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| 甲状腺结节微波消融术后组织病理的动态变化及其临床意义 |
| 章建全1,2△*,闫磊2,3△,陈红琼1,郑建明4,吴震中2,程杰1 |
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(1. 上海国际医学中心超微创诊疗中心, 上海 201318;
2. 海军军医大学(第二军医大学)长征医院超声诊疗科, 上海 200003;
3. 解放军904医院特诊科, 苏州 215007;
4. 海军军医大学(第二军医大学)长海医院病理科, 上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 探讨甲状腺结节微波消融术后近期消融区内组织结构随时间的变化规律，寻找消融区病理评估的适宜时间。方法 收集2017年1月至2018年12月甲状腺结节微波消融术后即刻及术后1、3、6、12个月复诊时接受消融区粗针穿刺活组织检查评估的患者60例共69个消融区，活组织检查标本取自各消融区的中央域和边缘域。采取常规H-E染色和免疫组织化学染色，观察不同时期、不同区域的消融区细胞形态、组织结构表现和甲状腺转录因子1（TTF1）的表达程度。结果 消融术后即刻和1、3、6、12个月活组织检查分别成功取材69、12、19、25和13个消融区。消融术后即刻69个（100.00%）消融区的中央域和边缘域均无坏死，仅为凝固变性；1个月时9个（75.00%）中央域及9个（75.00%）边缘域呈现完全坏死；3个月时16个（84.21%）中央域及15个（78.95%）边缘域呈现完全坏死；6个月及12个月时所有（100.00%）中央域及边缘域均完全坏死。结论 甲状腺结节微波消融术后其组织病理表现具有经时演变的特点。消融术后即刻消融区组织仅为凝固性变性，尚未发生坏死；随时间推移消融区组织发生坏死，坏死的程度与范围渐进趋于完全，且无区域间差异。提示微波消融对甲状腺结节的可靠疗效源于细胞的完全坏死。此外，术后6个月时消融区细胞全部即已达到完全坏死，提示消融后若对消融区进行病理学评估，第6个月是适宜的时间节点。 |
| 关键词: 良性甲状腺结节 甲状腺乳头状癌 桥本甲状腺炎 微波消融术 组织病理学 坏死 纤维增生 |
| DOI：10.16781/j.0258-879x.2019.11.1190 |
| 投稿时间：2019-04-16修订日期：2019-06-26 |
| 基金项目:国家自然科学基金（81171436）. |
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| Dynamic histopathological changes of thyroid nodule after microwave ablation and its clinical significance |
| ZHANG Jian-quan1,2△*,YAN Lei2,3△,CHEN Hong-qiong1,ZHENG Jian-ming4,WU Zhen-zhong2,CHENG Jie1 |
(1. Super-minimally Invasive Medicals, Shanghai International Medical Center, Shanghai 201318, China;
2. Department of Ultrasound, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China;
3. Department of Special Consultation, No. 904 Hospital of PLA, Suzhou 215007, Jiangsu, China;
4. Department of Pathology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the changes of tissue structure in the ablation area after microwave ablation of thyroid nodules and to identify the appropriate time for pathological evaluation of the ablation area. Methods From January 2017 to December 2018, a total of 69 core-needle biopsy tissue samples from the ablation area of thyroid nodules in 60 patients were investigated histologically using H-E and immunohistochemical staining. The samples were taken after microwave ablation at different stages and from different areas. Cellular morphology and tissue structure as well as thyroid transcription factor 1 (TTF1) in the tissues from the central zone and marginal zone of ablation area were observed immediately, 1 month, 3 months, 6 months and 12 months after microwave ablation. Results Successful biopsies were achieved in 69, 12, 19, 25 and 13 ablation areas immediately, 1 month, 3 months, 6 months and 12 months after microwave ablation. There was no necrosis but only coagulated degeneration in both the central zone and marginal zone of the 69 (100.00%) ablation areas immediately after microwave ablation. At 1 month after microwave ablation, 9 (75.00%) samples of central zone and 9 (75.00%) samples of marginal zone showed complete necrosis. At 3 months, 16 (84.21%) samples of central zone and 15 (78.95%) samples of marginal zone showed complete necrosis. At 6 and 12 months, all (100.00%) samples of central zone and marginal zone became necrotic completely. Conclusion The histopathologic feature of thyroid nodules after microwave ablation varies with time. There is only coagulated degeneration in the freshly ablated thyroid tissue, and no necrosis is found. Necrosis occurs and progresses to the whole ablation area in all patients. It suggests that the reliable therapeutic effect of microwave ablation on thyroid nodules is due to complete necrocytosis. Necrosis occurs in all the ablation area at 6 months after microwave ablation, indicating the 6th month is an appropriate time for pathological evaluation of the ablation area. |
| Key words: benign thyroid nodule papillary thyroid carcinoma Hashimoto's thyroiditis microwave ablation histopathology necrosis fibroplasia |
