Efficacy of ultrasound-guided microwave ablation versus reoperation for cervical metastatic lymph nodes in patients after surgery for papillary thyroid cancer

doi:10.3877/cma.j.issn.1672-6448.2025.09.011

Abstract

Abstract:

Objective

To compare the effectiveness, safety, and cost of ultrasound-guided percutaneous microwave ablation versus conventional reoperation for cervical metastatic lymph nodes in patients after surgery for papillary thyroid carcinoma and to provide reference for clinical practice.

Methods

This retrospective study included 53 patients with postoperative cervical metastatic lymph nodes treated at the First Affiliated Hospital of Fujian Medical University from December 2021 to December 2023, who were assigned to either a microwave ablation group (15 cases) or a reoperation group (38 cases) according to the treatment modality used. Baseline differences were controlled using propensity scoring combined with inverse probability of treatment weighting (IPTW). In the microwave ablation group, the maximum lesion diameter, lesion volume, volume reduction ratio (VRR), and serum thyroglobulin levels at 1, 3, 6, and 12 months after treatment were analyzed by repeated-measures analysis of variance. Between-group comparisons after weighting were performed using weighted t tests, weighted rank-sum tests, and the Rao-Scott corrected chi-square test, while within-group comparisons were conducted using paired t tests and the Wilcoxon signed-rank test. Surgical indicators (length of stay, operative time, intraoperative blood loss, incision length, and hospitalization costs), as well as thyroid function and serum thyroglobulin pre-treatment and 1 month post-treatment were compared. A subgroup analysis was performed among patients with baseline serum thyroglobulin ≥1 ng/ml.

Results

After IPTW, the microwave ablation group showed significantly shorter length of stay and operative time as well as lower intraoperative blood loss, incision length, and hospitalization costs than the reoperation group [(1.00±0.01) d vs (7.44±1.37) d, 0.3(0.3, 0.3) h vs 2.1(1.5, 2.8) h, 1.0 (1.0, 1.0) ml vs 10.0 (5.0, 10.0) ml, 0.2 (0.1, 0.2) cm vs 6.0 (6.0, 12.0) cm, and 2699.3 (2285.7, 8318.4) yuan vs 15293.5 (11263.5, 18655.7) yuan, respectively; t=28.18; Z=4.86, 6.84, 6.37, and 4.36, respectively; all P<0.001). All 19 lymph nodes in the microwave ablation group were successfully ablated. Post-treatment, the mean maximum lesion diameter, lesion volume, volume reduction ratio, VRR, and serum thyroglobulin decreased significantly over time (all P<0.05). At 1 month post-treatment, changes in serum thyroglobulin in the reoperation group were statistically different from pretreatment and from the microwave ablation group (0.66 (0.16, 5.84) ng/ml vs 2.22 (0.86, 11.11) ng/ml vs 5.50 (1.00, 8.00) ng/ml; Z=−2.589 and −4.404; P=0.010 and <0.001, respectively). The thyroglobulin negativity rate was numerically higher in the reoperation group (46.4%) than in the microwave ablation group (41.7%), but the difference was not significant (P>0.05). No severe complications occurred in either group, with no significant between-group difference (P>0.05). During follow-up, only one case of recurrence occurred, in the reoperation group.

Conclusion

Ultrasound-guided percutaneous microwave ablation for cervical metastatic lymph nodes recurring after surgery for papillary thyroid carcinoma offers the advantages of minimal invasiveness, safety, rapid recovery, and lower costs, and may serve as an alternative for patients who are unsuitable for or unwilling to undergo a second operation.

Key words: Papillary thyroid carcinoma, Metastatic lymph nodes, Ultrasound-guided, Microwave ablation, Surgical dissection

Xinyu Gao, Kaiyi Yang, Huiting Chen, Li Zhu, Yabin Fang, Mei Song, Jinshu Zeng. Efficacy of ultrasound-guided microwave ablation versus reoperation for cervical metastatic lymph nodes in patients after surgery for papillary thyroid cancer[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(09): 858-867.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2025.09.011

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Figures/Tables 7

变量	IPTW前				IPTW后
变量	再次手术组（38例）	微波消融组（15例）	P值	SMD值	再次手术组（38例）	微波消融组（15例）	P值	SMD值
年龄（岁， $x ¯$ ±s）	45.28±13.59	46.79±13.51	0.202	0.39	45.35±13.66	43.83±11.45	0.679	0.12
性别[例（%）]			0.665	0.23			0.724	0.13
男	16（42.1）	8（53.3）			15.1（39.7）	5.0（33.7）
女	22（57.9）	7（46.7）			22.9（60.3）	10.0（66.3）
最大径（cm， $x ¯$ ±s）	1.05±0.26	1.14±0.32	0.313	0.29	1.06±0.26	1.05±0.29	0.911	0.04
随访时间（月， $x ¯$ ±s）	15.84±4.76	19.73±6.90	0.023	0.66	16.92±5.50	17.06±5.49	0.939	0.03
术前是否接受碘剂治疗[例（%）]			0.092	0.66			0.932	0.04
否	19（50.0）	3（20.0）			22.2（58.4）	9.3（62.0）
是	19（50.0）	12（80.0）			15.8（41.6）	5.7（38.0）
共病指数[例（%）]			0.494	0.36			0.963	0.09
0种	29（76.3）	9（60.0）			28.0（73.6）	10.7（71.3）
1种	6（15.8）	4（26.7）			6.4（16.7）	2.4（16.3）
2种	3（7.9）	2（13.3）			3.7（9.7）	1.9（12.4）
淋巴结位置[例（%）]			0.403	0.39			0.554	0.22
中央区^a	11（28.9）	2（13.3）			9.2（24.2）	2.4（16.0）
侧颈区	27（71.1）	13（86.7）			28.8（75.8）	12.6（84.0）

变量	IPTW前				IPTW后
变量	再次手术组（38例）	微波消融组（15例）	P值	SMD值	再次手术组（38例）	微波消融组（15例）	P值	SMD值
年龄（岁， $x ¯$ ±s）	45.28±13.59	46.79±13.51	0.202	0.39	45.35±13.66	43.83±11.45	0.679	0.12
性别[例（%）]			0.665	0.23			0.724	0.13
男	16（42.1）	8（53.3）			15.1（39.7）	5.0（33.7）
女	22（57.9）	7（46.7）			22.9（60.3）	10.0（66.3）
最大径（cm， $x ¯$ ±s）	1.05±0.26	1.14±0.32	0.313	0.29	1.06±0.26	1.05±0.29	0.911	0.04
随访时间（月， $x ¯$ ±s）	15.84±4.76	19.73±6.90	0.023	0.66	16.92±5.50	17.06±5.49	0.939	0.03
术前是否接受碘剂治疗[例（%）]			0.092	0.66			0.932	0.04
否	19（50.0）	3（20.0）			22.2（58.4）	9.3（62.0）
是	19（50.0）	12（80.0）			15.8（41.6）	5.7（38.0）
共病指数[例（%）]			0.494	0.36			0.963	0.09
0种	29（76.3）	9（60.0）			28.0（73.6）	10.7（71.3）
1种	6（15.8）	4（26.7）			6.4（16.7）	2.4（16.3）
2种	3（7.9）	2（13.3）			3.7（9.7）	1.9（12.4）
淋巴结位置[例（%）]			0.403	0.39			0.554	0.22
中央区^a	11（28.9）	2（13.3）			9.2（24.2）	2.4（16.0）
侧颈区	27（71.1）	13（86.7）			28.8（75.8）	12.6（84.0）

变量	IPTW前
变量	微波消融组（15例）	再次手术组（38例）	统计值	P值
住院时间[d，M（Q₁，Q₃）]	1.0（1.0，1.0）	7.0（6.0，8.0）	U=0.50	<0.001
手术时间（h， $x ¯$ ±s）	0.33±0.08	2.12±0.83	t=13.13	<0.001
术中出血量[ml，M（Q₁，Q₃）]	1.0（0.5，1.0）	10.0（5.0，10.8）	U=0.00	<0.001
切口长度[cm，M（Q₁，Q₃）]	0.2（0.1，0.2）	6.0（6.0，12.0）	U=0.00	<0.001
住院费用[元，M（Q₁，Q₃）]	3523.4（2300.2，10 314.7）	15 489.9（11 635.4，18 683.4）	U=39.00	<0.001
并发症[例（%）]	3（20.0）	7（18.4）	χ²=0.02	0.895
生存率[例（%）]	15（100）	38（100）
变量	IPTW后
变量	微波消融组（15例）	再次手术组（38例）	统计值	P值
住院时间（d， $x ¯$ ±s）	1.00±0.01	7.44±1.37	t=28.18	<0.001
手术时间[h，M（Q₁，Q₃）]	0.3（0.3，0.3）	2.1（1.5，2.8）	Z=4.86	<0.001
术中出血量[ml，M（Q₁，Q₃）]	1.0（1.0，1.0）	10.0（5.0，10.0）	Z=6.84	<0.001
切口长度[cm，M（Q₁，Q₃）]	0.2（0.1，0.2）	6.0（6.0，12.0）	Z=6.37	<0.001
住院费用[元，M（Q₁，Q₃）]	2699.3（2285.7，8318.4）	15 293.5（11 263.5，18 655.7）	Z=4.36	<0.001
并发症[例（%）]	3（20.0）	5（13.2）	χ²=0.55	0.525
生存率[例（%）]	15（100）	38（100）

变量	IPTW前
变量	微波消融组（15例）	再次手术组（38例）	统计值	P值
住院时间[d，M（Q₁，Q₃）]	1.0（1.0，1.0）	7.0（6.0，8.0）	U=0.50	<0.001
手术时间（h， $x ¯$ ±s）	0.33±0.08	2.12±0.83	t=13.13	<0.001
术中出血量[ml，M（Q₁，Q₃）]	1.0（0.5，1.0）	10.0（5.0，10.8）	U=0.00	<0.001
切口长度[cm，M（Q₁，Q₃）]	0.2（0.1，0.2）	6.0（6.0，12.0）	U=0.00	<0.001
住院费用[元，M（Q₁，Q₃）]	3523.4（2300.2，10 314.7）	15 489.9（11 635.4，18 683.4）	U=39.00	<0.001
并发症[例（%）]	3（20.0）	7（18.4）	χ²=0.02	0.895
生存率[例（%）]	15（100）	38（100）
变量	IPTW后
变量	微波消融组（15例）	再次手术组（38例）	统计值	P值
住院时间（d， $x ¯$ ±s）	1.00±0.01	7.44±1.37	t=28.18	<0.001
手术时间[h，M（Q₁，Q₃）]	0.3（0.3，0.3）	2.1（1.5，2.8）	Z=4.86	<0.001
术中出血量[ml，M（Q₁，Q₃）]	1.0（1.0，1.0）	10.0（5.0，10.0）	Z=6.84	<0.001
切口长度[cm，M（Q₁，Q₃）]	0.2（0.1，0.2）	6.0（6.0，12.0）	Z=6.37	<0.001
住院费用[元，M（Q₁，Q₃）]	2699.3（2285.7，8318.4）	15 293.5（11 263.5，18 655.7）	Z=4.36	<0.001
并发症[例（%）]	3（20.0）	5（13.2）	χ²=0.55	0.525
生存率[例（%）]	15（100）	38（100）

时间	最大直径（cm， $x ¯$ ±s）	体积（cm³， $x ¯$ ±s）	VRR（%， $x ¯$ ±s）	Tg［ng/ml，M（Q₁，Q₃）］^*
微波消融术前	1.14±0.32	0.19±0.12	0.00±0.00	9.37（3.59，17.22）
微波消融后1个月	0.96±0.36^a	0.15±0.13	20.82±26.86^a	6.10（1.00，12.00）
微波消融后3个月	0.83±0.33^a	0.07±0.06^a	67.21±23.82^a	1.91（0.78，4.00）^a
微波消融后6个月	0.72±0.33^a	0.02±0.02^a	87.70±14.24^a	0.40（0.04，1.38）^a
微波消融后12个月	0.60±0.31^a	0.02±0.02^a	91.83±10.16^a	0.06（0.03，1.06）^a
F值	20.892	23.205	87.885	18.262
P值	<0.001	<0.001	<0.001	<0.001

时间	最大直径（cm， $x ¯$ ±s）	体积（cm³， $x ¯$ ±s）	VRR（%， $x ¯$ ±s）	Tg［ng/ml，M（Q₁，Q₃）］^*
微波消融术前	1.14±0.32	0.19±0.12	0.00±0.00	9.37（3.59，17.22）
微波消融后1个月	0.96±0.36^a	0.15±0.13	20.82±26.86^a	6.10（1.00，12.00）
微波消融后3个月	0.83±0.33^a	0.07±0.06^a	67.21±23.82^a	1.91（0.78，4.00）^a
微波消融后6个月	0.72±0.33^a	0.02±0.02^a	87.70±14.24^a	0.40（0.04，1.38）^a
微波消融后12个月	0.60±0.31^a	0.02±0.02^a	91.83±10.16^a	0.06（0.03，1.06）^a
F值	20.892	23.205	87.885	18.262
P值	<0.001	<0.001	<0.001	<0.001

组别	例数	TSH（ml/UL）	FT3（pmol/L）	FT4（pmol/L）	Tg（ng/ml）
微波消融组	15
术前		1.65（0.30，7.28）	4.84±0.63	20.10±2.73	9.90（2.88，15.50）
术后1个月		0.09（0.05，1.06）	4.65±0.81	20.55±2.58	5.50（1.00，8.00）
统计值		Z=-1.882	t=-0.795	t=-0.421	Z=-1.489
P值		0.064	0.442	0.681	0.136
再次手术组	38
术前		0.60（0.12，2.18）	5.02（4.63，5.99）	18.90（17.33，22.10）	2.22（0.86，11.11）
术后1个月		0.63（0.15，4.10）	4.60（4.00，5.65）	19.50（18.88，22.62）	0.66（0.16，5.84）
Z值		-0.907	-1.775	-0.613	-2.589
P值		0.364	0.076	0.540	0.010
Z值^a		1.315	-0.203	-1.391	-1.691
P值^a		0.190	0.839	0.164	0.091
Z值^b		-0.660	-1.407	-0.026	-4.404
P^b值		0.509	0.160	0.979	<0.001

项目	微波消融组（15例）	再次手术组（38例）	统计值	P值
术前
Tg≥1 ng/ml患者[例（%）]	12（80.0）	28（73.7）	χ²=1.566	0.211
Tg水平[ng/ml，M（Q₁，Q₃）]	10.50（3.72，15.60）	5.46（2.22，15.80）	Z=-0.295	0.768
术后
Tg≥1 ng/ml患者[例（%）]	7（46.7）	15（39.5）	χ²=0.213	0.644
Tg水平[ng/ml，M（Q₁，Q₃）]	8.00（6.46，11.15）	6.01（5.63，7.92）	Z=1.271	0.203
Tg下降值[ng/ml，M（Q₁，Q₃）]	2.92（0.99，10.57）	2.04（0.83，11.75）	Z=0.811	0.417
Tg转阴患者[例（%）]^a	5（41.7）	13（46.4）	χ²=0.021	0.885

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