1. What is the difference between ablation therapy and surgical resection?
Surgical excision is commonly known as open surgery, in short, it means cutting down the thyroid lesion and taking it out of the body. It is the work of a surgeon. Ablative treatment means that instead of cutting down the lesion and taking it out of the body, the lesion is left in its original anatomical position and necrosis occurs through thermogenic techniques such as microwave, radiofrequency or laser. The advantages of ablation therapy are minimally invasive, no scarring of the skin, extremely fast recovery after treatment, short hospitalization time for patients, and a very high recovery index. It not only completely inactivates the lesion, but also protects the patient’s normal thyroid function from the inconvenience and trouble caused by long-term use of Eugenol. Ablation therapy can be done not only by surgeons but also by ultrasound physicians, and from the historical experience at home and abroad, ablation therapy was started by interventional ultrasound physicians, and now it is still mainly performed by interventional ultrasound physicians, but gradually some surgeons have joined the ranks of treatment, indicating that the clinical status of thyroid ablation therapy is becoming more and more stable and has shown an unstoppable development momentum.
Ablation therapy can be divided into two phases: the first phase is the thermal coagulation process, which results in the complete inactivation of the lesion; the second phase is the immunophagocytosis of the ablation zone, which results in the gradual reduction of the ablation zone until it disappears. Patients are usually concerned about the results of the second stage, i.e. when the nodules will disappear after ablation, but in fact, whether the inactivation of the nodules in the first stage is complete is the key. Usually, an ultrasonographer with experience in whole-body interventional ultrasound can master the technical methods and techniques of ablation within 3 months of intensive study, but to fully grasp and master the ablation of thyroid nodules requires a wealth of basic medical and surgical knowledge as well as expertise in testing and pathology. In the second stage, regular follow-up visits help patients to understand the evolution of the ablation zone and whether other new problems are occurring.
Over the past 10 years, a large sample of tens of thousands of cases has confirmed that ultrasound-guided and monitored ablation therapy is precise, targeted, minimally invasive and effective, and is a new and reliable minimally invasive treatment for thyroid nodules.
2.How long does it take for the lesions to be absorbed after ablation?
Ablation treatment is to allow the lesion to necrotize in its original location and gradually shrink until it disappears, and the original lesion area will be replaced by normal thyroid tissue. Therefore, patients should first be prepared that the nodules will still be present for some time after treatment. The ablation treatment makes the blood supply to the lesion disappear completely and also causes direct thermal denaturation and coagulative necrosis of the cells in the nodule. The treated nodule is no longer a lesion, but a coagulated necrotic ablation zone. After thermal ablation, the ablated area naturally enters into a damage repair period which is not subject to the subjective will of the doctor and the patient, i.e., the patient’s immunophagocytic system actively carries out immune recognition, immune attack and immune phagocytosis on the ablated area, and various lymphocytes and lymphokines generated by the lymph nodes are the main force of immunity in this process, therefore, it has theoretical basis and clinical significance to emphasize not to remove the normal lymph nodes in the neck easily. . Over time, the ablation zone will slowly shrink as the coagulated necrotic tissue is continuously removed by phagocytosis, and there are obvious individual differences in this process, which vary in speed, and this difference is influenced by the size of the original lesion and the immune function status of the patient. Most of the nodules will disappear after 1 year of follow-up, but the ablated necrotic area of individual patients is absorbed extremely slowly and exists for several years, but it does not bring any adverse effects to the patients.
3.Why did the nodules become hard after ablation?
Both microwave and radiofrequency have strong dehydrating effect, and the effect of microwave is relatively stronger. After the nodules are ablated, the water is lost and the texture becomes hard, so the nodules are harder to touch after the operation than before the treatment, which is a normal and inevitable postoperative change.
4.Why does the ultrasound performance of the ablated nodules resemble malignant tumors?
The echogenicity of the ablation area is different from that of the preoperative area. The echogenicity of the ablation area is reduced and disorganized, and there is no blood flow signal in it.
5.What is the content and time of postoperative follow-up?
Pre- and post-operative ultrasonography of the thyroid gland and cervical lymph nodes, blood sampling for thyroid function indicators, allowing patients to score their clinical performance according to the clinical symptom scale, and puncture biopsy of the nodules to obtain pathological diagnosis are all required. The above basic information is an important parameter for evaluating the efficacy and side effects, and is used to objectively reflect the treatment effect. The postoperative follow-up time points were: 1 month postoperative, 3 months postoperative, 6 months postoperative, and 12 months postoperative.
During the ultrasound follow-up examination, patients may find that the size of the ablation area at the first month review is larger than the original lesion, which is a normal postoperative performance. The reason is that the ablation area must exceed the size of the original lesion, otherwise there is a possibility of incomplete ablation. However, at the 3rd, 6th and 12th month review, the measured value will show a tendency to become gradually smaller.
After ablation, some patients may find mild fluctuations in T3 and T4, which is a normal postoperative manifestation. The reason is that during the ablation process, a small part of thyroid hormones will be released into the blood with the inactivation of the thyroid nodules with high secretion function or the normal thyroid tissues cannot release hormones in time because they are suppressed for a long period of time, these changes will be self-corrected and return to normal after 1-3 months, so no treatment is needed.
6.Is ablation treatment of thyroid cancer effective and safe?
Sufficient clinical data confirmed (after ablation of more than 200 thyroid cancer patients, only 2 patients found new lesions and 4 patients found abnormal lymph nodes in postoperative follow-up, which is significantly lower than the recurrence rate after surgical resection), we can conclude that thermal ablation treatment can completely cure thyroid cancer (excluding medullary carcinoma and undifferentiated carcinoma, mainly referring to papillary and follicular carcinoma, especially microscopic carcinoma)! After the operation, we will closely follow up and evaluate each thyroid cancer patient by puncture. Once new cancer foci or metastatic lymph nodes in the neck are found, they can also be treated again by ablation!
7.Is puncture biopsy necessary? Will biopsy of thyroid cancer cause metastasis of the puncture needle tract?
Diagnosis is the front stop of treatment, clear and correct diagnosis is the foundation of all medical work, and pathological diagnosis is not only the gold standard, but also the requirement of evidence-based medicine! Ultrasound-guided puncture biopsy is safe, minimally invasive and convenient, and has become a common method for preoperative pathological diagnosis of thyroid, breast and lymph node tumors. No matter coarse needle biopsy or fine needle biopsy, as long as the puncture is invasive, it may cause tumor cells to be shed and spread along the puncture needle tract, but for papillary thyroid cancer and follicular carcinoma, the chance of metastasis caused by puncture is minimal, which is the result of large sample statistics worldwide. Therefore, it is not necessary to hold back or even take individual cases or small probability events to negate or even hinder this minimally invasive diagnostic technique which has more advantages than disadvantages because of the fear of metastasis.
8.Why do some patients need staged ablation of thyroid nodules?
There are many uncertainties in the occurrence and development of the disease, and the differences between individual patients can be significant. Some thyroid nodules are not only large in number, but also large in size, deep in location or close to important blood vessels, trachea, esophagus, nerves, etc., which are not suitable for one-time ablation treatment. In some patients, although the nodules are eligible for one-time ablation, they may not be tolerated during the treatment, so for safety reasons, the doctor will discontinue the treatment in due course. Therefore, the staged ablation is mainly determined by the patient’s condition, and the main purpose is to ensure the safety of the treatment.