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Uncooled Microwave Ablation as a Treatment Option to Preserve Thyroid Function in Patients with Benign Thyroid Nodules. J Belg Soc Radiol 2022; 106:50. [PMID: 35651913 PMCID: PMC9138712 DOI: 10.5334/jbsr.2746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/12/2022] [Indexed: 11/20/2022] Open
Abstract
Objective: The objective is to evaluate the long-term efficacy and safety of uncooled MWA for the treatment of benign thyroid nodules and its long-term effect on thyroid functions. Material and Methods: The study was conducted on 40 patients with 40 nodules. They were treated between September 2019 and December 2020. Nodules’ volumes, thyroid functions (triiodothyronine, free thyroxine, thyrotropin) and anti-thyroid peroxidase and anti-thyroglobulin antibodies were measured before treatment and at 3rd, 6th and 12th month following the treatment. Volume reduction rates and changes in clinical findings were evaluated. Results: The mean volume reduction rate was 49.88, 65.3, and 79.06% at 3rd, 6th, and 12th month, respectively. Antibody levels and thyroid function tests have remained within normal limits and were not exhibited significant change during follow-ups (p > 0.05), except for a significant increase in free thyroxin level at 12th-month (p = 0.007). Subjective symptoms and cosmetic scores were significantly improved all follow-up (p < 0.0001). The only complication was a first-degree skin burn in a patient. Conclusion: In conclusion, uncooled microwave ablation is an effective and safe method for the treatment of benign thyroid nodules and preserves thyroid function.
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Sambo Salas ME, Añez Ramos RJ, López Guerra A, Rivas Montenegro AM, González Fernández L, González Albarrán O, Monereo Megías S. Eficacia de la ablación por radiofrecuencia en el control morfológico, clínico y funcional (a corto y mediano plazo) de los nódulos tiroideos predominantemente sólidos, de gran tamaño y clínicamente relevantes en pacientes no candidatos a cirugía: experiencia tras 100 procedimientos. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stan MN, Papaleontiou M, Schmitz JJ, Castro MR. Nonsurgical Management of Thyroid Nodules: The Role of Ablative Therapies. J Clin Endocrinol Metab 2022; 107:1417-1430. [PMID: 34953163 PMCID: PMC9016471 DOI: 10.1210/clinem/dgab917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 12/02/2022]
Abstract
CONTEXT After a thorough evaluation most thyroid nodules are deemed of no clinical consequence and can be observed. However, when they are compressive, toxic, or involved by papillary thyroid carcinoma surgery or radioactive iodine (RAI) (if toxic) are the treatments of choice. Both interventions can lead to hypothyroidism and other adverse outcomes (eg, scar, dysphonia, logistical limitation with RAI). Active surveillance might be used for papillary thyroid microcarcinoma (PTMC) initially, but anxiety leads many cases to surgery later. Several ablative therapies have thus evolved over the last few years aimed at treating these nodules while avoiding described risks. CASES We present 4 cases of thyroid lesions causing concern (compressive symptoms, thyrotoxicosis, anxiety with active surveillance of PTMC). The common denominator is patients' attempt to preserve thyroid function, bringing into focus percutaneous ethanol injection (PEI) and thermal ablation techniques (radiofrequency ablation [RFA] being the most common). We discuss the evidence supporting these approaches and compare them with standard therapy, where evidence exists. We discuss additional considerations for the utilization of these therapies, their side-effects, and conclude with a simplified description of how these procedures are performed. CONCLUSION Thermal ablation, particularly RFA, is becoming an attractive option for managing a subgroup of solid thyroid nodules, while PEI has a role in managing thyroid cysts and a select group of PTMC. Their role in the algorithm of thyroid nodule management is still being refined and technical expertise will be essential to reproduce the reported results into everyday practice.
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Affiliation(s)
- Marius N Stan
- Correspondence: Marius N. Stan, Division of Endocrinology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Jasim S, Patel KN, Randolph G, Adams S, Cesareo R, Condon E, Henrichsen T, Itani M, Papaleontiou M, Rangel L, Schmitz J, Stan MN. American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions. Endocr Pract 2022; 28:433-448. [PMID: 35396078 DOI: 10.1016/j.eprac.2022.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE The objective of this disease state clinical review is to provide clinicians with a summary of the nonsurgical, minimally invasive approaches to managing thyroid nodules/malignancy, including their indications, efficacy, side effects, and outcomes. METHODS A literature search was conducted using PubMed and appropriate key words. Relevant publications on minimally invasive thyroid techniques were used to create this clinical review. RESULTS Minimally invasive thyroid techniques are effective and safe when performed by experienced centers. To date, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Both ultrasound-guided laser and radiofrequency ablation can be safely used for symptomatic solid nodules, both toxic and nontoxic. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. Despite limited data, encouraging results suggest that minimally invasive techniques can also be used in small-size primary and locally recurrent thyroid cancer. CONCLUSION Surgery and radioiodine treatment remain the conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective alternatives when used appropriately and by trained professionals to treat symptomatic or enlarging thyroid masses.
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Affiliation(s)
- Sina Jasim
- Division of Endocrinology, Metabolism and Lipid Research, School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
| | | | - Gregory Randolph
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Adams
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, Florida
| | - Roberto Cesareo
- Unit of Metabolic Diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leonardo Rangel
- Head and Neck Surgery Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - John Schmitz
- Mayo Clinic Department of Radiology, Rochester, Minnesota
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
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Rodriguez Escobedo R, Martinez Tames G, Lanes Iglesias S, Alonso Felgueroso C, Montes Garcia AM, Prieto Fernandez A, Sanchez Ragnarsson C, Menendez Torre EL. Efficacy in size and symptom reduction of radiofrequency ablation of benign non-functioning thyroid nodules. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Introduction. Tech Vasc Interv Radiol 2022; 25:100815. [DOI: 10.1016/j.tvir.2022.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lim JY, Kuo JH. Thyroid Nodule Radiofrequency Ablation: Complications and Clinical Follow Up. Tech Vasc Interv Radiol 2022; 25:100824. [DOI: 10.1016/j.tvir.2022.100824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Rodriguez Escobedo R, Martinez Tames G, Lanes Iglesias S, Alonso Felgueroso C, Montes Garcia AM, Prieto Fernandez A, Sanchez Ragnarsson C, Menendez Torre EL. Efficacy in size and symptom reduction of radiofrequency ablation of benign non-functioning thyroid nodules. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2022; 69:194-200. [PMID: 35396117 DOI: 10.1016/j.endien.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/08/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) plays an increasing role in the management of thyroid nodules. The purpose of this study was to evaluate the safety and efficacy of RFA of benign thyroid nodules in terms of volume reduction and symptom relief. METHODS We reviewed the medical records of patients with a solitary thyroid nodule who received RFA at our centre from April 2016 to January 2020. Ultrasound-guided RFA was performed by the moving-shot technique. Patients were followed up with ultrasound examinations and thyroid function tests. We evaluated changes in volume and in compressive (0-10 scale) and cosmetic (4-point scale) symptoms to analyse efficacy and complications, and in thyroid function to evaluate safety. RESULTS A total of 72 patients were included in the study. The mean follow-up was 11.1±0.7 months. There was a statistically significant reduction in size of the nodules at Month 1, 3, 6 and 12 after RFA (expressed as volume reduction rate: 34%±2.1, 50.8%±2.2, 60.3%±2.6, 58.87%±3.5, p<0.0001). We found statistically significant improvement in compressive symptoms (from 7.1±0.26 to 1.76±0.33, p<0.0001) and in cosmetic alteration (from 3.66±0.09 to 2.14±0.14, p<0.0001). No major complications were observed. DISCUSSION RFA achieved significant volume reduction and improved compressive symptoms as well as cosmetic complaints, with minimum side effects. Our results are in line with recent available evidence and further support the use of RFA as a safe and effective therapeutic option in the management of benign thyroid nodules.
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Affiliation(s)
- Raul Rodriguez Escobedo
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad, Instituto de Investigación del Principado de Asturias (ISPA), Oviedo, Spain.
| | - Gema Martinez Tames
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Soraya Lanes Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Carlos Alonso Felgueroso
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad, Instituto de Investigación del Principado de Asturias (ISPA), Oviedo, Spain
| | - Ana Maria Montes Garcia
- Department of Radiology, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Amador Prieto Fernandez
- Department of Radiology, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Cecilia Sanchez Ragnarsson
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad, Instituto de Investigación del Principado de Asturias (ISPA), Oviedo, Spain
| | - Edelmiro Luis Menendez Torre
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad, Instituto de Investigación del Principado de Asturias (ISPA), Oviedo, Spain
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Huber T. Review of the Korean Society of Interventional Radiology and European Thyroid Association guidelines regarding the role of radiofrequency ablation for benign and malignant thyroid tumors. Tech Vasc Interv Radiol 2022; 25:100817. [DOI: 10.1016/j.tvir.2022.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bo XW, Lu F, Yu SY, Yue WW, Li XL, Hu M, Wu LL, Lv ZY, Sun LP, Xu HX. Comparison of efficacy, safety, and patient satisfaction between thermal ablation, conventional/open thyroidectomy, and endoscopic thyroidectomy for symptomatic benign thyroid nodules. Int J Hyperthermia 2022; 39:379-389. [PMID: 35188057 DOI: 10.1080/02656736.2022.2040608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Xiao-Wan Bo
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng Lu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Song-Yuan Yu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Man Hu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Li-Li Wu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhu-Ying Lv
- Department of Diagnostic Ultrasound, Hangzhou Cancer Hospital, Hangzhou, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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61
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Ho T, Tai DK, Chick W, Chiang BJ, Kwok PCH. Initial Experience of Ultrasound Guided Radiofrequency Ablation of Benign Symptomatic Thyroid Nodules: Safety and
Short‐Term
Efficacy. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tsit‐lai Ho
- Department of Surgery Queen Elizabeth Hospital
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Radiofrequency ablation for benign symptomatic thyroid nodules in the Netherlands: successful introduction of a minimally-invasive treatment option improving quality of life. J Vasc Interv Radiol 2022; 33:530-537.e1. [PMID: 35121096 DOI: 10.1016/j.jvir.2022.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/16/2021] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The aim is to report the results of radiofrequency ablation (RFA) in patients with symptomatic benign thyroid nodules (SBTN) within our regional Thyroid Network and to evaluate their health-related and thyroid-related quality of life (QoL). MATERIALS AND METHODS Eligibility criteria for RFA were nodule size between 2.0 cm and 5.0 cm; solid component >20%; benign cytology on two separate cytological assessments and unequivocal symptoms related to mechanical compression. The primary end point of this study was volume reduction at 1 year post ablation. Secondary outcomes were health-related and thyroid related QoL measured by the SF-36 and ThyPRO-39 questionnaire as well as complication rates. RESULTS A total of 72 SBTN in 67 patients were included. The median age was 50.0 [IQR: 41.0 - 56.0] years and 91.0% were women. Median volume reduction at 6 weeks, 6 months, 1 year, 2 years, and 3 years were 51.0%, 63.9%, 65.2%, 81.3% and 90.3% respectively. Patients showed significant improvement on the SF-36 physical component scale and the ThyPRO-39 overall QoL-impact scale. An absolute improvement was seen within the ThyPRO-39 goiter and cosmetic complaints. The overall complication rate was 9.0%, of which 4.5% were considered major. CONCLUSION RFA is an effective treatment option for SBTN with significant volume reduction and improvement in health-related and thyroid-related QoL.
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Bom WJ, Joosten FBM, van Borren MMGJ, Bom EP, van Eekeren RRJP, de Boer H. Radiofrequency ablation for symptomatic, non-functioning, thyroid nodules: a single-center learning curve. Endocr Connect 2022; 11:EC-21-0304.R2. [PMID: 34887358 PMCID: PMC8859967 DOI: 10.1530/ec-21-0304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Radiofrequency ablation (RFA) is increasingly considered the prime option for treating symptomatic, benign, non-functioning thyroid nodules (NFTN). However, little is known about the degree of operator experience required to achieve optimal results. This study describes the RFA learning curve of a single-center team. METHODS A retrospective cohort study of the first 103 patients receiving RFA treatment for a single, symptomatic, and benign NFTN, with a follow-up of at least 1 year. The primary outcome measure was technique efficacy, defined as the percentage of patients with a 6-month nodal volume reduction ratio (VRR) >50% after single-session RFA. Optimal treatment efficacy was defined as a 6-month VRR >50% achieved in at least 75% of patients. Secondary outcomes were complications of RFA and indications of secondary interventions. RESULTS Median nodal volume at baseline was 12.0 mL (range 2.0-58.0 mL). A 6-month VRR >50% was achieved in 45% of the first 20 patients, 75% of the next 20, and 79% of the following 63 patients. Complications included minor bleeding (N = 4), transient hyperthyroidism (N = 4), and transient loss of voice (N = 1). Poor volume reduction or nodular regrowth led to diagnostic lobectomy in 11 patients and a second RFA in 5. Lobectomy revealed a follicular carcinoma (T2N0M0) in 2 patients. In 1 patient, nodule regrowth was caused by an intranodular solitary B-cell lymphoma. CONCLUSION About 40 procedures are required to achieve a 6-month VRR >50% in the majority of patients. Appropriate follow-up with re-evaluation is recommended for all patients with a VRR <50% and in those with regrowth to exclude underlying malignancy.
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Affiliation(s)
- W J Bom
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - F B M Joosten
- Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands
- Correspondence should be addressed to F B M Joosten or H de Boer: or
| | - M M G J van Borren
- Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, the Netherlands
| | - E P Bom
- Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - H de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
- Correspondence should be addressed to F B M Joosten or H de Boer: or
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Multicenter Study of Benign Thyroid Nodules with Radiofrequency Ablation: Results of 762 Cases over 4 Years in Taiwan. J Pers Med 2022; 12:jpm12010063. [PMID: 35055378 PMCID: PMC8782025 DOI: 10.3390/jpm12010063] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness and safety of radiofrequency ablation (RFA) treatment for benign thyroid nodules (BTNs) in five medical centers in Taiwan. METHODS From April 2016 to July 2020, 762 patients underwent ultrasound guided RFA treatment of 826 benign thyroid nodules at five medical centers in Taiwan. The RFA procedure was performed by radiologists, otolaryngologists, or surgeons. Patients were grouped into three subgroups according to the initial volume of BTNs. The volume reduction ratio (VRR) of each nodule, and complications were analyzed at 1, 3, and 6 months after RFA treatment and the three groups compared. RESULTS The large nodular group showed greater VRR compared to the other two groups at first 1-month follow-up. At 6-months follow-up, there was no significant difference of VRR among the three groups. Goiters with difference in size can attain a successful VRR (>50%) although different specialists demonstrated variable VRR after 6-months follow-up. A total of 40 (4.8%) complications were reported. All patients recovered spontaneously without surgery intervention. CONCLUSIONS The reliability and safety of RFA for benign thyroid nodules had been established. RFA has gradually become an alternative to surgery in the treatment of benign thyroid nodules in Taiwan.
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Lee KH, Jeon EY, Jang SJ. Efficacy and Safety of Radio Frequency Ablation for Benign Thyroid Nodules: Initial Clinical Experience in United Arab Emirates. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1750110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Objectives Radio frequency ablation (RFA) to treat thyroid nodules is well known as one of alternative therapeutic modalities. This study aimed to investigate the efficacy and complications of RFA to treat symptomatic benign thyroid nodules in United Arab Emirates.
Materials and Methods Eight-nine benign thyroid nodules of 63 patients were enrolled, who were treated by percutaneous ultrasound (US)-guided RFA from 2017 to 2020, and had following US examinations during 12 months after RFA procedure. Symptomatic score with 10-cm visual scale, cosmetic score with four-point scale, and US findings (nodule diameter, volume, composition and vascularity) were compared before and after RFA procedures. RFA-related complications (hematoma, voice change, hypothyroidism, and hyperthyroidism) were assessed.
Statistical Analysis Paired t test was applied to compare laboratory findings before and after RFA procedure. Multiple linear regression analysis was applied to determine significant factors to predict the efficacy of RFA. One-way analysis of variance was applied to compare volume reduction rate (VRR) at 3, 6, and 12 months.
Results Symptomatic and cosmetic scores were significantly improved (pre-RFA vs. post-RFA; 6.07 ± 1.89 vs. 2.06 ± 1.09, 2.94 ± 0.84 vs. 1.27 ± 0.51, p< 0.001). Nodule diameter (cm), volume (mL) at pre-RFA, post-RFA 3 months, 6 months, and 12 months were 3.86 ± 1.26, 2.64 ± 1.14, 2.06 ± 1.09, 1.82 ± 1.14, and 18.8 ± 18.79, 8.82 ± 12.42, 4.47 ± 5.59, 4.11 ± 9.17 (p< 0.001). VRR (%) was 52.81 ± 23.48 at post-RFA 3 months, 79.77 ± 16.91 at 6 months, and 82.08 ± 19.54 at 12 months. Composition of solidity was a significant predictive factor, related to VRR at post-RFA 12 months (p = 0.003). Complication rate was 12.7% (8 of 63 patients). Major complications did not occur.
Conclusion RFA can be an effective and safe alternative modality to treat benign thyroid nodules, and be preferable to treat symptomatic cystic thyroid nodules in Middle East population.
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Affiliation(s)
- Kwang Hwi Lee
- Department of Radiology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
| | - Eui Yong Jeon
- Department of Radiology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
| | - Sung June Jang
- Department of Nuclear Medicine, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
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Chen WC, Chou CK, Chang YH, Chiang PL, Lim LS, Chi SY, Luo SD, Lin WC. Efficacy of radiofrequency ablation for metastatic papillary thyroid cancer with and without initial biochemical complete status. Front Endocrinol (Lausanne) 2022; 13:933931. [PMID: 35992153 PMCID: PMC9381930 DOI: 10.3389/fendo.2022.933931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The application of radiofrequency ablation (RFA) for recurrent thyroid cancer has been demonstrated to effectively manage lesions at critical locations, such as abutting the trachea, with limited complications. Comprehensive investigation of both biochemical (B) and structural (S) change after RFA remains limited. We herein present the first single-center experience of RFA for the treatment of locoregional recurrent thyroid cancer in Taiwan. DESIGN 23 patients were enrolled, and the treatment responses after RFA were divided into four groups (E, S(+), B(+), and SB(+)), and then compared. The RFA technique, follow-up strategy, changes in pre-and post-operative status, and complications are presented. The volume reduction rate at 1, 3, and 6 months, and the differing responses between lesions abutting/not abutting the trachea are also discussed. RESULTS In patients with pre-RFA structural and biochemical incomplete (SB(+)) status, presenting with lesion with an initial maximum diameter of >3.2cm, a higher rate of structural incomplete status at the 6-month follow-up was noted in ROC analysis, with a sensitivity of 57% and specificity of 91%. Favorable structural remission after RFA was noted, and 60.9% of patients achieved biochemical complete status. No significant correlation was noted between the trachea-abutted lesion number and complete remission (p= 0.474). No significant difference in RFA efficacy was noted between the lesions abutting/not abutting the trachea. CONCLUSIONS This retrospective study reveals that RFA can achieve both structural and biochemical improvements for locoregionally recurrent thyroid cancer, with a low complication rate. Nearly half of the patients achieved an excellent response after RFA, while a favorable treatment response can be achieved despite the lesion abutting the trachea, with a mean VRR of 84.74%.
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Affiliation(s)
- Wen-Chieh Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Kai Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Lay-San Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Division of General Surgery and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- *Correspondence: Wei-Che Lin,
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McManus C, Kuo JH. Intraoperative Neuromonitoring: Evaluating the Role of Continuous IONM and IONM Techniques for Emerging Surgical and Percutaneous Procedures. Front Endocrinol (Lausanne) 2022; 13:808107. [PMID: 35432220 PMCID: PMC9005846 DOI: 10.3389/fendo.2022.808107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Intraoperative nerve monitoring (IONM) is a tool used during thyroid surgery to assist in the identification of the recurrent laryngeal nerve (RLN). Multiple IONM systems that exist for thyroidectomy require intubation with an endotracheal tube. Given that one of the advantages of thermal ablation procedures, such as radiofrequency ablation, is that they can be done safely without the use of general anesthesia, nerve monitoring systems that utilize cutaneous surface electrodes have been developed, though are not widely available in the United States. This article will review the use of IONM for RFA including the cutaneous surface electrode system.
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Zhu Y, Jiao Z, Zhu L, Xie F, Song Q, Yan L, Luo Y, Zhang M. A New Perspective for Predicting the Therapeutic Success of RFA in Solid BTNs: Quantitative Initial RFA Ratio by Contrast-Enhanced Ultrasound. Front Endocrinol (Lausanne) 2022; 13:904459. [PMID: 35774147 PMCID: PMC9237222 DOI: 10.3389/fendo.2022.904459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The short-term therapeutic success of radiofrequency ablation (RFA) in solid benign thyroid nodules is of great concern. The aim of this study was to investigate a new method, initial radiofrequency ablative ratio (IRAR) using contrast-enhanced ultrasound (CEUS), for predicting therapeutic success of RFA in solid benign thyroid nodules (BTNs) immediately and effectively after RFA. METHODS A total of 813 nodules in 776 patients with benign thyroid nodules were treated with RFA from January 2014 to August 2018, among which 120 patients (M:F=41:79) with 120 solid BTNs (small: ≤10ml, n=57; medium: 10-30ml, n=42; large: >30ml, n=21) were enrolled in our study according to the inclusion criteria. The IRAR was defined as the ablative volume ratio immediately after RFA displayed by CEUS. The therapeutic success was evaluated at the 6-month follow-up. The relationship between the IRAR and volume reduction ratio (VRR) at 6-month was analyzed. The marginal regrowth of solid BTNs was also examined by CEUS at the 6 and 12 months of follow-up. RESULTS In medium and large nodules, the IRAR was significantly and positively correlated with VRR (r= 0.69, P < 0.001) at 6 months after RFA. There was a tendency to achieve therapeutic success (50% VRR: 55/63, 87.3%) when the IRAR exceeded 75%, and marginal regrowth was also relatively slow within 12 months after a single session treatment. No significant correlation between IRAR and VRR of small nodules was found. In conclusion, IRAR is significantly and positively correlated with VRR, which may indicate therapeutic success when it exceeds 75%. CONCLUSIONS CEUS can be used to accurately quantify the IRAR, which is positively correlated with the VRR. Moreover, the IRAR may be used as a parameter to predict the short-term therapeutic success of RFA in solid BTNs.
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Affiliation(s)
- Yaqiong Zhu
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Ziyu Jiao
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lianhua Zhu
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Fang Xie
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Qing Song
- Departments of Ultrasound, The Seventh Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Yukun Luo, ; Mingbo Zhang,
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Yukun Luo, ; Mingbo Zhang,
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Li YR, Chou WY, Chan WK, Cheng KL, Sun JH, Liu FH, Chen ST, Liou MJ. Successful Applications of Food-Assisted and -Simulated Training Model of Thyroid Radiofrequency Ablation. Front Endocrinol (Lausanne) 2022; 13:809835. [PMID: 35432189 PMCID: PMC9009177 DOI: 10.3389/fendo.2022.809835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) for benign thyroid nodules is one kind of scarless treatment for symptomatic or cosmetic benign thyroid nodules. However, how to train RFA-naive physicians to become qualified operators for thyroid RFA is an important issue. Our study aimed to introduce a successful training model of thyroid RFA. MATERIALS AND METHODS We used a food-assisted and -simulated training model of thyroid RFA. Chicken hearts were simulated into thyroid nodules, three-layer pork meats were simulated into peri-thyroid structure, and gel bottles were simulated into trachea, respectively. Successful training ablations were defined as chicken hearts that were fully cooked. After repeating training ablations of chicken hearts at least 100 times with the nearly 100% success rates for three young trainees, they served as the first assistant for the real procedures of thyroid RFA and then were qualified to perform thyroid RFA on real patients under the supervision of one experienced interventional radiologist. RESULTS 23 real patients who received RFA and follow-up at least 6 months after treatment were included in Linkou Chang Gung Memorial Hospital from January 1, 2020 to October 1, 2021. Three young endocrinologists performed thyroid RFA independently. The outcomes were volume reduction rate (VRR), major complications and minor complications. The median VRR at 12 months was 82.00%, two major complications were transient hoarseness, and three minor complications were wound pain. All complications were completely recovered within three days. CONCLUSIONS For young and RFA-native physicians without any basic skills of echo-guided intervention, this food-assisted and -simulated training model of thyroid RFA was useful for medical training and education.
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Affiliation(s)
- Yan-Rong Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Yu Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wai-Kin Chan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kai-Lun Cheng
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Jui-Hung Sun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Feng-Hsuan Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Miaw-Jene Liou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Miaw-Jene Liou,
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Lin Y, Shi YP, Tang XY, Ding M, He Y, Li P, Zhai B. Significance of radiofrequency ablation in large solid benign thyroid nodules. Front Endocrinol (Lausanne) 2022; 13:902484. [PMID: 36325454 PMCID: PMC9618621 DOI: 10.3389/fendo.2022.902484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study is to explore efficacy and safety for radiofrequency ablation (RFA) among cases attacked by large benign solid thyroid nodules, mainly focusing on volume reduction, complication rate, and thyroid function. METHODS AND MATERIALS From June 2015 to November 2019, 24 patients with 25 large benign solid thyroid nodules (more than 25 ml) underwent single or sequential RFA in our institution. Eleven nodules achieved complete ablation after single RFA, whereas the other 14 nodules received sequential RFA. Volume reduction in large nodules was evaluated. Following single or sequential RFA, all patients received clinical and ultrasound evaluations, and the median follow-up duration among them was 23.5 months. Technical success, complication rate, and recurrence rate were assessed as well. RESULTS In single RFA group, volume reduction ranged from 62.6% to 99.4% (mean ± SD, 93.6 ± 9.9%) 6 months after RFA. In sequential RFA group, volume reduction ranged from 30.6% to 92.9% (mean ± SD, 67.4 ± 17.8%) after the first RFA and was between 83.4% and 98.4% (mean ± SD, 94.8± 3.8%) 6 months after the second RFA. The concentrations of FT3 and FT4 increased slightly 1 day after RFA and returned to normal level 1 month after. CONCLUSIONS Single or sequential RFA is safe and effective in treating large benign solid thyroid nodules (more than 25 ml) that cause obvious compressive symptoms. Hence, compression symptoms and cosmetic conditions could be effectively improved through single or sequential RFA without marginal recurrence.
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Affiliation(s)
| | | | | | | | | | - Ping Li
- *Correspondence: Ping Li, ; Bo Zhai,
| | - Bo Zhai
- *Correspondence: Ping Li, ; Bo Zhai,
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Retrospective analysis of ultrasound-guided minimally invasive treatment of various thyroid cysts. Am J Otolaryngol 2022; 43:103192. [PMID: 34487996 DOI: 10.1016/j.amjoto.2021.103192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/15/2021] [Accepted: 08/26/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of this article was to determine the efficacy and safety of the combined use of ethanol and microwave (MWA) to thyroid cysts and explore the differences of various cysts. MATERIALS AND METHODS A total of 136 patients and 142 thyroid cystic nodules and predominantly cystic nodules received combination therapy of ethanol and MWA between January 2016 and December 2019 in BeiJing Friendship Hospital. They were divided into different groups according to the size, and the characteristics of fluid aspirated. We compared the Initial size, treatment procedure, postoperative complications, and follow-up results to analyze the characteristics of different groups. RESULTS The combination treatments reduced the size of cysts by more than 93% with less complications at the end of follow-up. The treatment duration was longest in the colloid cysts (difference from the clear-fluid group, p < 0.01), the absolute volume of the clear-fluid group at the end of follow-up was the smallest (difference from the other two groups: P < 0.01).There were the similar mean volume reduction rate (VRR) between the large cysts and the small cysts (p > 0.05). CONCLUSION The combination treatments were applicable to all types of cysts. Understanding the characteristics of different cystic nodules and adopting different methods are helpful for us to carry out the minimally invasive treatment of cysts better.
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Chai HH, Zhao Y, Zeng Z, Ye RZ, Hu QH, He HF, Baek JH, Peng CZ. Efficacy and Safety of Ultrasound-Guided Radiofrequency Ablation for Primary Hyperparathyroidism: A Prospective Study. Korean J Radiol 2022; 23:555-565. [PMID: 35506529 PMCID: PMC9081691 DOI: 10.3348/kjr.2021.0716] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To assess the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) in patients with primary hyperparathyroidism (PHPT). Materials and Methods This prospective study enrolled 39 participants (14 male, 25 female; mean age, 59.5 ± 15.3 [range, 18–87] years) between September 1, 2018, and January 31, 2021. All participants had parathyroid lesions causing PHPT, proven biochemically and through imaging. The imaging features of the PHPT nodules, including the shape, margin, size, composition, and location, were evaluated before treatment. Serum intact parathyroid hormone, calcium, and phosphorus levels; parathyroid nodule volume; and PHPT-related symptoms were recorded before and after treatment. We calculated the technical success, biochemical cure, and clinical cure rates for these patients. Complications were evaluated during and after the ablation. Results Complete ablation was achieved in 38 of the 39 nodules in the 39 enrolled participants. All the patients were treated in one session. The technical success rate was 97.4% (38/39). The mean follow-up duration was 13.2 ± 4.6 (range, 6.0–24.9) months. At 6 and 12 months post-RFA, the biochemical cure rates were 82.1% (32/39) and 84.4% (27/32), respectively, and the clinical cure rates were 100% (39/39) and 96.9% (31/32), respectively. Only 2.6% (1/39) of the patients had recurrent PHPT. At 1, 3, 6, and 12 months after technically successful RFA, 44.7% (17/38), 34.3% (12/35), 15.8% (6/38), and 12.5% (4/32) of participants, respectively, had elevated eucalcemic parathyroid hormone levels. Recurrent laryngeal nerve paralysis occurred in 5.1% (2/39) of the patients, who recovered spontaneously within 1–3 months. Conclusion US-guided RFA was effective and safe for PHPT patients. RFA may be an alternative treatment tool for patients who cannot tolerate or refuse to undergo surgery.
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Affiliation(s)
- Hui-hui Chai
- Department of Graduate, Bengbu Medical College, Bengbu, China
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yu Zhao
- Health Management Center, Department of Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, China
| | - Zeng Zeng
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Rui-zhong Ye
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Qiao-hong Hu
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Hong-feng He
- Department of Ultrasound, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheng-zhong Peng
- Department of Graduate, Bengbu Medical College, Bengbu, China
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Tongji University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
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Squarcia M, Mora M, Aranda G, Carrero E, Martínez D, Jerez R, Valero R, Berenguer J, Halperin I, Hanzu FA. Long-Term Follow-Up of Single-Fiber Multiple Low-Intensity Energy Laser Ablation Technique of Benign Thyroid Nodules. Front Oncol 2021; 11:584265. [PMID: 34950572 PMCID: PMC8691264 DOI: 10.3389/fonc.2021.584265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Aim The short-term and long-term efficacy of different thermal percutaneous ablation techniques remains a topical issue. Our group implemented percutaneous laser ablation (LA), a moving-shot technique to increase efficiency and reduce costs and variability of LA by applying multiple lower-intensity energy illuminations (MLIEI) covering the nodular volume (V) through changes in position of a single laser fiber within the thyroid nodule. The aim of the present study was to evaluate the efficacy of the single-fiber LA-MLIEI during a 5-year follow-up and to identify possible predictors of the final outcome. Methods Prospective study: Thirty outpatients (23 women and seven men) with benign symptomatic thyroid nodules were assigned to single-fiber LA-MLIEI, between 2012 and 2015. A single LA session was performed under real-time ultrasound (US) guidance using a 1,064-nm continuous-wave laser at 3 W. A 400-µm optical fiber was inserted through a 21-gauge needle, and 3–10 illuminations were performed per nodule, administering between 400 and 850 J/illumination. The total administered energy was calculated on the initial V of the nodule and the estimated ablation area. US evaluation was performed after LA-MLIEI at 1 week and 1, 3, 6, and 12 months and after that annually up to 5 years. Clinical symptoms, laboratory thyroid function during follow-up, and acute and chronic complications of treatment were registered. Results On follow-up, 67% (n: 20) were responders to single-fiber LA-MLIEI, while 33% (n: 10) were non-responders. The responder group initiated V reduction (ΔV) at 1 month, with remission of symptoms, and presented a 50% ΔV at 3 months of treatment; the maximum response was achieved at 24 months and remained stable until the end of the study. The non-responder group presented a ΔV of less than 50% at 12 months; though a tendency to >50% ΔV was observed at 24–36 months, there was subsequent regrowth, and 40% of this group required surgery. ΔV was positively correlated with the total administered energy/V (J/V) and inversely with nodule V. No severe adverse effects were observed. Thyroid function remained normal in all patients. Remission of symptoms occurred rapidly after 1 month. Conclusions LA with multiple fractional discharges employing a single fiber in a unique session is a safe and inexpensive technique that allows rapid reduction of thyroid nodules, with a stable response up to 5 years, similarly to what has been reported with the conventional LA. Total nodule volume appears as a predictive factor of the reduction.
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Affiliation(s)
- Mattia Squarcia
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain.,Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mireia Mora
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Gloria Aranda
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Enrique Carrero
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Daniel Martínez
- Department of Pathology and Anatomy, Hospital Clinic, Barcelona, Spain
| | - Ramona Jerez
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Ricard Valero
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Joan Berenguer
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain
| | - Irene Halperin
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Felicia A Hanzu
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Orloff LA, Noel JE, Stack BC, Russell MD, Angelos P, Baek JH, Brumund KT, Chiang FY, Cunnane MB, Davies L, Frasoldati A, Feng AY, Hegedüs L, Iwata AJ, Kandil E, Kuo J, Lombardi C, Lupo M, Maia AL, McIver B, Na DG, Novizio R, Papini E, Patel KN, Rangel L, Russell JO, Shin J, Shindo M, Shonka DC, Karcioglu AS, Sinclair C, Singer M, Spiezia S, Steck JH, Steward D, Tae K, Tolley N, Valcavi R, Tufano RP, Tuttle RM, Volpi E, Wu CW, Abdelhamid Ahmed AH, Randolph GW. Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association. Head Neck 2021; 44:633-660. [PMID: 34939714 DOI: 10.1002/hed.26960] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The use of ultrasound-guided ablation procedures to treat both benign and malignant thyroid conditions is gaining increasing interest. This document has been developed as an international interdisciplinary evidence-based statement with a primary focus on radiofrequency ablation and is intended to serve as a manual for best practice application of ablation technologies. METHODS A comprehensive literature review was conducted to guide statement development and generation of best practice recommendations. Modified Delphi method was applied to assess whether statements met consensus among the entire author panel. RESULTS A review of the current state of ultrasound-guided ablation procedures for the treatment of benign and malignant thyroid conditions is presented. Eighteen best practice recommendations in topic areas of preprocedural evaluation, technique, postprocedural management, efficacy, potential complications, and implementation are provided. CONCLUSIONS As ultrasound-guided ablation procedures are increasingly utilized in benign and malignant thyroid disease, evidence-based and thoughtful application of best practices is warranted.
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Affiliation(s)
- Lisa A Orloff
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Julia E Noel
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Brendan C Stack
- Department of Otolaryngology - Head & Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Marika D Russell
- Department of Otolaryngology - Head & Neck Surgery, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Jung Hwan Baek
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kevin T Brumund
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA
| | - Feng-Yu Chiang
- Department of Otolaryngology - Head and Neck Surgery, E-Da Hospital, School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Mary Beth Cunnane
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Louise Davies
- The Section of Otolaryngology, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Andrea Frasoldati
- Department of Endocrinology and Metabolism, Arcispedale Santa Maria Nuova IRCCS-ASL, Reggio Emilia, Italy
| | - Anne Y Feng
- Department of Otolaryngology - Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Ayaka J Iwata
- Department of Otolaryngology - Head & Neck Surgery, Kaiser Permanente, Santa Clara, California, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jennifer Kuo
- Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Celestino Lombardi
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mark Lupo
- Thyroid & Endocrine Center of Florida, Sarasota, Florida, USA
| | - Ana Luiza Maia
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center, Research Institute, Tampa, Florida, USA
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | | | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Kepal N Patel
- Department of Surgery, New York University, New York, New York, USA
| | - Leonardo Rangel
- Division of Otorhinolaryngology - Head and Neck Surgery, State University of Rio de Janeiro, Rio de Janiero, Brazil
| | - Jonathon O Russell
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Shin
- Department of Otolaryngology - Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maisie Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - David C Shonka
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Amanda S Karcioglu
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA.,Clinician Educator, Pritzker School of Medicine, Chicago, Illinois, USA
| | - Catherine Sinclair
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai West Hospital, New York, New York, USA
| | - Michael Singer
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Stefano Spiezia
- Endocrine Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Jose Higino Steck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Campinas, Campinas, Brazil
| | - David Steward
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kyung Tae
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Neil Tolley
- Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK
| | | | - Ralph P Tufano
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Michael Tuttle
- Endocrine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erivelto Volpi
- Oncology Center, Oswaldo Cruz German Hospital, Sao Paulo, Brazil
| | - Che Wei Wu
- Department of Otolaryngology - Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Amr H Abdelhamid Ahmed
- Department of Otolaryngology - Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology - Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Liu LH, Yang BB, Liu Y, Wang JL, Wang DD, Ding HY, Wang SR. Factors related to the absorption rate of benign thyroid nodules after image-guided microwave ablation: a 3-year follow-up. Int J Hyperthermia 2021; 39:8-14. [PMID: 34936851 DOI: 10.1080/02656736.2021.1995632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To assess the absorption rate and factors related to the development of benign thyroid nodules (BTNs) following image-guided microwave ablation (MWA). MATERIALS AND METHODS This retrospective study reviewed nodule efficacy in patients who underwent MWA of BTNs between January 2016 and January 2018. The endpoint was a third-year follow-up. Nodules were categorized into those showing complete absorption (volumes with less than 100% volume reduction ratio (VRR) and those showing partial absorption (100% VRR)). Univariable and multivariable regression analyses were carried out to identify variables that were associated with nodule absorption rates. RESULTS A total of 173 BTNs (median volume= 4.23 ml; 25-75 percentiles= 2.27-9.00 ml) from 173 patients were evaluated. 49.7% (86/173) of patients had nodules that became completely absorbed. The mean VRRs of all BTNs were 18.0%, 78.7%, 89.0%, 94.5%, and 97.1% at the 1-, 6-,12-, 24- and 36- month follow-ups. At the 3-year follow-up time point, nodule characteristics related to nodule VRR included nodule volume (adjusted odds ratio [AOR], 1.1 [95% CI: 1.0, 1.2]; p = 0.03) and nodule margin (AOR, 5.3 [95% CI: 1.8, 16.0]; p < 0.01). Treatment-related characteristics included energy per ml in nodular volume (AOR, 1.0 [95% CI: 1.0, 1.0]; p < 0.01) and blockage of peripheral flow (AOR, 3.3 [95% CI: 1.3 8.3]; p = 0.01). CONCLUSIONS US-guided image-guided MWA results in satisfactory long-term outcomes for the patients with BTNs. Factors related to nodule absorption rate were the volume and margin of the nodule, energy per ml in nodular volume and blockage of peripheral flow.
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Affiliation(s)
- Li-Hong Liu
- Department of Ultrasound, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Bei-Bei Yang
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Ying Liu
- Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China
| | - Jin-Ling Wang
- Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China
| | - Dan-Dan Wang
- Department of Ultrasound, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hong-Yu Ding
- Department of Ultrasound, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan, China
| | - Shu-Rong Wang
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China.,Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China
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76
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Abd El-Galil MS, Ali AH, Botros RM, Abd El-Khaleq YI, Hetta OMA. Efficacy and safety of ultrasound (US)-guided radiofrequency ablation of benign thyroid nodules. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021; 52:57. [DOI: 10.1186/s43055-021-00435-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/03/2021] [Indexed: 09/01/2023] Open
Abstract
Abstract
Background
We evaluated 45 benign thyroid nodules of 40 patients treated with radiofrequency (RF) ablation and followed up for 6 months. The inclusion criteria included unilateral or bilateral thyroid nodules with compression symptoms or cosmetic problems, cytological confirmation of benignity without atypical cells, and patient refusal or unfit for surgery. There was no predilection for the size, number, ultrasound nature of the nodules, (solid, cystic, or complex). RF ablation was performed using Mygen (M-3004) RF generator from RF Medical Co., Ltd, South Korea. The volume of the nodules and clinical problems were evaluated before and after the procedure. Complications and factors related to volume reduction were evaluated. The purpose of the study is to evaluate the efficacy and safety of US-guided radiofrequency (RF) ablation in the treatment of benign thyroid nodules.
Results
The volume reduction ratio (%) of the thyroid nodules was statistically significant. The mean VRR was 58.41 ± 15.27SD at 1 month, 73.26 ± 11.22SD at 3 months, and 82.54 ± 12.49SD at 6 months. P value was < 0.001. The radiofrequency ablation did not affect the normal thyroid function of the 38 patients who were euthyroid at the start of the study. Thyroid function normalized 1 month after ablation of the two autonomously functioning thyroid nodules. The compressive symptoms resolved in 22 patients (55%) and improved in the rest of the 18 patients (45%) with the median decreased from 8 (IQR 6–9), range 4–10 before treatment to 0 (IQR 0–1), range 0–3 after 6 months. Cosmetic problems improved in all 40 patients by P value < 0.001. The procedure had no sustained or life-threatening complications.
Conclusions
RF ablation was effective in reducing the size of the benign thyroid nodules and in controlling nodule-related compressive symptoms as well as cosmetic problems. There were no major complications sustained and no life-threatening complications or sequelae happened. RF ablation can be used as an alternative non-surgical minimally invasive treatment for patients with benign thyroid nodules.
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77
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Lan Y, Li N, Song Q, Zhang MB, Luo YK, Zhang Y. Correlation and agreement between superb micro-vascular imaging and contrast-enhanced ultrasound for assessing radiofrequency ablation treatment of thyroid nodules: a preliminary study. BMC Med Imaging 2021; 21:175. [PMID: 34809604 PMCID: PMC8609811 DOI: 10.1186/s12880-021-00697-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/22/2021] [Indexed: 12/29/2022] Open
Abstract
Background To evaluate the correlation and agreement between superb micro-vascular imaging (SMI) mode and the contrast-enhanced ultrasound (CEUS) mode for the ablative completeness and the volumes of ablation lesions to determine the clinical application value of SMI in follow-up after radiofrequency ablation.
Methods From April 2020 to June 2020, two radiologists used SMI and CEUS mode to measure the volume of the ablation lesion. We use intra-class correlation coefficient (ICC), scatter plots and Bland–Altman plots to evaluate the correlation and agreement of the two techniques. In addition, intra- and inter-observer reliability in volume measurement of ablation lesions with SMI mode was assessed. Results SMI mode and CEUS mode have good agreement in the evaluation of ablative completeness. The ICC was 0.876 and 0.928 of reader A and reader B between SMI mode and CEUS mode in terms of ablation lesions volume measurement. There was a strong correlation between the two modes in both reader A and reader B (rA = 0.808; rB = 0.882). The ICC was 0.836 for the inter-observer reliability of SMI technique. The scatter plot showed a good linear relation (r = 0.715). In the Bland–Altman plot, 4.35% (1/23) of the points was outside the 95% limits of agreement. The ICC was 0.965 for the intra-observer reliability of SMI technique, the scatter plot also showed a strong linear correlation (r = 0.965). In the Bland–Altman plot, 8.70% (2/23) of the points was outside the 95% limits of agreement. Conclusions SMI and CEUS have good agreement and correlation in the ablation volume measurement. SMI technology is expected to be applied as an alternative to CEUS in the clinical follow-up of ablation lesions.
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Affiliation(s)
- Yu Lan
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, 94 Weijin Road, Nankai District, Tianjin, China.,Department of Ultrasound, The People's Hospital of Liaoning Province, Shenyang, China
| | - Nan Li
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China
| | - Qing Song
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China
| | - Ming-Bo Zhang
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China.
| | - Yu-Kun Luo
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China. .,School of Medicine, Nankai University, 94 Weijin Road, Nankai District, Tianjin, China.
| | - Yan Zhang
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China.
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78
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Schalch MS, Costa ACN, de Souza RP, Guerra FLB, Guerreiro R, De Cicco R. Radiofrequency ablation of thyroid nodules: prospective cost-effectiveness analysis in comparison to conventional thyroidectomy. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:752-757. [PMID: 34762781 DOI: 10.20945/2359-3997000000411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The objective of this study is to compare the total costs of surgery and radiofrequency (RF) ablation for the treatment of benign thyroid nodules. Methods This is a prospective randomized study comparing cases treated with US-guided RF ablation (cases) and surgery (control). They were selected and allocated to groups (thyroidectomy or radioablation) by permuted block randomization in blocks of five cases each. Results Five cases of RF Ablation were compared with five cases of thyroidectomies conducted in the same period. Similar complication rates were observed in both groups. Shorter operating time and hospital stay were observed for the RF group. In the evaluation of the total cost between procedures, radioblation represented 76% of the cost of partial thyroidectomy. Conclusion This study demonstrated that radioablation has a competitive cost, making it an effective alternative in the treatment of benign thyroid nodules.
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Affiliation(s)
- Marcelo Soares Schalch
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto do Câncer Arnaldo Vieira de Carvalho (ICAVC), São Paulo, SP, Brasil
| | - Anna Carolina Novais Costa
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto do Câncer Arnaldo Vieira de Carvalho (ICAVC), São Paulo, SP, Brasil
| | - Rafael Pereira de Souza
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto do Câncer Arnaldo Vieira de Carvalho (ICAVC), São Paulo, SP, Brasil
| | - Filipe Lamounier Barros Guerra
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto do Câncer Arnaldo Vieira de Carvalho (ICAVC), São Paulo, SP, Brasil
| | - Roberta Guerreiro
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto do Câncer Arnaldo Vieira de Carvalho (ICAVC), São Paulo, SP, Brasil
| | - Rafael De Cicco
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto do Câncer Arnaldo Vieira de Carvalho (ICAVC), São Paulo, SP, Brasil,
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Kuo JH, Sinclair CF, Lang B, Spiezia S, Yu M, Ha EJ, Na DG, Offi C, Patel KN, Baek JH. A comprehensive review of interventional ablation techniques for the management of thyroid nodules and metastatic lymph nodes. Surgery 2021; 171:920-931. [PMID: 34776258 DOI: 10.1016/j.surg.2021.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 01/15/2023]
Abstract
Thyroidectomy remains the gold standard treatment for benign, symptomatic, or enlarging thyroid nodules, malignant nodules, and metastatic lymph node disease. However, in the past 2 decades, image-guided interventional techniques have emerged as promising alternative treatments for these conditions. Percutaneous ethanol ablation is now an accepted first-line treatment for recurring cystic thyroid nodules. Thermal ablation techniques such as high-intensity focused ultrasound, laser ablation, radiofrequency ablation, and microwave ablation have shown efficacy in producing a nodular volume reduction of greater than 50% that is maintained for several years with resolution of local compressive symptoms. There is also increasing evidence that these techniques can effectively treat papillary thyroid microcarcinomas and recurrent metastatic lymph node disease. Because these interventional ablation techniques are performed safely in an outpatient setting, are well tolerated, and the risk for needing thyroid hormone supplementation is negligible, they are becoming a popular alternative treatment to surgical resection. In this comprehensive review, we discuss each of these percutaneous interventions: the devices and techniques, the advantages and disadvantages of each energy, and summarize the outcomes published in the literature.
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Affiliation(s)
- Jennifer H Kuo
- Section of Endocrine Surgery, Columbia University, New York, NY.
| | - Catherine F Sinclair
- Head and Neck Surgery, Mt. Sinai Hospital, New York, NY. https://twitter.com/drcathsinclair
| | - Brian Lang
- Division of Endocrine Surgery, Queen Mary Hospital, Hong Kong. https://twitter.com/BrianHLang1
| | - Stefano Spiezia
- Division of Endocrine Surgery and Interventional Ultrasound, Hospital "Ospedale del Mare" ASLNA1centro, Naples, Italy
| | - Mingan Yu
- Department of Interventional Ultrasound, China-Japan Friendship Hospital, Beijing China
| | - Eun Ju Ha
- Department of Radiology, Ajou University, Suwon, South Korea. https://twitter.com/EunjuHa3
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Chiara Offi
- Division of Endocrine Surgery and Interventional Ultrasound, Hospital "Ospedale del Mare" ASLNA1centro, Naples, Italy
| | - Kepal N Patel
- Division of Endocrine Surgery, NYU Langone Health, New York, NY
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ma Y, Wu T, Yao Z, Zheng B, Tan L, Tong G, Lian Y, Baek JH, Ren J. Continuous, Large-Volume Hydrodissection to Protect Delicate Structures around the Thyroid throughout the Radiofrequency Ablation Procedure. Eur Thyroid J 2021; 10:495-503. [PMID: 34956921 PMCID: PMC8647085 DOI: 10.1159/000519625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/30/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Small-volume hydrodissection liquid dissipates rapidly and confers only short-term protection during radiofrequency ablation (RFA) of benign thyroid nodules. The aim of this study was to establish a safe method for continuous, large-volume hydrodissection. METHODS A long needle was inserted and positioned outside the thyroid capsule; 5% glucose was injected to maintain a 3- to 5-mm continuous safety buffer. From October 2015 to July 2020, 166 patients underwent hydrodissection with different volumes, and ablation efficacy and complications associated with different liquid volumes (≤40 mL vs. >40 mL) were compared at 1-month postprocedure. Moreover, 20 mL liquid (equivalent to 250 mL in the human body) was injected around the thyroid of a rhesus monkey, after which CT scans were used to visualize the liquid's fate and verify its safety. RESULTS The 51 patients with 10-40 mL injections and 116 patients with larger injections (45-450 mL) showed similar complete ablation rates (88.46% vs. 90.44%, p = 0.582), comparable 6-month VRR (82.79% vs. 76.62%, p = 0.079), and complication incidences, although the latter group had larger nodules (9.11 mL vs. 13.79 mL, p = 0.003), more energy delivered (3.44 kcal vs. 6.04 kcal, p < 0.001), and longer operation times (51.37 min vs. 69.2 min, p < 0.001). In the animal experiment, the 20 mL of liquid diffused quickly (within 10 min) from the vicinity of the thyroid to the mediastinum and retropharyngeal space. It was observed in the kidneys at 10 min and disappeared from the neck and chest space by 24 h. CONCLUSIONS Continuous, large-volume hydrodissection can protect the delicate structures around the thyroid throughout the RFA procedure and might be beneficial in large thyroid nodule ablation.
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Affiliation(s)
- Yanping Ma
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
- *Jung Hwan Baek, , Jie Ren,
| | - Tao Wu
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Zhicheng Yao
- General Surgery Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Bowen Zheng
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Lei Tan
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Ge Tong
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Yufan Lian
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
- *Jung Hwan Baek, , Jie Ren,
| | - Jie Ren
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
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81
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Fu QQ, Kang S, Wu CP, Wang SY, Liu YY, Tian JW, Jiang SQ. A study on the efficacy of microwave ablation for benign thyroid nodules and related influencing factors. Int J Hyperthermia 2021; 38:1469-1475. [PMID: 34620026 DOI: 10.1080/02656736.2021.1988151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To explore the efficacy of microwave ablation (MWA) in the treatment of benign thyroid nodules, and analyze related influencing factors. METHODS The clinical and ultrasound data of 115 patients with 115 benign thyroid nodules treated with MWA were retrospectively analyzed. The volume of nodules at 1, 3, 6, and 12 months after the procedure was obtained, and the volume reduction rate (VRR) at each time point was calculated. With VRR > 90% as the criterion for nodule cure, binary logistic regression was employed to screen the factors that affect the efficacy. RESULTS ① At 1, 3, 6, and 12 months after the procedure, the volume of nodules continued to decrease, the VRR gradually increased, and the differences at each time point were statistically significant (p < 0.05). A total of 29 (25.21%) nodules disappeared completely at 12 months after the procedure; ② Multivariate stepwise logistic regression showed that there was a statistically significant difference for the internal component of nodules, enhancement mode, and immediate volume after the procedure in determining the ablation efficacy (p < 0.05); ③ The ROC curve was plotted for predicting the efficacy of MWA, with the results showing that the AUC, sensitivity, specificity, and accuracy were 0.82, 67.50, 88.00, 79.10%, respectively; ④ 11 cases (9.56%) had side effects, 10 cases (8.70%) had minor complications, and three cases (2.61%) had major complications. CONCLUSION MWA is safe and effective in the treatment of benign thyroid nodules. The internal component of nodules, enhancement mode, and immediate volume after the procedure are independent factors that affect the efficacy of ablation.
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Affiliation(s)
- Qian-Qian Fu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,Daqing People's Hospital, Ultrasound Room, Daqing, Heilongjiang, China
| | - Song Kang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Cui-Ping Wu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shi-Yu Wang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ying-Ying Liu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jia-Wei Tian
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shuang-Quan Jiang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Jin M, Kim HI, Ha J, Jeon MJ, Kim WG, Lim DJ, Kim TY, Chung JH, Shong YK, Kim TH, Kim WB. Tumor Volume Doubling Time in Active Surveillance of Papillary Thyroid Microcarcinoma: A Multicenter Cohort Study in Korea. Thyroid 2021; 31:1494-1501. [PMID: 34225475 DOI: 10.1089/thy.2021.0094] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Some papillary thyroid microcarcinomas (PTMCs) may progress with tumor enlargement or development of new lymph node (LN) metastasis during active surveillance (AS). This study evaluated the relevant predictors of disease progression, especially new cervical LN metastasis. Methods: This was a long-term follow-up study conducted using a previous multicenter cohort of AS in Korea. After excluding 54 (14.2%) patients with a short follow-up duration, 326 PTMC patients were evaluated for tumor kinetics, including changes in tumor volume (TV) and TV doubling time (TVDT). Results: During a median follow-up duration of 4.9 years, 17 (5.2%, 95% confidence intervals [CI] 2.7-7.6%) patients showed a maximal diameter increase of ≥3 mm after a median of 4.0 years follow-up, while 9 (2.8%, CI 1.0-4.5%) developed new LN metastasis after a median of 2.2 years follow-up. New cervical LN metastasis occurred exclusively of a maximal diameter increase of ≥3 mm. The prevalence of new development of LN metastasis was higher in patients with TVDT <5 years (7.4%) than in those with TV ≥50% (3.2%). Furthermore, only TVDT <5 years was significantly associated with LN metastasis (p = 0.002). In univariate and multivariate analyses, TVDT <5 years was an independent risk factor for disease progression with respect to new development of LN metastasis (hazard ratio [HR] = 6.51, CI 1.73-24.50; p = 0.002) and tumor enlargement (HR = 20.89, CI 5.78-75.48; p < 0.001). Finally, 86 (22.6%) patients underwent delayed surgery, and the most common reason was patient anxiety. Conclusions: TVDT <5 years is a predictor of disease progression during AS in terms of new LN metastasis development as well as tumor enlargement. Determination of TVDT in the early phase of AS could help in predicting disease progression, tailoring follow-up intensity of AS and in determining if early surgical intervention is needed.
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Affiliation(s)
- Meihua Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye In Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Wu MH, Chen KY, Chen A, Chen CN. Differences in the ultrasonographic appearance of thyroid nodules after radiofrequency ablation. Clin Endocrinol (Oxf) 2021; 95:489-497. [PMID: 33938024 DOI: 10.1111/cen.14480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 01/07/2023]
Abstract
CONTEXT Radiofrequency ablation (RFA) is a well-tolerated approach to treating benign thyroid nodules (TNs), but no index can predict its success. Other than size decrease, little is known about TN appearance on ultrasonography (US) after RFA. OBJECTIVE This study aimed to (a) assess the effectiveness of single-session RFA treatment, (b) determine whether pre-ablation US characteristics correlate with its effectiveness, and (c) demonstrate TN characteristics on baseline and follow-up US. DESIGN Retrospective cohort study among the patients who underwent single-session RFA for the treatment of benign TNs at a referral medical center between January 2018 and April 2019. PATIENTS A total of 116 patients (137 nodules) were included in the study. MEASUREMENTS Characteristics were quantified using commercial software. TNs were classified into 2015 American Thyroid Association (ATA) sonographic patterns and American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TI-RADS) categories. RESULTS The average volume reduction ratio (VRR) was 74.51% in 1 year (95% confidence interval, 70.63%-78.39%). The only pre-ablation US feature significantly different between nodules with VRR <50% and VRR >50% was the cyst composition (0.05 vs. 0.02, p-value = .02). The VRR and margin change in the first 3 months after ablation were found to be leading indicators significantly correlated to the VRR in 6 months with correlation coefficients (r) = .72 and -.28 (p-value < .0001 and = .0008) and VRR in 1 year with r = .65 and -.17 (p-value < .0001 and = .046), respectively. After RFA, more TNs became ATA high suspicion (2.9% vs. 19.7%, p < .0001) and more appeared to be the non-ATA patterns (12.4% vs. 23.4%, p < .0001). Also, a greater number of post-RFA TNs were classified as ACR-TI-RADS categories 4 and 5 (40.1% vs. 70.1%, p < .0001). CONCLUSIONS Radiofrequency ablation therapy is effective for treating TNs. Pre-ablation cyst components, 3-month post-ablation volume reduction and margin change of TNs were related to the 6-month and 1-year response. Clinicians should consider that TNs would appear peculiar on US after RFA, mistakenly suggesting malignant potential.
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Affiliation(s)
- Ming-Hsun Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuen-Yuan Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Argon Chen
- Graduate Institute of Industrial Engineering, National Taiwan University, Taipei, Taiwan
| | - Chiung-Nien Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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84
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Ultrasound-Guided Moving Shot Radiofrequency Ablation of Benign Soft Tissue Neoplasm. ACTA ACUST UNITED AC 2021; 57:medicina57080830. [PMID: 34441036 PMCID: PMC8402204 DOI: 10.3390/medicina57080830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022]
Abstract
Background and Objective: To evaluate the effectiveness of radiofrequency ablation (RFA) using the moving-shot technique for benign soft tissue neoplasm. Materials and Methods: This retrospective study reviewed eight patients with benign soft tissue neoplasm presenting with cosmetic concerns and/or symptomatic issues who refused surgery. Six patients had vascular malformation, including four with venous malformation and two with congenital hemangioma. The other two patients had neurofibroma. All patients underwent RFA using the moving-shot technique. Imaging and clinical follow-up were performed in all patients. Follow-up image modalities included ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging. The volume reduction ratio (VRR), cosmetic scale (CS), and complications were evaluated. Results: Among the seven patients having received single-stage RFA, there were significant volume reductions between baseline (33.3 ± 21.2 cm3), midterm follow-up (5.1 ± 3.8 cm3, p = 0.020), and final follow-up (3.6 ± 1.4 cm3, p = 0.022) volumes. The VRR was 84.5 ± 9.2% at final follow-up. There were also significant improvements in the CS (from 3.71 to 1.57, p = 0.017). The remaining patient, in the process of a scheduled two-stage RFA, had a 33.8% VRR after the first RFA. The overall VRR among the eight patients was 77.5%. No complications or re-growth of the targeted lesions were noted during the follow-up period. Of the eight patients, two received RFA under local anesthesia, while the other six patients were under general anesthesia. Conclusions: RFA using the moving-shot technique is an effective, safe, and minimally invasive treatment for benign soft tissue neoplasms, achieving mass volume reduction within 6 months and significant esthetic improvement, either with local anesthesia or with general anesthesia under certain conditions.
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85
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Muhammad H, Tehreem A, Russell JO, Tufano RP. Radiofrequency Ablation and Autonomous Functioning Thyroid Nodules: Review of the Current Literature. Laryngoscope 2021; 132:906-914. [PMID: 34375454 DOI: 10.1002/lary.29811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Autonomously functioning thyroid nodules (AFTNs) have long been treated with either surgery or radioactive iodine (RAI). Being an invasive procedure, even thyroid lobectomy for this condition is associated with complications such as anesthesia side effects, scarring, iatrogenic hypothyroidism, and injury to other structures. Similarly, RAI is associated with hypothyroidism and may require multiple courses. Therefore, minimally invasive techniques such as radiofrequency ablation (RFA) are being advocated as an alternative treatment for AFTNs. To date, only few studies have been published on this topic and are largely on European and Asian populations. The aim of this review is to assess the efficacy and safety of RFA as a potential alternative for treatment of AFTNs compared to conventional surgery and radioiodine. METHODS/STUDY DESIGN Comprehensive PubMed and Embase searches were performed using the following terms such as (autonomously functioning thyroid nodules and radiofrequency ablation), (radiofrequency ablation and hyperthyroidism), and (radiofrequency ablation and toxic thyroid nodule). Both prospective and retrospective studies were included based on the inclusion and exclusion criteria specified in the text. RESULTS Initially, 57 studies were identified and after excluding 47 studies, finally 10 studies were included in the review. CONCLUSION Although surgery remains the first line treatment for AFTN. However, RFA is a safe option compared to RAI or surgery, especially in patients who are high-risk surgical candidates or have absolute contraindications to RAI. Currently, trials with follow-up greater than or equal to 5 years are warranted. It will aid in formulating a standardized surveillance protocol and also generalize RFA's use for AFTN. Laryngoscope, 2021.
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Affiliation(s)
- Haris Muhammad
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, Maryland, U.S.A
| | - Aniqa Tehreem
- Department of Internal Medicine, Sinai Hospital, Baltimore, Maryland, U.S.A
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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86
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Wang N, Zheng B, Wu T, Tan L, Lian Y, Ma Y, Guo R, Xu S, Zeng L, Xu W, Ren J. Thyroid dysfunction following radiofrequency ablation for benign thyroid nodules: more likely to occur within one-week and in high-risk population. Int J Hyperthermia 2021; 38:1060-1068. [PMID: 34265235 DOI: 10.1080/02656736.2021.1950849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) has been recommended as the treatment for benign thyroid nodules (BTNs) by some guidelines. However, detailed follow-up instructions for thyroid function about the timing and affected populations after RFA are lacked due to insufficient researches. This 12-month prospective study aimed to evaluate the incidence and risk factors of thyroid dysfunction at different time points after RFA, especially within 1 week that previous studies didn't concern. METHODS Seventy-five euthyroid patients who underwent RFA for symptomatic BTNs were enrolled (ChiCTR-INR-16007884). The incidence of thyroid dysfunction within 1 week, at 1, 6, and 12 months after RFA was evaluated. The risk factors for different types of thyroid dysfunction in the different terms were further analyzed. RESULTS Within 1 week after RFA, the incidence of thyroid dysfunction was as high as 36.00% unexpectedly, and only overt thyrotoxicosis and subclinical thyrotoxicosis occurred, which were significantly associated with the low-normal baseline thyrotropin (TSH) level (p = 0.001) and high ablation volume ratio (p = 0.008). From 1 to 12 months (the long term), the incidence dropped significantly and remained low (8.00-12.00%); and thyroid dysfunction presented as overt thyrotoxicosis, subclinical thyrotoxicosis, and subclinical hypothyroidism. The long-term thyrotoxicosis group had more cases with diabetes and lower baseline TSH levels. The long-term subclinical hypothyroidism group had more cases with positive thyroid peroxidase antibodies, higher baseline TSH levels, and higher ablation volume ratios. CONCLUSIONS After the RFA of BTNs, thyroid dysfunction was more likely to occur within 1 week and in populations with risk factors.
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Affiliation(s)
- Nana Wang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Bowen Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Tao Wu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Lei Tan
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Yufan Lian
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Yanping Ma
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Rui Guo
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Shicheng Xu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Longyi Zeng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, Guangdong, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, Guangdong, China
| | - Jie Ren
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
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87
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Hussain I, Zulfiqar F, Li X, Ahmad S, Aljammal J. Safety and Efficacy of Radiofrequency Ablation of Thyroid Nodules-Expanding Treatment Options in the United States. J Endocr Soc 2021; 5:bvab110. [PMID: 34258495 PMCID: PMC8271212 DOI: 10.1210/jendso/bvab110] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Radiofrequency ablation (RFA) has only recently gained popularity in the United States for treatment of thyroid nodules (TNs), with a limited number of patients having undergone the procedure in this country. OBJECTIVE To evaluate the safety and efficacy of RFA of TNs performed in an outpatient setting in the United States. METHODS This is a retrospective, single-center study of 53 patients who underwent RFA of 58 TNs between November 2018 and January 2021. The reduction in volume of nodule, cosmetic and symptomatic improvement, effect on thyroid function, and complications following RFA were assessed. RESULTS Eleven out of 53 patients were excluded from the analysis. A total of 47 benign TNs (23 nonfunctioning thyroid nodules [NFTNs] and 24 autonomously functioning thyroid nodules [AFTNs]), were assessed after RFA. The median reduction in volume was 70.8% after a median follow-up period of 109 days, with symptomatic and cosmetic improvement (P < 0.0001). Compared with larger nodules, smaller nodules had greater volume reduction (P = 0.0266). RFA improved thyrotropin (TSH) in AFTNs (P value = 0.0015) and did not affect TSH in NFTNs (P value = 0.23). There were no major complications; however, 1 patient had self-limited local bleeding and another had transient voice change that recovered in 6 months. CONCLUSION RFA is a safe and efficacious treatment for symptomatic NFTNs and AFTNs in our population and is especially effective for smaller nodules. RFA should be considered an alternative for TNs in patients who cannot or do not want to undergo surgery.
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Affiliation(s)
- Iram Hussain
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-8537, USA
| | | | - Xilong Li
- Division of Biostatistics, Department of Population and Data Science, University of Texas Southwestern Medical Center, Dallas, TX 75390-8537, USA
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Implications of radiofrequency ablation in patients undergoing thyroid surgery for benign disease in the United States. Surgery 2021; 171:160-164. [PMID: 34304890 DOI: 10.1016/j.surg.2021.04.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Radiofrequency ablation is an alternative strategy for the management of benign thyroid conditions. We analyzed the proportion of patients who underwent thyroid surgery for benign conditions who would be potentially eligible for radiofrequency ablation. METHODS We identified patients who underwent thyroid surgery from 2015 to 2019 at the study institution for Bethesda II cytopathology or toxic adenoma. Patients were considered potentially eligible for radiofrequency ablation if they had a dominant nodule >2 cm with or without compression symptoms, a dominant nodule <2 cm with compression symptoms, or a toxic adenoma. RESULTS Of 411 patients in total, 284 (69.1%) would be eligible to consider thyroid radiofrequency ablation. In the radiofrequency ablation-eligible group, 20 (7.0%) experienced voice change after surgery, and 2 (0.7%) were dissatisfied or concerned about their scar. In the radiofrequency ablation-eligible group, 70 patients (24.6%) had malignancy diagnosed by final pathology, and 23 patients (8.1%) had cancers that were equal to or larger than 1 cm in size. CONCLUSION Many patients who undergo surgery for benign thyroid disease could be considered for radiofrequency ablation as an alternative treatment modality. Given the rate of occult malignancy, optimal evaluation of nondominant nodules before radiofrequency ablation and long-term thyroid surveillance for patients who undergo radiofrequency ablation should be further studied.
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89
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Russ G, Ben Hamou A, Poirée S, Ghander C, Ménégaux F, Leenhardt L, Buffet C. Learning curve for radiofrequency ablation of benign thyroid nodules. Int J Hyperthermia 2021; 38:55-64. [PMID: 33491515 DOI: 10.1080/02656736.2021.1871974] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: To evaluate the effect of operator experience on the treatment outcomes of radiofrequency ablation (RFA) for benign thyroid nodules (BTN). Methods: Data from the 90 first RFA procedures of a single operator in treating benign thyroid nodules were prospectively collected and retrospectively analyzed. Patients were divided into 3 groups according to their chronological treatment rank: patients 1-30 (G1), 31-60 (G2) and 61-90 (G3). Clinical symptoms, volume reduction ratio (VRR), technique efficacy (TE) defined as a VRR > 50% and ablation ratio (AR) were compared between the three groups at 6 months follow-up. All complications and side effects were recorded. Results: No significant difference was observed in improvement of clinical symptoms after the RFA procedure between the three groups, with higher satisfaction however for pressure symptoms than for esthetic complaints (complete resolution 87.5% and 52.6%, respectively). In groups 1, 2 and 3, TE was 60%, 93.3%, 76.7%, VRR 54%, 65%, 60% and AR 13.1%, 34%, 34.6%, respectively. Thus, all ultrasound efficacy parameters (TE, VRR, AR) improved significantly between G1 and G2, with no difference between G2 and G3. Solely did AR improve in nodules ≤ 30 mL between G2 and G3 to reach a median value of 94.4% in G3 versus 57.1% in G2 and 13.7% in G1. Maximum values of TE and VRR (95.6% and 68%, respectively) were seen in nodules ≤ 30 mL in G2 at 6 months follow-up, with no improvement in G3 (84.2% and 63%, respectively). Both baseline volume and energy per volume were independently associated with VRR and AR. Three minor complications were recorded which all recovered totally after conservative treatment. Conclusion: There was a measurable learning curve in RFA for benign thyroid nodules regarding efficacy until 90 patients. VRR and AR can be used as proficiency markers. Only three transient complications occurred confirming the safety of the procedure.
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Affiliation(s)
- Gilles Russ
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Centre of Pathology and Radiology, Paris, France.,Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | | | - Sylvain Poirée
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Cécile Ghander
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Fabrice Ménégaux
- Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.,Service de Chirurgie Générale et Digestive, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Laurence Leenhardt
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Camille Buffet
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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90
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Song Q, Gao H, Ren L, Tian X, Lan Y, Yan L, Luo Y. Radiofrequency ablation versus total thyroidectomy in patients with papillary thyroid microcarcinoma located in the isthmus: a retrospective cohort study. Int J Hyperthermia 2021; 38:708-714. [PMID: 33899651 DOI: 10.1080/02656736.2021.1916625] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This retrospective study aimed to examine the benefits and complications of radiofrequency ablation (RFA) in patients with papillary thyroid microcarcinoma (PTMC) in the isthmus. METHODS This retrospective study included patients with PTMC in the isthmus and treated at the Chinese People's Liberation Army hospital from 05/2014 to 05/2018. The patients were divided into the RFA and total thyroidectomy (TT) groups. The outcomes were operation-related complications, rate of recurrence, metastasis rate, and thyroid carcinoma-specific questionnaire of quality of life (THYCA-QOL). RESULTS Among 218 patients, 115 patients underwent RFA, and 103 underwent TT. The rates of disappearance of the ablation zone at 1, 3, 6, 12, and 18 months after RFA were 0.8% (1/115), 10.4% (12/115), 51.3% (59/115), 90.4% (104/115), and 100% (115/115), respectively. Surgical time, blood loss, hospital stays, and treatment costs were higher with TT than with RFA (all p < 0.001). The final THYCA-QOL score of the RFA group was significantly higher than in the TT group (p < 0.001). Minor pain at the operation site was seen in all patients in the RFA group. No distant metastasis was detected in all patients, but one patient in the RFA group had a recurrence after 6 months. The final THYCA-QOL score of the RFA group was significantly lower than in the TT group (p < 0.001). CONCLUSION These results suggest that RFA for PTMC in the isthmus had similar outcomes than TT. It will have to be confirmed in future studies.
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Affiliation(s)
- Qing Song
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China.,Department of Ultrasound, Seventh Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Hanjing Gao
- Department of Ultrasound, Second Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Ling Ren
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Xiaoqi Tian
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Yu Lan
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Lin Yan
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
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91
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Yan L, Luo Y, Zhang M, Xiao J. Vital volume increase versus clinical evaluation as the indication of additional radiofrequency ablation for benign thyroid nodule: a single center retrospective study. Int J Hyperthermia 2021; 37:777-785. [PMID: 32619366 DOI: 10.1080/02656736.2020.1778197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: To compare results in patients treated with additional radiofrequency ablation (RFA) after clinical evaluation or vital volume (Va) increase.Methods: Forty patients with 42 benign thyroid nodules who underwent additional RFA were evaluated in this retrospective study. According to the different indication for additional RFA, 18 patients were divided into Vv increase group (V group) and 22 into clinical evaluation group (C group). Patients were followed up at 1, 3, 6, 12 months and every 12 months thereafter by conventional ultrasound (US), contrast-enhancement ultrasound (CEUS) and clinical evaluation. Volume, volume reduction rate (VRR), symptom score and cosmetic score were evaluated before treatment and each ablation.Results: After the first RFA, there were no statistically differences between two groups in volume, VRR, cosmetic and symptom scores. Compared with the first RFA, volume of all the patients after additional RFA decreased significantly (p < 0.001). In additional RFA, during a mean follow-up time of 10.15 ± 9.17 months, volume in V group was significantly smaller than in C group (2.84 ± 5.43 ml Vs 7.39 ± 13.01 ml, p = 0.046). VRR in V group was significantly larger than in C group (90.18 ± 12.74% Vs 75.66 ± 26.47%, p = 0.007) with significant improvement of cosmetic and symptom scores (p = 0.047; p = 0.030). No complications occurred after each session ablation.Conclusion: Vv increase was a more reliable indicator for additional RFA than clinical evaluation. Additional RFA performed after Vv increase was more effective with respect to volume reduction and improvement of clinical outcomes. Therefore, Vv increase should be set as an indication for additional RFA.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.,Health Management Center, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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92
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Lan Y, Jin Z, Zhang Y, Song Q, Xiao J, Yan L, Zhu Y, Zhang M, Luo Y. Factors associated with health-related quality of life in papillary thyroid microcarcinoma patients undergoing radiofrequency ablation: a cross-sectional prevalence study. Int J Hyperthermia 2021; 37:1174-1181. [PMID: 33043742 DOI: 10.1080/02656736.2020.1812738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To explore the association of demographic characteristics, clinical symptoms and the fear of the disease progression factors with the physical and mental summary components of the health-related of life (HRQoL) of the papillary thyroid microcarcinoma (PTMC) patients undergoing radiofrequency ablation (RFA). METHODS 123 PTMC survivors undergoing RFA were enrolled in this study from October 2019 to March 2020. Demographic, clinical symptoms and the fear of the disease progression data were collected. SF-36, THYCA-QoL and FoP-Q-SF were used to evaluate the HRQoL of patients, clinical symptoms and the fear of disease progression. A multivariate regression model was performed to evaluate the association between the independent variable and the HRQoL variable. RESULTS The average self-reported HRQoL score was 81.17 ± 15.48 for the PCS and 73.40 ± 18.03 for the MCS. The multivariate linear regression model shows that the factors related to a poorer PCS were dependent for the female patients, the symptoms of neuromuscular and the throat/mouth, the fear of disease progression; the psychological disorder, symptoms of throat/mouth, inability to concentrate were related to worse scores for the MCS. The condition that was most strongly related to a poorer HRQoL (in both PCS and MCS) was the fear of their physical health. CONCLUSIONS The factors related to significantly worse HRQoL scores across PCS and MCS for PTMC survivors include the female gender, the symptoms of neuromuscular and the throat/mouth, the psychological disorder, inability to concentrate, and the fear of their own physical health. Identification, management, and prevention of these factors are critical to improving the HRQoL of patients.
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Affiliation(s)
- Yu Lan
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Ultrasound, The People's Hospital of Liaoning Province, Shenyang, China
| | - Zhuang Jin
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Ultrasound, General Hospital of Northern Military Area, Shenyang, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jing Xiao
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yaqiong Zhu
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Shen K, Xue S, Xie Y, Wang H, Li J, Sun Y, Wang K, Xu G, Guo T, Fan B, Zhu L, Ren A. Comparison of thermal ablation and routine surgery for the treatment of papillary thyroid microcarcinoma: a systematic review and Meta-analysis. Int J Hyperthermia 2021; 37:913-924. [PMID: 32722973 DOI: 10.1080/02656736.2020.1777331] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Thermal ablation (TA), as an alternative to surgery, has shown some benefits in the treatment of papillary thyroid microcarcinoma (PTMC) patients, especially for those who are at high risk for surgery or refuse surgery. We performed a systematic review and meta-analysis to evaluate the efficiency, safety, and economy of TA, compared with those of routine surgery (RS), for the treatment of PTMC. METHODS PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases were retrieved from inception to 10 January 2020 to identify relevant original studies on comparison of TA and RS for treatment of PTMC. The recurrence rate, recurrence-free survival (RFS), complication rate, operation time, postoperative length of stay, and cost during the perioperative period were extracted as main indices. The pooled standardized mean difference (SMD) or odds ratio (OR) with 95% confidence intervals (CI) were calculated and analyzed. Chi-square test and I 2 statistic were applied to determine the heterogeneity among studies. The sensitivity analysis was applied to explore the origin of heterogeneity, and the publication bias was evaluated by Egger's test. RESULTS Seven retrospective studies with a total of 867 patients met the eligibility criteria and were included in the final meta-analysis. Our study demonstrated that TA showed significant reduction in complication with a pooled OR 0.24 (95% CI 0.13 to 0.43), postoperative length of stay with a pooled SMD -3.14 (95% CI -4.77 to -1.51) and cost during the perioperative period with a pooled SMD of -1.69 (95% CI -3.18 to -0.20). It also demonstrated that both TA and RS had similar pooled proportion of recurrence of OR 0.93 (95% CI 0.38 to 2.30) and recurrence-free survive (RFS). The sensitivity analysis showed that each included study had no significant effect on the results and the results were stable and reliable. The Egger's test demonstrated publication bias was acceptable. CONCLUSIONS TA may not be oncologically inferior to RS, and it is a relatively safe and economical alternative for the treatment of PTMC.
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Affiliation(s)
- Kangjie Shen
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Shengbai Xue
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Yi Xie
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Hongye Wang
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Jing Li
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yifan Sun
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Kexuan Wang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Guochao Xu
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Tao Guo
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Boqiang Fan
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingjun Zhu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Anjing Ren
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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94
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Fei Y, Qiu Y, Huang D, Xing Z, Li Z, Su A, Zhu J. Effects of energy-based ablation on thyroid function in treating benign thyroid nodules: a systematic review and meta-analysis. Int J Hyperthermia 2021; 37:1090-1102. [PMID: 32981370 DOI: 10.1080/02656736.2020.1806362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Whether thyroid function would be affected by ablation remains controversial. This systematic review and meta-analysis aimed to investigate the effects of energy-based ablation on thyroid function in treating benign thyroid nodules. METHODS EMBASE, PubMed, Cochrane Library, and Web of Science databases were searched. The mean difference (MD) or standard MD (SMD) was applied to assess changes in thyroid function, thyroglobulin (Tg), and antibodies after ablation. RevMan version 5.3 was used for data synthesis. RESULTS Forty-two studies involving 6380 patients were eligible. The pooled results revealed significant decrease of 1-day thyroid-stimulating hormone (95% CI, -0.67 to -0.14), significant increase of 1-day, 1-week, and 1-month free thyroxine (95% CI, 1.57 to 5.28; 95% CI, 0.61 to 2.42; 95% CI, -0.76 to -0.15), 1-day and 1-week Tg level (95% CI, 0.40 to 0.81; 95% CI, 0.21 to 1.29), 6-month anti-thyroglobulin antibodies (95% CI, 0.02 to 0.26), 1- and 3-month thyroperoxidase antibody (95% CI, 0.02 to 0.22; 95% CI, 0.17 to 0.43), and 1-day, 1-, and 3-month thyrotrophin receptor antibody (95% CI, 0.10 to 0.43; 95% CI, 0.00 to 0.30; 95% CI, 0.13 to 0.36) after ablation. No statistically significant differences were found in these six indicators in the longer term. The results of subgroup analysis were similar to the pooled results. No significant publication bias was found. CONCLUSIONS Energy-based ablation was more likely to have negative effects on thyroid function and antibodies and led to transient increase in Tg level in the short term. However, most of the patients would not develop any thyroid dysfunction in the long-term follow-up.
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Affiliation(s)
- Yuan Fei
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Yuxuan Qiu
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.,Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhichao Xing
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhe Li
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Anping Su
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Jingqiang Zhu
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
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95
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Long-Term Outcomes of Radiofrequency Ablation for Treatment of Cystic Warthin Tumors versus Solid Warthin Tumors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126640. [PMID: 34205502 PMCID: PMC8296459 DOI: 10.3390/ijerph18126640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/06/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
Background: To describe the long-term outcomes of radiofrequency ablation (RFA) of parotid Warthin tumors that have different consistencies and locations. Methods: We reviewed ten patients with Warthin tumors undergoing RFA treatment from 2016 to 2019. The mean follow-up was 24.3 ± 13.1 months (range 7–42 months). Results: RFA was performed on 11 tumors in ten patients. Cystic tumors (n = 4) had better volume reduction ratios (VRR) than solid tumors (n = 7) at month one and month six, following RFA (77.9% vs. 47.3%, 95.1% vs. 80.6%, respectively, p = 0.003). Tumors in both superficial lobes and deep lobes (n = 7) were larger than tumors in superficial lobes alone (n = 4), though there was no difference in VRR after treatment. All residual tumors were found in superficial lobes. There was no increase in residual tumor size. Every patient showed marked cosmetic improvements, with visible tumors becoming non-palpable masses. Conclusions: RFA is a safe and effective treatment for Warthin tumors, with better volume reduction in cystic tumors. Results remained satisfying over the long-term for all residual tumors found in superficial lobes, making it easier for re-intervention if necessary.
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96
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Muhammad H, Santhanam P, Russell JO. Radiofrequency ablation and thyroid nodules: updated systematic review. Endocrine 2021; 72:619-632. [PMID: 33449296 DOI: 10.1007/s12020-020-02598-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE In the thyroid gland, radiofrequency ablation (RFA) is being applied to both benign nodules and cancers internationally, while interest is also growing in the West. Benign thyroid nodules (BTNs) may be candidates for intervention when symptoms develop. For differentiated thyroid cancers (DTC), surgery is currently the first-line treatment. However, for candidates with high surgical risk or those who refuse to undergo repeated surgery, newer techniques such as RFA are an option. Surgery is associated with complications including hypothyroidism, voice change, hypocalcemia, and a scar. RFA has been used in Asian and European institutions as an alternative to surgery, but is relatively new in North America. Although RFA is not associated with significant complications, few randomized control trials have assessed its efficacy. The studies to date suggest a low rate of severe complications and a small need for thyroid hormone replacement following RFA. Further large-scale studies focusing on a Western population are needed. The aim of this review is to evaluate the evidence with respect to the current studies and data about the safety and efficacy of radiofrequency ablation for the management of BTNs and DTC. METHODS We systematically searched the PubMed/MEDLINE, EMBASE, Clinical Queries, and Web of Science databases, for articles published up to April 30th, 2020. RESULTS Total of 75 studies that met the inclusion criteria were included in the review. Thirty-five studies focused on RFA use for solid nodules, 12 studies on predominantly cystic nodules, 10 for autonomously functioning thyroid nodules, and 18 studied were published on differentiated thyroid cancer. CONCLUSIONS RFA seems to be an effective and safe alternative to surgery in high-risk surgical patients with thyroid cancers and for selected BTNs. Additional trials with longer follow-up in North American patients are needed to validate its full role in the armamentarium of thyroid ologists.
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Affiliation(s)
- Haris Muhammad
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, 21204, USA
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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97
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Monpeyssen H, Alamri A, Ben Hamou A. Long-Term Results of Ultrasound-Guided Radiofrequency Ablation of Benign Thyroid Nodules: State of the Art and Future Perspectives-A Systematic Review. Front Endocrinol (Lausanne) 2021; 12:622996. [PMID: 34122328 PMCID: PMC8187951 DOI: 10.3389/fendo.2021.622996] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background Nearly 20 years after the first feasibility study, minimally invasive ultrasound (US)-guided therapeutic techniques are now considered as a safe and effective alternative to surgery for symptomatic benign thyroid nodules. Radiofrequency ablation (RFA) is one of the most widely used treatment in specialized thyroid centers but, due to the relatively recent introduction into clinical practice, there are limited long-term follow-up studies. Aim of our work was to review the outcomes of RFA on solid nonfunctioning and on autonomous thyroid nodules (AFTN) on a long-time period for assessing the results in term of efficacy, complications, and costs and to compare them to the current indications of RFA. Methods A systematic review was performed using EMBASE and Medline library data between 2008 and 2021. Seventeen studies evaluated RFA for the treatment of benign solid (nonfunctioning or autonomous) thyroid nodules, with an at least 18 months of follow-up. Data extraction and quality assessment were performed by two endocrinologist according to PRISMA guidelines. Anthropometric data, safety and efficacy parameters were collected. Results The majority of the studies was retrospective study and reported 933 nodules, mostly solid. Baseline volume ranged between 6.1 ± 9.6 and 36.3 ± 59.8 ml. Local analgesia was used and the time duration of the treatment was between 5 ± 2 and 22.1 ± 10.9 min. The volume reduction rate at 12 months ranged from 67% to 75% for the nodule treated with a single procedure and reached to 93.6 ± 9.7% for nodules treated with repeat ablations. The regrowth rate at 12 months ranged from 0% to 34%. Conclusion All the studies under examination consistently validated the long-term clinical efficacy and the substantial safety of RFA for the treatment of benign thyroid nodules. Thermal ablation, however, is an operator-dependent technique and should be performed in centers with specific expertise. The selection of the patients should be rigorous because the nodule size and the structural and functional characteristics influence the appropriateness and the outcomes of the treatment. Future perspectives as the treatment of micro-papillary thyroid cancer or cervical recurrence need further investigations.
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Affiliation(s)
- Hervé Monpeyssen
- American Hospital of Paris, Thyroid Unit, Neuilly-sur-Seine, France
| | - Ahmad Alamri
- Department of Endocrinology, Diabetology and Nutrition, Paris Saint-Joseph Hospital, Paris, France
| | - Adrien Ben Hamou
- American Hospital of Paris, Thyroid Unit, Neuilly-sur-Seine, France
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Paris, France
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98
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Sim JS, Baek JH. Unresolved Clinical Issues in Thermal Ablation of Benign Thyroid Nodules: Regrowth at Long-Term Follow-Up. Korean J Radiol 2021; 22:1436-1440. [PMID: 34047509 PMCID: PMC8316783 DOI: 10.3348/kjr.2021.0093] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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99
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Bisceglia A, Rossetto R, Garberoglio S, Franzin A, Cerato A, Maletta F, Papotti MG, Ghigo E, Pagano L, Maccario M, Garberoglio R. Predictor Analysis in Radiofrequency Ablation of Benign Thyroid Nodules: A Single Center Experience. Front Endocrinol (Lausanne) 2021; 12:638880. [PMID: 34079521 PMCID: PMC8165384 DOI: 10.3389/fendo.2021.638880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/23/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To confirm the efficacy of ultrasound (US) guided radiofrequency ablation (RFA) in the treatment of benign thyroid nodules, we evaluated as primary outcome the technical efficacy and clinical success in a single center dataset. The secondary outcome was to find a correlation between nodules' pre-treatment features and volume reduction rate (VRR) ≥75% at 12 months after RFA and during follow-up period. Methods This retrospective study included 119 consecutive patients (99 females, 20 males, 51.5 ± 14.4 years) with benign thyroid nodules treated in our hospital between October 2014 and December 2018 with a mean follow-up of 26.8 months (range 3-48). Clinical and US features before and after RFA were evaluated by a US examination at 1, 3, 6, 12 months and annually thereafter up to 48 months. Results The median pre-treatment volume was 22.4 ml; after RFA we observed a statistically significant volume reduction from the first month (11.7 ml) to the last follow-up (p < 0.001 for all follow-up times). The median VRR was 47.1, 55.3, 61.2, 67.6, 72.8, 71.3, and 62.9% at 1, 3, 6, 12, 24, 36, and 48 months of follow-up respectively, showing a progressive significant improvement up to 24 months (VRRs 1 vs 3 months, 3 vs 6 months and 6 vs 12 months p < 0.001, 12 vs 24 months p = 0.05) while no differences at 24 vs 36 and 36 vs 48 months were observed. Symptoms improved significantly (complete resolution 64.35%, partial resolution 35.65%), and neck circumference was reduced as compared to pre-treatment (p < 0.001). Lower pre-treatment neck circumference (37.5 vs 36.0 cm, p = 0.01) was a positive predictor of VRR ≥75% at 12 months. Macrocystic echostructure (HR 2.48, p 0.046) and pre-treatment volume >22.4 ml (HR 0.54, p 0.036) were found to be independent positive and negative predictors of VRR ≥75% respectively. One-month post RFA VRR ≥50% represented the best positive predictor of technical success. Conclusions This study confirmed the efficacy of RFA in the treatment of benign thyroid nodules. In particular we show that by selecting macrocystic nodules smaller than 22.4 ml better long-term response can be achieved, which is predicted by an early shrinkage of the nodule.
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Affiliation(s)
- Alessandro Bisceglia
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ruth Rossetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Sara Garberoglio
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
- Centro Multidisciplinare Della Tiroide (CMT), Humanitas Cellini, Turin, Italy
| | - Angelica Franzin
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alice Cerato
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesca Maletta
- Pathology Unit, Department of Laboratory Medicine, City of Health and Science Hospital, Turin, Italy
| | - Mauro Giulio Papotti
- Pathology Unit, Department of Oncology, University of Turin and City of Health and Science Hospital, Turin, Italy
| | - Ezio Ghigo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Loredana Pagano
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mauro Maccario
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Roberto Garberoglio
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
- Centro Multidisciplinare Della Tiroide (CMT), Humanitas Cellini, Turin, Italy
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100
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Cesareo R, Manfrini S, Pasqualini V, Ambrogi C, Sanson G, Gallo A, Pozzilli P, Pedone C, Crescenzi A, Palermo A. Laser Ablation Versus Radiofrequency Ablation for Thyroid Nodules: 12-Month Results of a Randomized Trial (LARA II Study). J Clin Endocrinol Metab 2021; 106:1692-1701. [PMID: 33608728 DOI: 10.1210/clinem/dgab102] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Indexed: 12/14/2022]
Abstract
CONTEXT Radiofrequency ablation (RFA) seems to achieve a significantly larger nodule volume reduction rate (VRR) than laser ablation (LA) in benign nonfunctioning thyroid nodules (BNTNs). OBJECTIVE To compare the efficacy and safety of both treatments at 12-month follow-up in patients with solid or predominantly solid BNTN. METHODS This was a single-center, 12-month, randomized, superiority, open-label, parallel-group trial conducted in an outpatient clinic. Sixty patients with a solitary BNTN or dominant nodule characterized by pressure symptoms/cosmetic problems were randomly assigned (1:1 ratio) to receive either a single session of RFA or LA. Twenty-9 patients per group completed the study. The main outcome measures were VRR and proportion of nodules with more than 50% reduction (technical success rate). RESULTS At 12 months, VRR was 70.9 ± 16.9% and 60.0 ± 19.0% in the RFA and LA groups, respectively (P = .024). This effect was confirmed in the linear regression model that was adjusted for age, sex, nodule baseline volume, and proportion of cellular components (RFA treatment: β = .390; P = .009). No significant between-group difference was observed in the technical success rate at 12 months after treatment. A statistically significant improvement was observed from the baseline to the 12-month follow-up for compression (RFA: 4.6 ± 2.6 and 1.3 ± 0.8, P < .001; and LA: 4.6 ± 2.1 and 1.6 ± 0.8, respectively, P < .001) and cosmetic (RFA: 3.4 ± 0.6 and 1.3 ± 0.5, P < .001; and LA: 3.4 ± 0.5 and 1.4 ± 0.6, P < .001) scores although the between-group differences were not significant. CONCLUSION RFA achieved a significantly larger nodule volume reduction at 12 months; however, the technical success rate was similar in the RFA and LA groups.
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Affiliation(s)
- Roberto Cesareo
- Unit of metabolic diseases, "S. M. Goretti" Hospital, Latina, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | | | - Cesare Ambrogi
- Department of Radiology, "S. M. Goretti" Hospital, Latina, Italy
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Gallo
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Claudio Pedone
- Geriatric Unit, Campus Bio-Medico University, Rome, Italy
| | - Anna Crescenzi
- Unit of Pathology, University Hospital Campus Bio-Medico, Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
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