiofrequency ablation,radiographic examination of nodules was performed and preoperative thyroid function was assessed.The volume and volume loss rate(VRR)of the ablation sites were followed up at 1 month,3 months,6 months,1 year and every 6 months after ablation.Results:Among all patients,38 were male and 262 were female.75(25%)had single nodules and 225(75%)had more than 2 nodules.Preoperative thyroid function(FT3,FT4,TSH)was normal or adjusted to the normal range after endocrinology treatment.For all thyroid nodules,the preoperative minimum volume was about 0.01mL,the maximum volume was about 72.43mL,and the average volume was 1.05±4.21 mL.The nodular volume was 0.31±0.69 mL and 0.14±0.79mL at 1 and 3 months after radiofrequency ablation,respectively,and the thyroid nodular volume reduction rate(VRR)was 65.08%and 85.58%.The nodule volume and VRR were statistically different before and after treatment(P<0.05).The ablation rate of thyroid nodule was 99.17%.The thyroid function was normal after operation.No serious complications occurred after operation.Conclusion:Radiofrequency ablation for benign thyroid nodules has clear effect,low incidence of postoperative complications,strong controllability,no surgical incision,less damage to normal thyroid tissue around the lesion,and no effect on thyroid function.Therefore,it can be used as one of the important treatment options for benign thyroid nodules.2.Changes of thyroid antibody and T lymphocyte subsets after radiofrequency ablation of thyroid nodules in autoimmune thyroiditisObjective:To investigate the changes of thyroid antibody and T lymphocyte subsets after radiofrequency ablation of thyroid nodules in autoimmune thyroiditis,in order to provide help for the mechanism study and treatment of autoimmune thyroiditis.Materials and methods:135 patients with autoimmune thyroiditis complicated with thyroid nodules were treated by ultrasound-guided percutaneous radiofrequency ablation of thyroid nodules.Free triiodothyrosine,free thyroxine,thyroid stimulating hormone,thyroglobulin antibody and thyroid peroxidase antibody were detected before operation,1 day after operation and 1 month after operation respectively.CD4+/CD8+,PERCENTAGE of CD4+T cells,percentage of CD8+T cells,absolute value of lymphocytes,absolute value of B cells,absolute value of T cells,absolute value of CD4+T cells,absolute value of CD8+T cells were detected.The complications of active bleeding,infection,recurrent laryngeal nerve injury,parathyroid gland injury and skin scald within 1 month after operation were recorded.Results:FT3,FT4 and TSH of all patients were in the normal range before surgery,1 day after surgery and 1 month after surgery,without thyroid dysfunction.Percentage of CD8+T cells and absolute value of B cells:there were no statistically significant differences before surgery compared with 1 day and 1 month after surgery(P>0.01),and the indexes are in the normal range.TG-Ab,TPO-AB,CD4+/CD8+,percentage of CD4+T cells,absolute value of lymphocytes,absolute value of T cells,absolute value of CD4+T cells,absolute value of CD8+T cells:significantly decreased on the 1st postoperative day compared with the preoperative day(P<0.01);One month after the operation,it recovered to the preoperative level again(P>0.01).Within 1 month after surgery,no patient developed active bleeding,infection and other complications.Conclusion:In patients with autoimmune thyroiditis complicated with thyroid nodules,radiofrequency ablation is safe and does not affect thyroid function.TG-Ab and TPO-Ab can be significantly reduced and the distribution of T lymphocyte subsets can be changed in the short term after surgery.Further research may have guiding significance for the mechanism and treatment of autoimmune thyroiditis.3.Effect of radiofrequency ablation on primary thyroid micropapillary carcinomaObjective:To evaluate the safety,efficacy and one-year recurrence rate of radiofrequency ablation for primary thyroid micropapillary carcinoma.Materials and Methods:Clinical data of 60 PTMC nodules from 60 patients undergoing radiofrequency ablation in our center from September 2018 to September 2020 were retrospectively analyzed.Before radiofrequency ablation,radiographic examination of nodules was performed and preoperative thyroid function was assessed.Ablation site volume and volume loss rate(VRR)were followed up at 1,3,6,12 months after radiofrequency ablation and every 6 months thereafter.Results:The preoperative mean volume of nodules was 0.11±0.10ml.60 PTMC nodules were treated by ultrasound-guided radiofrequency ablation in 60 patients.All nodules were completely ablated,with a complete ablation rate of 100%.No complications occurred and thyroid function was not affected.During follow-up,the nodular volume of PTMC decreased gradually.After 12 months of ablation,the mean volume of nodules decreased significantly to 0.01±0.02 mL and VRR was 99.4±3.2%.The follow-up time was 12 months,58 of the 60 nodules were completely absorbed,and 2 were not completely absorbed but inactive,and the 1-year recurrence rate was 0%.Conclusion:The preliminary results show that ultrasound-guided radiofrequency ablation for PTMC has good safety and high cure rate,and can be used as an important alternative treatment option for patients with primary thyroid micropapillary carcinoma. |
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