Patient Question:Disease:Nearly 4 years after PTC, can lymphatic metastases be thermally ablated Description:Papillary thyroid CA was operated in March 2012, radical thyroid CA was performed on the right side, right side + isthmus + most of the left side was removed, no lymphatic clearance was done intraoperatively.Ultrasound at the review in July 2015 suggested that 1 metastatic lymph node was found in the supraclavicular fossa of zone VII, and then in August 2015, zone VII was found Multiple lymph nodes in the supraclavicular fossa (1 large and 3 small), 1 hyperechoic node and 1 hypoechoic node were found in the affected (right) area IV. Hope to provide help:Hello, Director Zhang! After I found the metastatic lymph nodes after PTC, I went to various clinics and checked some papers and journals, and I was fortunate to find some of your papers in China Knowledge! 1. I was preparing for pregnancy before the metastasis was discovered and I have not had any children yet. I have consulted with many famous surgeons who recommended surgery, but considering the slow recovery from conventional surgery and the risk of involving the parathyroid glands in a second surgery, I personally prefer thermal ablation treatment. I would like to ask you whether my current situation is suitable for ablation and whether it is risky to operate on the lymph nodes in the superior sternal fossa VII area. 2.In your experience, how long is the recovery time after the ablation treatment, and when is the right time to have a child. 3.When I go to Shanghai to see you for diagnosis, can you operate for me personally? 4.Will you take samples for pathological examination during the ablation procedure? In addition, I saw that there is a paper about thermal ablation for nail removal in China, has it been widely used in clinical practice? I look forward to your reply, thank you very much! Hospital Department: PLA General Hospital, Union Hospital General Surgery, Ultrasound Diagnostic Department Treatment: Time: 2012-03-09 2012-03-25 Hospital Department: PLA General Hospital General Surgery Treatment Process: PTC diagnosed by puncture pathology, surgery to remove the right side and isthmus, the left side of the large part; no lymphatic dissection Medication: Drug name: Eugenol Dosing instructions: dosage: one day The time of dosing: taken before breakfast, for 3 years and 11 months; adverse reactions: palpitations after dosing when sleep is not good Zhang Jianquan, Department of Ultrasound, Shanghai Long March Hospital replied: 1. There is a certain relationship between the metastatic lymph nodes and the growth location of the thyroid cancer nodes, but there are cases where the exact relationship cannot be found. Even after total thyroidectomy combined with lymph node dissection in the neck, recurrence of lymph node metastasis is more common, both the possibility of missing during surgery and the possibility of new metastasis after lymphatic system regeneration. Treatment of recurrence of cervical lymph node metastasis after surgery 1. 131-I radiation therapy, the method is not complicated and the technical requirements are not high, but total thyroid removal is a prerequisite, and the metastases in the lymph nodes must have the ability to absorb iodine, otherwise this method is not feasible. Your thyroid gland is not completely removed, and the residual left thyroid tissue will absorb most of the 131-I (competing with the metastases in the lymph nodes for absorption), so this method is not appropriate. 2. Surgical reoperation In the days when there was no thermal ablation technology, surgical reoperation was not an option, no matter how many disadvantages it had. But nowadays, for lymph node metastases after surgery, re-surgery may not be needed because the operation risk of re-surgery is obviously increased, mainly in the chance of damaging the recurrent laryngeal nerve and parathyroid gland than in the first operation, and secondly, there is no benefit to the mobility and aesthetics of the patient’s neck. 3. Ultrasound-guided percutaneous percutaneous thermal ablation therapy, firstly, has high resolution high-definition ultrasound images for real-time dynamic monitoring, which provides precise positioning and quantification for the percutaneous operation and ablation operation, and is extremely directional. Secondly, the thermal energy is not picky about the tissue type of the lesion, and there is no question of affinity size. As long as the microwave or RF ablation needle enters the lesion and the thermal dose reaches the proper level, the cancer lesion will rapidly coagulate and denature, lose its vitality, and then become necrotic and absorbed by the organism. It is a real ultra-minimally invasive treatment, of course, provided that the lesion can be seen on the ultrasound image. Nowadays, with the availability of thermal ablation technology and its increasing maturity, it is natural to seek thermal ablation to remove metastatic lymph nodes. This is the trend of development, which cannot be stopped. The lymph nodes in zone 4 are indeed the manifestation of metastatic cancer, while the lymph nodes in zone 7 cannot be said to be due to metastatic cancer. But no matter it is zone 4 or zone 7, as long as the ultrasound image can see where the problem lymph nodes are, ablation treatment can be achieved through technical means. This morning I also successfully treated a case of papillary carcinoma 18 months postoperative, which occurred in the right inferior bulb of the internal jugular vein and the beginning of the common carotid artery, surrounded by metastatic lymph nodes skirting the vagus nerve and the recurrent laryngeal nerve, the site of which can be considered tricky. 2. After thermal ablation of both thyroid nodules and metastatic lymph nodes, the inactivated tissues in the ablation area will naturally enter the stage of being phagocytosed, and these necrotic tissues are not large in amount and are eventually turned into harmless macromolecules and discharged out of the body through immunophagocytosis. It is not likely to have a significant negative impact on pregnancy. When it comes to affecting pregnancy, eugenol is something to be aware of because it can cause miscarriage. However, in your case, Eugenol has been taken and the dosage will not be increased after the lymph nodes are ablated, so there should be no increase in adverse effects on pregnancy after the lymph nodes are ablated. However, we would still advise patients to consider pregnancy 6-8 months after ablation, at least until the necrotic tissue in the ablated area has been almost absorbed.