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中华医学超声杂志(电子版) ›› 2025, Vol. 22 ›› Issue (07) : 656 -660. doi: 10.3877/cma.j.issn.1672-6448.2025.07.012

综述

甲状腺乳头状癌热消融治疗研究新进展
杨雨晴1,2, 何年安2,()   
  1. 1 241002 安徽 芜湖,皖南医学院,安徽省立医院研究生培养基地
    2 230001 安徽 合肥,中国科学技术大学附属第一医院(安徽省立医院)超声医学科
  • 收稿日期:2025-06-09 出版日期:2025-07-01
  • 通信作者: 何年安

New progress in research of thermal ablation for papillary thyroid carcinoma

Yuqing Yang, Nian’an He()   

  • Received:2025-06-09 Published:2025-07-01
  • Corresponding author: Nian’an He
引用本文:

杨雨晴, 何年安. 甲状腺乳头状癌热消融治疗研究新进展[J/OL]. 中华医学超声杂志(电子版), 2025, 22(07): 656-660.

Yuqing Yang, Nian’an He. New progress in research of thermal ablation for papillary thyroid carcinoma[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(07): 656-660.

表1 甲状腺癌热消融治疗指南和共识及推荐意见
年份 机构 指南共识 热消融治疗推荐意见
2012 CSE等 甲状腺结节和分化型甲状腺癌诊治指南(第一版)[13] 不建议常规使用非手术方法治疗良性甲状腺结节,包括RFA
2012 KSThR RFA治疗良性甲状腺结节和复发性甲状腺癌:共识声明和建议[14] 不建议对滤泡性肿瘤或原发性甲状腺癌进行RFA,RFA可用于手术风险高的患者和拒绝重复手术的患者
2015 ATA 成人甲状腺结节和分化型甲状腺癌症患者管理指南[5] 可用于手术风险高或甲状腺癌转移但拒绝进一步外科手术的患者
2015 ZACA-TTC 甲状腺良性结节、微小癌及颈部转移性淋巴结热消融治疗浙江省专家共识(2015版)[15] 同时符合:(1)单发结节直径≤1 cm(距离包膜>2 mm)的乳头状癌,无可疑淋巴结转移;(2)患者不能耐受外科手术或主观拒绝外科手术治疗;(3)思想顾虑过重影响正常生活且拒绝临床观察
2016 CATO 甲状腺微小乳头状癌诊疗专家共识与指南[16] 不推荐热消融作为PTMC的常规治疗
2017 KSThR 2017甲状腺射频消融指南:韩国甲状腺放射学会[17] 手术是甲状腺癌的标准治疗手段,对无法耐受或拒绝手术者,热消融作为一种可选择的方案
2018 CMDA等 甲状腺良性结节、微小癌及颈部转移性淋巴结热消融治疗专家共识[18] 不推荐将热消融治疗作为甲状腺微小癌治疗的常规手段,对于符合适应证的患者可以使用热消融治疗
2019 CUDA 甲状腺微小乳头状癌热消融诊疗指征专家共识[19] 对符合适应证的PTMC推荐使用热消融治疗
2019 CSCO 持续/复发及转移性分化型甲状腺癌诊疗指南[20] 适应证:经规范的外科治疗或RAI治疗后,仍存在孤立病灶;外科手术风险较高;患者拒绝手术。消融病灶控制在3~4个以内,大小控制在2 cm以内,消融安全且有效
2021 ETA 甲状腺恶性病变微创治疗临床实践指南[21] 对无法耐受或拒绝手术或拒绝主动监测者,热消融可作为部分低风险PTMC患者的一种可选治疗方案
2021 CSCO 分化型甲状腺癌诊疗指南2021[22] 可作为手术高风险或拒绝手术治疗的甲状腺癌原位复发或侧颈淋巴结转移患者的替代性或姑息治疗方法
2022 CACA 中国肿瘤整合诊治指南(CACA)——甲状腺癌[23] 暂不推荐热消融作为治疗PTMC的常规治疗手段
2023 CSE等 甲状腺结节和分化型甲状腺癌诊治指南(第二版)[24] 对于手术风险高、不能耐受手术以及治疗无效的淋巴结转移患者,可采用热消融治疗
2023 ATA 良性甲状腺结节消融技术的安全操作、训练和准入的基本原则:美国甲状腺协会声明[12] 恶性结节直径>1.5 cm、细胞学未确定但分子标志物阳性是绝对禁忌证,超声可疑恶性结节、细胞学未确定且分子标志物阴性、无高风险特征的PTMC是相对禁忌证
2024 CSCO-TA等 甲状腺乳头状癌热消融治疗专家共识(2024版)[25] 将热消融技术作为T1aN0M0期PTC的一线治疗方案之一,并将T1bN0M0期PTC纳入热消融治疗的适用范畴,对于侵犯被膜但未累及被膜外组织的PTC、峡部PTC以及多灶PTC(≤3个)可在仔细评估后确定是否采用热消融治疗,对于术后残留腺体内新发或复发病灶,亦可考虑热消融治疗
2025 KSThR RFA治疗复发性甲状腺癌:2025年韩国甲状腺放射学会指南[26] 对于拒绝手术或手术风险高的患者,可以在甲状腺切除术床、颈淋巴结清扫术部位和转移性颈淋巴结处对复发性甲状腺癌进行治疗性或姑息性射频消融术
1
Kitahara CM, Sosa JA. The changing incidence of thyroid cancer [J]. Nat Rev Endocrinol, 2016, 12(11): 646-653.
2
DeSantis CE, Lin CC, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2014 [J]. CA Cancer J Clin, 2014, 64(4): 252-271.
3
Choi Y, Jung S. Efficacy and safety of thermal ablation techniques for the treatment of primary papillary thyroid microcarcinoma: a systematic review and meta-analysis [J]. Thyroid, 2020, 30(5): 720-731.
4
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018 [J]. CA Cancer J Clin, 2018, 68(1): 7-30.
5
Haugen BR, Alexander EK, Bible KC, et al. 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 [J]. Thyroid, 2016, 26(1): 1-133.
6
Pace-Asciak P, Russell JO, Tufano RP. The treatment of thyroid cancer with radiofrequency ablation [J]. Tech Vasc Interv Radiol, 2022, 25(2): 100825.
7
Zhu Y, Che Y, Gao S, et al. Long-term follow-up results of PTMC treated by ultrasound-guided radiofrequency ablation: a retrospective study [J]. Int J Hyperthermia, 2021, 38(1): 1225-1232.
8
Cho SJ, Baek JH, Chung SR, et al. Thermal ablation for small papillary thyroid cancer: a systematic review [J]. Thyroid, 2019, 29(12): 1774-1783.
9
Dupuy DE, Monchik JM, Decrea C, et al. Radiofrequency ablation of regional recurrence from well-differentiated thyroid malignancy [J]. Surgery, 2001, 130(6): 971-977.
10
Monchik JM, Donatini G, Iannuccilli J, et al. Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma [J]. Ann Surg, 2006, 244(2): 296-304.
11
Kim JH, Baek JH, Sung JY, et al. Radiofrequency ablation of low-risk small papillary thyroidcarcinoma: preliminary results for patients ineligible for surgery [J]. Int J Hyperthermia, 2017, 33(2): 212-219.
12
Sinclair CF, Baek JH, Hands KE, et al. General principles for the safe performance, training, and adoption of ablation techniques for benign thyroid nodules: an American Thyroid Association Statement [J]. Thyroid®, 2023, 33(10): 1150-1170.
13
中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南 [J]. 中华内分泌代谢杂志, 2012, 28(10): 779-797.
14
Na DG, Lee JH, Jung SL, et al. Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations [J]. Korean J Radiol, 2012, 13(2): 117-125.
15
葛明华, 徐栋. 甲状腺良性结节、微小癌及颈部转移性淋巴结热消融治疗浙江省专家共识(2015版) [J]. 中国普通外科杂志, 2016, 25(7): 944-946.
16
Gao M, Ge M, Ji Q, et al. 2016 Chinese expert consensus and guidelines for the diagnosis and treatment of papillary thyroid microcarcinoma [J]. Cancer Biol Med, 2017, 14(3): 203-211.
17
Kim J, Baek JH, Lim HK, et al. 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology [J]. Korean J Radiol, 2018, 19(4): 632-655.
18
葛明华, 徐栋, 杨安奎, 等. 甲状腺良性结节、微小癌及颈部转移性淋巴结热消融治疗专家共识(2018版) [J]. 中国肿瘤, 2018, 27(10): 768-773.
19
中国医师协会超声医师分会. 甲状腺微小乳头状癌热消融诊疗指征专家共识 [J/CD]. 中华医学超声杂志(电子版), 2019, 16(8): 571-574.
20
中国临床肿瘤学会指南工作委员会甲状腺癌专家委员会. 中国临床肿瘤学会(CSCO)持续/复发及转移性分化型甲状腺癌诊疗指南-2019 [J]. 肿瘤预防与治疗, 2019, 32(12): 1051-1079.
21
Mauri G, Hegedüs L, Bandula S, et al. European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical Practice Guideline for the Use of Minimally Invasive Treatments in Malignant Thyroid Lesions [J]. Eur Thyroid J, 2021, 10(3): 185-197.
22
中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)分化型甲状腺癌诊疗指南2021 [J]. 肿瘤预防与治疗, 2021, 34(12): 1164-1200.
23
葛明华, 高明, 程若川. 中国肿瘤整合诊治指南(CACA)——甲状腺癌 [M]. 天津: 天津科学技术出版社, 2022: 1-138.
24
中华医学会内分泌学分会, 中华医学会外科学分会甲状腺及代谢外科学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南(第二版) [J]. 中华内分泌代谢杂志, 2023, 39(3): 181-226.
25
中国抗癌协会肿瘤消融治疗专业委员会, 肿瘤消融专家委员会中国临床肿瘤学会, 中国医师协会介入医师分会肿瘤消融专业委员会, 等. 甲状腺乳头状癌热消融治疗专家共识(2024版)[J]. 中华内科杂志, 2024, 63(4): 355-364.
26
Ha EJ, Lee MK, Baek JH, et al. Radiofrequency Ablation for Recurrent Thyroid Cancers: 2025 Korean Society of Thyroid Radiology Guideline [J]. Korean J Radiol, 2025, 26(1): 10-28.
27
Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer [J]. Thyroid, 2009, 19(11): 1167-1214.
28
嵇庆海, 程若川, 田文, 等. 对《甲状腺乳头状癌热消融治疗专家共识(2024版)》部分内容的探讨 [J]. 中华耳鼻咽喉头颈外科杂志, 2024, 59(10): 1088-1093.
29
Yan L, Li X, Li Y, et al. Comparison of ultrasound-guided radiofrequency ablation versus thyroid lobectomy for T1bN0M0 papillary thyroid carcinoma [J]. Eur Radiol, 2023, 33(1): 730-740.
30
Han ZY, Dou JP, Zheng L, et al. Safety and efficacy of microwave ablation for the treatment of low-risk papillary thyroid microcarcinoma: a prospective multicenter study [J]. Eur Radiol, 2023, 33(11): 7942-7951.
31
Guo MH, Dou JP, Zheng L, et al. Ultrasound-guided microwave ablation versus surgery for solitary T1bN0M0 papillary thyroid carcinoma: a prospective multicenter study [J]. Eur Radiol, 2024, 34(1): 569-578.
32
Nguyen VC, Park JS, Song CM, et al. Efficacy and oncologic outcomes of thermal ablation techniques in the treatment of primary low-risk papillary thyroid carcinoma: a systematic review and network meta-analysis [J]. Head Neck, 2025, 47(2): 759-775.
33
Jeong SY, Baek SM, Shin S, et al. Radiofrequency ablation of low-risk papillary thyroid microcarcinoma: a retrospective cohort study including patients with more than 10 years of follow-up [J]. Thyroid, 2025, 35(2): 143-152.
34
Song Q, Gao H, Ren L, et al. Radiofrequency ablation versus total thyroidectomy in patients with papillary thyroid microcarcinoma located in the isthmus: a retrospective cohort study [J]. Int J Hyperthermia, 2021, 38(1): 708-714.
35
陈治光, 何文, 张巍. 甲状腺微小乳头状癌的热消融治疗现状与展望 [J]. 中国医学影像学杂志, 2022, 30(8): 856-860.
36
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 [J]. Eur Radiol, 2022, 32(2): 1216-1226.
37
Wu J, Zhao Z, Cao X, et al. A feasibility study of microwave ablation for papillary thyroid cancer close to the thyroid capsule [J]. Int J Hyperthermia, 2021, 38(1): 1217-1224.
38
Zheng L, Dou JP, Han ZY, et al. Microwave ablation for papillary thyroid microcarcinoma with and without US-detected capsule invasion: a multicenter prospective cohort study [J]. Radiology, 2023, 307(3): e220661.
39
Tuttle RM, Haugen B, Perrier ND. Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): What Changed and Why? [J]. Thyroid, 2017, 27(6): 751-756.
40
Wang LY, Nixon IJ, Palmer FL, et al. Comparable outcomes for patients with pT1a and pT1b differentiated thyroid cancer: is there a need for change in the AJCC classification system? [J]. Surgery, 2014, 156(6): 1484-1489, discussion 1489-1490.
41
Xiao J, Zhang Y, Zhang M, et al. Ultrasonography-guided radiofrequency ablation vs. Surgery for the treatment of solitary T1bN0M0 papillary thyroid carcinoma: a comparative study [J]. Clin Endocrinol (Oxf), 2021, 94(4): 684-691.
42
He H, Wu R, Zhao J, et al. Ultrasound-guided radiofrequency ablation versus surgical resection for the treatment of T1bN0M0 papillary thyroid carcinoma in different age groups [J]. Front Endocrinol (Lausanne), 2021, 12: 734432.
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