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Teng D, Sui G, Liu C, Wang Y, Xia Y, Wang H. Long-term efficacy of ultrasound-guided low power microwave ablation for the treatment of primary papillary thyroid microcarcinoma: a 3-year follow-up study. J Cancer Res Clin Oncol 2018; 144:771-779. [PMID: 29427209 DOI: 10.1007/s00432-018-2607-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/05/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of ultrasound-guided low-power microwave ablation (MWA) for the treatment of papillary thyroid microcarcinoma (PTMC) with a 3-year follow-up. METHODS A total of 21 nodules diagnosed as PTMC from the 15 patients were performed with MWA at a power of 20 W. The images of the nodules were recorded by ultrasound before MWA and 1, 3, 6, 12 months after MWA, and every 6 months thereafter, respectively. The volumes of the nodules were compared before MWA and at each follow-up point after MWA. The volume reduction rate (VRR) of nodules was also calculated. RESULTS The mean volume of the nodules was 134.3 ± 129.8 mm3 initially (the range was 7.4-423.8 mm3), which decreased significantly to 2.3 ± 10.5 mm3 (the range was 0-48.1 mm3) of the ablation area (P = 0.000) at the follow-up point of 36 months with a mean VRR as 98.78 ± 5.61% (the range was 74.28-100%). During the follow-up period (the range was 36-48 months), 20 of the 21 nodules were completely absorbed and no recurrent nodule was found. CONCLUSIONS After a long-term follow-up of 3 years, the low power MWA showed a good safety and efficacy for the treatment of PTMC. In addition to surgery and active surveillance, MWA might be another alternative for patients with PTMC.
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Affiliation(s)
- Dengke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130000, Jilin, China
| | - Guoqing Sui
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130000, Jilin, China
| | - Caimei Liu
- Department of Interventional Ultrasound, the 208th Hospital of PLA, Changchun, 130000, Jilin, China
| | - Yu Wang
- Department of Interventional Ultrasound, the 208th Hospital of PLA, Changchun, 130000, Jilin, China
| | - Yongxu Xia
- Department of Interventional Ultrasound, the 208th Hospital of PLA, Changchun, 130000, Jilin, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130000, Jilin, China.
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202
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Cesareo R, Naciu AM, Iozzino M, Pasqualini V, Simeoni C, Casini A, Campagna G, Manfrini S, Tabacco G, Palermo A. Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules. Int J Hyperthermia 2018; 34:617-623. [PMID: 29357717 DOI: 10.1080/02656736.2018.1430868] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT No defined pre-treatment factors are able to predict the response to radiofrequency ablation (RFA) of an autonomously functioning thyroid nodule (AFTN). OBJECTIVE Primary endpoint was to evaluate the success rate of RFA to restore euthyroidism in a cohort of adult patients with small solitary AFTN compared with medium-sized nodules. Secondary endpoints included nodule volume reduction and rate of conversion from hot nodules to cold using scintiscan. METHODS This was a 24-month prospective monocentric open parallel-group trial. Twenty-nine patients with AFTN were divided into two groups based on thyroid volume: 15 patients with small nodules (<12 mL) in group A and 14 patients with medium nodules (>12 mL) in group B. All patients underwent a single session of RFA and were clinically, biochemically, and morphologically evaluated at baseline and at 1, 6, 12 and 24 months after treatment. RESULTS After RFA, there was greater nodule volume reduction in group A compared with group B (p < 0.001 for each follow-up point). In group A, there was a greater increase in TSH levels than in group B at 6 (p = 0.01), 12 (p = 0.005), and 24 months (p < 0.001). At 24 months, the rate of responders was greater in group A than in group B (86 vs. 45%; p < 0.001). In group A, 86% of nodules converted from hot to cold compared with 18% in group B (p < 0.001). CONCLUSIONS A single session of RFA was effective in restoring euthyroidism in patients with small AFTNs. Nodule volume seems to be a significant predictive factor of the efficacy of RFA in treating AFTN.
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Affiliation(s)
- R Cesareo
- a Thyroid Disease Center , "S. M. Goretti" Hospital , Latina , Italy
| | - A M Naciu
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
| | - M Iozzino
- c Department of Radiology , "S. M. Goretti" Hospital , Latina , Italy
| | - V Pasqualini
- c Department of Radiology , "S. M. Goretti" Hospital , Latina , Italy
| | - C Simeoni
- d Workers Compensation Authority (INAIL) - Research Area , Roma , Italy
| | - A Casini
- a Thyroid Disease Center , "S. M. Goretti" Hospital , Latina , Italy
| | - G Campagna
- a Thyroid Disease Center , "S. M. Goretti" Hospital , Latina , Italy
| | - S Manfrini
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
| | - G Tabacco
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
| | - A Palermo
- b Unit of Endocrinology and Diabetes , Campus Bio-Medico University , Rome , Italy
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203
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Kim HI, Jang HW, Ahn HS, Ahn S, Park SY, Oh YL, Hahn SY, Shin JH, Kim JH, Kim JS, Chung JH, Kim TH, Kim SW. High Serum TSH Level Is Associated With Progression of Papillary Thyroid Microcarcinoma During Active Surveillance. J Clin Endocrinol Metab 2018; 103:446-451. [PMID: 29211863 DOI: 10.1210/jc.2017-01775] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/28/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Thyroid-stimulating hormone (TSH) is a growth factor affecting initiation or progression of papillary thyroid cancer (PTC), which supports TSH suppressive therapy in patients with PTC. In patients with papillary thyroid microcarcinoma (PTMC) during active surveillance, however, the association between serum TSH level and growth of PTMC has not been demonstrated. PATIENTS We analyzed 127 PTMCs in 126 patients under active surveillance with serial serum TSH measurement and ultrasonography. DESIGN The patients were categorized into groups with the highest, middle, and lowest time-weighted average of TSH (TW-TSH). PTMC progression was defined as a volume increase of ≥50% compared with baseline. Kaplan-Meier survival analysis according to TW-TSH groups and Cox proportional hazard modeling was performed. We identified the cutoff point for TSH level by using maximally selected log-rank statistics. RESULTS During a median follow-up of 26 months, PTMC progression was detected in 28 (19.8%) patients. Compared with the lowest TW-TSH group, the adjusted hazard ratio (HR) for PTMC progression in the highest TW-TSH group was significantly higher [HR 3.55; 95% confidence interval (CI), 1.22 to 10.28; P = 0.020], but that in the middle TW-TSH group was not (HR 1.52; 95% CI, 0.46 to 5.08; P = 0.489). The cutoff point for the serum TSH level for PTMC progression was 2.50 mU/L. CONCLUSIONS Sustained elevation of serum TSH levels during active surveillance is associated with PTMC progression. Maintaining a low-normal TSH range with levothyroxine treatment during active surveillance of PTMC might be considered in future studies.
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Affiliation(s)
- Hye In Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Won Jang
- Department of Medical Education, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon Seon Ahn
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Soohyun Ahn
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - So Young Park
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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204
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Wei Y, Qian L, Liu JB, Liu Y. Sonographic measurement of thyroid nodule changes after microwave ablation: relationship between multiple parameters. Int J Hyperthermia 2018; 34:660-668. [PMID: 29303011 DOI: 10.1080/02656736.2017.1418537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ying Wei
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Yujiang Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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205
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Radzina M, Cantisani V, Rauda M, Nielsen MB, Ewertsen C, D'Ambrosio F, Prieditis P, Sorrenti S. Update on the role of ultrasound guided radiofrequency ablation for thyroid nodule treatment. Int J Surg 2018; 41 Suppl 1:S82-S93. [PMID: 28506420 DOI: 10.1016/j.ijsu.2017.02.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 12/19/2022]
Abstract
Thyroid nodules can be frequently detected in general population, most of them are benign, however malignant cases are rising in the past decades. Ultrasound (US) is the most common imaging modality to assess thyroid nodular lesions, plan patient work-up and guide minimally invasive treatment. The present review paper has been researched to evaluate the current status of radiofrequency ablation (RFA) treatment in order to evaluate indications, techniques, complications, limitations and outcome assessment in benign solid, partially cystic nodules and recurrent malignant nodules. RFA comparison with other ablation techniques has been provided as well. US guided Radiofrequency ablation has been proved to be effective and safe in cases of benign thyroid nodules and a promising treatment method alternative to surgery for patients with recurrent papillary thyroid cancer. It's major role lies in significant reduction of thyroid nodule mean volume and improvement of the patient symptoms. However, future multicenter studies are warranted to better clarify the multi-parametric patient selection criteria and evaluate RFA technique efficacy, advantages and limitations in the variety of thyroid nodular disease.
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Affiliation(s)
- Maija Radzina
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Pilsonu Street 13, LV - 1002, Riga, Latvia.
| | - Vito Cantisani
- Department of Radiological Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Viale Regina Elena 324, Italy.
| | - Madara Rauda
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Pilsonu Street 13, LV - 1002, Riga, Latvia.
| | | | - Caroline Ewertsen
- Department of Radiology, University of Copenhagen, Copenhagen, Denmark.
| | - Ferdinando D'Ambrosio
- Department of Radiological Sciences, Policlinico Umberto I, Univ. Sapienza, Roma, 00185, Viale Regina Elena 324, Italy.
| | - Peteris Prieditis
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Pilsonu Street 13, LV - 1002, Riga, Latvia.
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Policlinico Umberto I, University Sapienza, Roma, 00185, Viale Regina Elena 324, Italy.
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206
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Happel C, Heck K, Ackermann H, Grünwald F, Korkusuz H. Percutaneous thermal microwave ablation of thyroid nodules. Nuklearmedizin 2018; 53:123-30. [DOI: 10.3413/nukmed-0631-13-10] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/11/2014] [Indexed: 12/22/2022]
Abstract
SummaryMicrowave ablation (MWA) is a new minimal invasive method for thermal ablation of benign thyroid nodules. In contrast to well-established radiofrequency ablation (RFA), MWA offers several advantages with similarly successful results. There has not been any use of functional imaging with 99mTc-per- technetate and 99mTc-MIBI-scans as a mere qualitative analysis of this imaging in the field of MWA in Europe until now. The aim of this study has been to demonstrate the feasibility of MWA as well as the applicability of functional imaging to verify effectiveness with a centerspecific score. Patients, methods: 11 patients (5 women, 6 men, average age 62.3 years) with 18 benign thyroid nodules were treated. MWA was operated under local anesthesia with a system working in a wavelength field of 902 to 928 MHz (Avecure MWG881, MedWaves, Inc. San Diego, CA). Pre- and postablative scans were controlled by two specialists in nuclear medicine with longtime work experience. Results: A center specific functional imaging score (CSFIS) was defined, a decrease of 1.4 points at an average was noticeable (range 1-3 points). In 66.7% (n = 12) of all nodules the score decreased by 1 point, 27.8% (n = 5) by 2 points and 5.6% (n = 1) by 3 points. The treatment was well tolerated and no severe complications were observed. Conclusion: The preliminary data suggests that MWA is an effective method to treat benign thyroid nodules. Functional imaging is a promising technique for early verification of effectiveness of thermal ablation.
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207
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Oddo S, Felix E, Mussap M, Giusti M. Quality of Life in Patients Treated with Percutaneous Laser Ablation for Non-Functioning Benign Thyroid Nodules: A Prospective Single-Center Study. Korean J Radiol 2018; 19:175-184. [PMID: 29354015 PMCID: PMC5768500 DOI: 10.3348/kjr.2018.19.1.175] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/06/2017] [Indexed: 12/15/2022] Open
Abstract
Objective While many studies have reported that laser ablation (LA) for benign non-fuctioning thyroid nodules is efficacious in reducing nodular volume and neck symptoms, none have described changes in quality of life (QoL). The purpose of this study was to report post-LA changes in QoL in our cohort of patients. Materials and Methods Fourteen patients with benign thyroid nodules were involved in a prospective, single-center study and underwent a single session of LA. We evaluated the following: changes in nodule volume, thyroid function, and autoimmunity; adverse events during and after LA; changes in neck discomfort by means of a visual analogic scale (VAS) at one week and 1, 3, 6, and 12 months; and changes in QoL through the 13-scale Thyroid-specific Patient Reported Outcome (ThyPRO) questionnaire at 1, 3, 6, and 12 months. ThyPRO is a validated questionnaire for thyroid diseases, which consists of 13 scales with multiple-choice answers. They investigate several aspects of life that may be impaired by goiter-related compression symptoms, by esthetic alterations and by hypo- or hyperthyroidism. Results Nodule volume decrease was −37 ± 23%, −55 ± 22%, −53 ± 25%, −58 ± 25% (p < 0.01 vs. baseline) at the first, third, sixth, and twelfth month, respectively. No hypothyroidism or positivization of autoimmunity was observed. There were no major complications during or after LA. After LA, VAS scores improved significantly from 1 week onwards in 100% of patients, while a significant improvement was seen in the goiter symptoms score after one month, and in the general score and mean values of ThyPRO after six months. Scores on the other ThyPRO scales did not change significantly. Conclusion Laser ablation is safe and effective in reducing nodule volume and neck symptoms; this is confirmed by improvements in the goiter scale, general score, and mean values of ThyPRO and in the VAS score.
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Affiliation(s)
- Silvia Oddo
- Endocrinology Unit, IRCSS San Martino University Hospital-IST, Largo Rosanna Benzi, n°10, I-16132 Genoa, Italy
| | - Edineia Felix
- Endocrinology Unit, IRCSS San Martino University Hospital-IST, Largo Rosanna Benzi, n°10, I-16132 Genoa, Italy
| | - Michele Mussap
- Laboratory Medicine Service Unit, IRCSS San Martino University Hospital-IST, Largo Rosanna Benzi, n°10, I-16132 Genoa, Italy
| | - Massimo Giusti
- Endocrinology Unit, IRCSS San Martino University Hospital-IST, Largo Rosanna Benzi, n°10, I-16132 Genoa, Italy
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208
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Jung SL, Baek JH, Lee JH, Shong YK, Sung JY, Kim KS, Lee D, Kim JH, Baek SM, Sim JS, Na DG. Efficacy and Safety of Radiofrequency Ablation for Benign Thyroid Nodules: A Prospective Multicenter Study. Korean J Radiol 2018; 19:167-174. [PMID: 29354014 PMCID: PMC5768499 DOI: 10.3348/kjr.2018.19.1.167] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/24/2017] [Indexed: 12/31/2022] Open
Abstract
Objective To assess the efficacy and safety of thyroid radiofrequency (RF) ablation for benign thyroid nodules by trained radiologists according to a unified protocol in a multi-center study. Materials and Methods From 2010 to 2011, 345 nodules from 345 patients (M:F = 43:302; mean age ± SD = 46.0 ± 12.7 years, range = 15–79) who met eligibility criteria were enrolled from five institutions. At pre-ablation, the mean volume was 14.2 ± 13.2 mL (1.1–80.8 mL). For 12 months or longer after treatment, 276 lesions, consisting of 248 solid and 28 predominantly cystic nodules, were followed. All operators performed RF ablation with a cool-tip RF system and two standard techniques (a transisthmic approach and the moving-shot technique). Volume reduction at 12 months after RF ablation (the primary outcome), therapeutic success, improvement of symptoms as well as of cosmetic problems, and complications were evaluated. Multiple linear regression analysis was applied to identify factors that were independently predictive of volume reduction. Results The mean volume reduction at 12 months was 80.3% (n = 276) and at the 24-, 36-, 48-, and 60-month follow-ups 84.3% (n = 198), 89.2% (n = 128), 91.9% (n = 57), and 95.3% (n = 6), respectively. Our therapeutic success was 97.8%. Both mean symptom and cosmetic scores showed significant improvements (p < 0.001). The rate of major complications was 1.0% (3/276). Solidity and applied energy were independent factors that predicted volume reduction. Conclusion Radiofrequency ablation performed by trained radiologists from multiple institutions using a unified protocol and similar devices was effective and safe for treating benign thyroid nodules.
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Affiliation(s)
- So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Kee Shong
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jin Yong Sung
- Department of Radiology, Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | - Kyu Sun Kim
- Department of Radiology, Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | - Ducky Lee
- Department of Internal Medicine, Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Seon Mi Baek
- Department of Radiology, Sharing and Happiness Hospital, Busan 48101, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam 13590, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging & Intervention Center, Seoul 06524, Korea
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209
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Dietrich CF, Müller T, Bojunga J, Dong Y, Mauri G, Radzina M, Dighe M, Cui XW, Grünwald F, Schuler A, Ignee A, Korkusuz H. Statement and Recommendations on Interventional Ultrasound as a Thyroid Diagnostic and Treatment Procedure. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:14-36. [PMID: 29126752 DOI: 10.1016/j.ultrasmedbio.2017.08.1889] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
The recently published guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on interventional ultrasound (INVUS)-guided procedures summarize the intended interdisciplinary and multiprofessional approach. Herewith, we report on recommendations for interventional procedures for diagnosis and treatment of the thyroid gland.
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Affiliation(s)
- Christoph F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany; Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Thomas Müller
- Medizinische Klinik I, Klinikum am Steinenberg, Reutlingen, Germany
| | - Jörg Bojunga
- 1st Medical Department, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Maija Radzina
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Riga, Latvia
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Frank Grünwald
- Department of Nuclear Medicine, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany; German Center for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas Schuler
- Zentrum für Innere Medizin, Alb Fils Kliniken, Helfenstein Klinik, Germany
| | - Andre Ignee
- Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Huedayi Korkusuz
- Department of Nuclear Medicine, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany; German Center for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
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210
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Sennert M, Happel C, Korkusuz Y, Grünwald F, Polenz B, Gröner D. Further Investigation on High-intensity Focused Ultrasound (HIFU) Treatment for Thyroid Nodules: Effectiveness Related to Baseline Volumes. Acad Radiol 2018; 25:88-94. [PMID: 28844602 DOI: 10.1016/j.acra.2017.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 02/09/2023]
Abstract
RATIONALE AND OBJECTIVES Several minimally invasive thermal techniques have been developed for the treatment of benign thyroid nodules. A new technique for this indication is high-intensity focused ultrasound (HIFU). The aim of this study was to assess effectiveness in varying preablative nodule volumes and whether outcome patterns that were reported during studies with other thermal ablative procedures for thyroid nodule ablation would also apply to HIFU. MATERIALS AND METHODS Over the last 2 years, 19 nodules in 15 patients (12 women) whose average age was 58.7 years (36-80) were treated with HIFU in an ambulatory setting. Patients with more than one nodule were treated in multiple sessions on the same day. The mean nodule volume was 2.56 mL (range 0.13-7.67 mL). The therapeutic ultrasound probe (Echopulse THC900888-H) used in this series functions with a frequency of 3 MHz, reaching temperatures of approximately 80°C-90°C and delivering an energy ranging from 87.6 to 320.3 J per sonication. To assess the effectiveness of thermal ablation, nodular volume was measured at baseline and at 3-month follow-up. The end point of the study was the volume reduction assessment after 3 months' follow-up. Therapeutic success was defined as volume reduction of more than 50% compared to baseline. This study was retrospectively analyzed using the Wilcoxon signed rank test and Kendall tau. RESULTS The median percentage volume reduction of all 19 nodules after 3 months was 58%. An inverse correlation between preablative nodular volume and percentage volume shrinking was found (tau = -0.46, P < .05). Therapeutic success was achieved in 10 out of 19 patients (53%). CONCLUSIONS HIFU of benign thyroid nodules can be carried out as an alternative therapy for nodules ≤3 mL if patients are refusing surgery or radioiodine therapy.
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211
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Tsumagari K, Abd Elmageed ZY, Sholl AB, Green EA, Sobti S, Khan AR, Kandil A, Murad F, Friedlander P, Boulares AH, Kandil E. Bortezomib sensitizes thyroid cancer to BRAF inhibitor in vitro and in vivo. Endocr Relat Cancer 2018; 25:99-109. [PMID: 29269566 PMCID: PMC9048863 DOI: 10.1530/erc-17-0182] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/02/2017] [Indexed: 12/25/2022]
Abstract
Although overall survival rate for patients with thyroid cancer (TC) is high, there is an alarming 10-year recurrence rate of up to 30% conferring a ~50% survival among these high-risk patients. The BRAFV600E mutation is estimated to be present in over 50% of papillary thyroid cancer (PTC) cases besides being associated with carcinogenesis and poor prognosis. We assessed the status of NF-κB, Ki-67, cyclin D1 and BRAFV600E in TC tissues and TC cell lines using immunohistochemistry and Western blot analysis. Concurrently, we evaluated the outcomes of combined targeting of the proteasome pathway in addition to selective BRAF inhibitors in cases of PTC. In this study, BRAFV600E-bearing TC cells were treated with BRAFV600E inhibitor, Vemurafenib alone or in combination with the proteasome inhibitor, Bortezomib. The combination of both drugs showed synergistic effects as evidenced by cell growth inhibition (P < 0.05), increased G2-phase cell cycle arrest and induced apoptosis (P < 0.05). In our TC xenograft model, the combination of Vemurafenib and Bortezomib significantly reduced tumor size (P < 0.05) and expression of the markers of cell growth and proliferation, Ki-67 and cyclin D1 (P < 0.001), when compared to monotherapy. Further analysis demonstrated that treatment with Bortezomib sensitized TC cells to Vemurafenib via mitochondrial dysregulation and apoptosis of TC cells, as evidenced by the increase in the expression of p53, Noxa protein, the loss of mitochondrial membrane potential, cytochrome c release and Poly (ADP-ribose) polymerase cleavage. Our results demonstrate a strong clinical potential for the combination of the Bortezomib and the BRAF inhibitor Vemurafenib as an efficient therapeutic approach for the treatment of TC.
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Affiliation(s)
- Koji Tsumagari
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Andrew B Sholl
- Department of PathologyTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Erik A Green
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Saboori Sobti
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Abdul Razzaq Khan
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Abdulrahman Kandil
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Fadi Murad
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Paul Friedlander
- Department of OtolaryngologyTulane University School of Medicine, New Orleans, Louisiana, USA
| | - A Hamid Boulares
- The Stanley Scott Cancer CenterLouisiana State University Health Science Center, New Orleans, Louisiana, USA
- Department of PharmacologyLouisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - Emad Kandil
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
- Department of OtolaryngologyTulane University School of Medicine, New Orleans, Louisiana, USA
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212
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Nimsdorf F, Happel C, Ackermann H, Grünwald F, Korkusuz H. Percutaneous microwave ablation of benign thyroid nodules. Nuklearmedizin 2017; 54:13-9. [DOI: 10.3413/nukmed-0678-14-06] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/11/2014] [Indexed: 12/16/2022]
Abstract
SummaryAim: Thyroid nodules represent a common clinical issue. Amongst other minimally invasive procedures, percutaneous microwave ablation (MWA) poses a promising new approach. The goal of this retrospective study is to find out if there is a correlation between volume reduction after 3 months and 99mTcuptake reduction of treated thyroid nodules. Patients, methods: 14 patients with 18 nodules were treated with MWA. Pre-ablative assessment included sonographical and functional imaging of the thyroid with 99mTcpertechnetate and 99mTc-MIBI. Additionally, patients underwent thyroid scintigraphy 24 hours after ablation in order to evaluate the impact of the treatment on a functional level and to ensure sufficient ablation of the targeted area. At a 3-month follow-up, ultrasound examination was performed to assess nodular volume reduction. Results: Mean relative nodular volume reduction after three months was 55.4 ± 17.9% (p < 0.05). 99mTcuptake 24 hours after treatment was 45.2 ± 31.9% (99mTc-MIBI) and 35.7 ± 20.3% (99mTcpertechnetate) lower than prior to ablation (p < 0.05). Correlating reduction of volume and 99mTc-uptake, Pearson's r was 0.41 (p < 0.05) for nodules imaged with 99mTc-MIBI and –0.98 (p < 0.05) for 99mTc-pertechnetate. According to scintigraphy 99.6 ± 22.6% of the determined target area could be successfully ablated. Conclusions: MWA can be considered as an efficient, low-risk and convenient new approach to the treatment of benign thyroid nodules. Furthermore, scintigraphy seems to serve as a potential prognostic tool for the later morphological outcome, allowing rapid evaluation of the targeted area in post-ablative examination.
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213
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Cesareo R, Palermo A, Pasqualini V, Cianni R, Gaspa G, Manfrini S, Pacella CM. Radiofrequency ablation for the management of thyroid nodules: A critical appraisal of the literature. Clin Endocrinol (Oxf) 2017; 87:639-648. [PMID: 28718950 DOI: 10.1111/cen.13422] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/13/2017] [Accepted: 07/11/2017] [Indexed: 11/28/2022]
Abstract
The majority of benign thyroid nodules are asymptomatic, remain stable in size and do not require treatment. However, a minority of patients with growing nodules may have local symptoms or cosmetic concerns, and thus demand surgical therapy. The timely use of ultrasound-guided, minimally invasive thermal therapies has changed the natural history of benign, enlarging thyroid nodules (TNs). These procedures produce persistent shrinkage of TNs and an improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first-line treatment for thyroid cysts, while in solid cold nodules, laser and radiofrequency ablation (RFA) have proven to be very effective and safe techniques in producing significant volume reduction that remains stable over several years. In particular, RFA seems to be suited for the management of small and medium nodules, while larger nodules may require repeated RFA treatments, and could be difficult to treat if they extend into the chest. RFA is performed in outpatient clinics and has a lower risk of complications compared to surgery. However, to date, there is still no unanimous consensus on the percutaneous treatment of benign nodules using such minimally invasive thermal techniques. In this review, we critically revise the literature to identify patients who are more likely to benefit from RFA treatment as an alternative to surgery.
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Affiliation(s)
- Roberto Cesareo
- Thyroid Disease Center, "S. M. Goretti" Hospital, Latina, Italy
| | - Andrea Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | | | - Roberto Cianni
- Department of Radiology, "S. M.Goretti" Hospital, Latina, Italy
| | - Gianluigi Gaspa
- Department of Food Science and Nutrition, University Campus Bio-Medico, Rome, Italy
| | - Silvia Manfrini
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
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214
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Cervelli R, Mazzeo S, De Napoli L, Boccuzzi A, Pontillo-Contillo B, Materazzi G, Miccoli P, Cioni R, Caramella D. Radiofrequency Ablation in the Treatment of Benign Thyroid Nodules: An Efficient and Safe Alternative to Surgery. J Vasc Interv Radiol 2017; 28:1400-1408. [DOI: 10.1016/j.jvir.2017.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 01/05/2023] Open
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Liu YJ, Qian LX, Liu D, Zhao JF. Ultrasound-guided microwave ablation in the treatment of benign thyroid nodules in 435 patients. Exp Biol Med (Maywood) 2017; 242:1515-1523. [PMID: 28847173 DOI: 10.1177/1535370217727477] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The objective of the present study was to investigate the effectiveness and safety of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules. A total of 474 benign thyroid nodules in 435 patients who underwent ultrasound-guided microwave ablation from September 2012 to August 2015 were included. Nodule volume and thyroid function were measured before treatment and at 1, 3, 6, and 12 months and subsequently after every 6 months. The nodule volume reduction rate and changes of thyroid function were evaluated. The volume of all thyroid nodules significantly decreased after ultrasound-guided microwave ablation. The average volume was 13.07 ± 0.95 ml before treatment, and 1.14 ± 0.26 ml at 12-months follow-up. The mean volume reduction rate was 90% and the final volume reduction rate was 94%. The volume reduction rate of mainly cystic nodules was significantly higher than that of simple solid and mainly solid nodules (all P < 0.05). The pretreatment volume of nodules was positively correlated with the final volume reduction rate at final follow-up ( P = 0.004). No serious complications were observed after treatment. In conclusion, ultrasound-guided microwave ablation is an effective and safe technique for treatment of benign thyroid nodules, and has the potential for clinical applications. Impact statement Ultrasound-guided MWA is an effective and safe technique for the treatment of benign thyroid nodules. It can significantly reduce the nodule volume, improve the patients' clinical symptoms, has less complication, guarantees quick recovery, meets patients' aesthetic needs, and shows less interference on the physiological and psychological aspects of the body. MWA should be a good complement to traditional open surgery and has potentials in clinical applications.
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Affiliation(s)
- Yu-Jiang Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lin-Xue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Dong Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jun-Feng Zhao
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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216
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Jeong SY, Baek JH, Choi YJ, Lee JH. Ethanol and thermal ablation for malignant thyroid tumours. Int J Hyperthermia 2017; 33:938-945. [PMID: 28797186 DOI: 10.1080/02656736.2017.1361048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid malignancy and has a good prognosis and low mortality rate. Surgery is the standard treatment for patients with primary and recurrent thyroid cancer. Although patients with PTC usually exhibit excellent treatment outcome, the incidence of recurrence in the neck ranges from 20% to 59%. When a patient with thyroid cancer is contraindicated for surgery, ultrasound (US)-guided ablation techniques, including ethanol ablation (EA) and thermal ablations, are suggested alternatives. In this review, we evaluated the indications, devices, techniques, clinical outcomes, and complications associated with US-guided EA and thermal ablations based on available scientific evidence and expert opinions regarding the use of ablation for primary and recurrent thyroid cancers.
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Affiliation(s)
- So Yeong Jeong
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
| | - Jung Hwan Baek
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
| | - Young Jun Choi
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
| | - Jeong Hyun Lee
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
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217
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Gong X, Zhou Q, Chen S, Wang F, Wu W, Chen X. Efficacy and safety of ultrasound-guided percutaneous polidocanol sclerotherapy in benign predominantly cystic thyroid nodules: a prospective study. Curr Med Res Opin 2017; 33:1505-1510. [PMID: 28466660 DOI: 10.1080/03007995.2017.1325732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of percutaneous polidocanol injection (PPI) in treatment of predominantly cystic thyroid nodules. MATERIALS AND METHODS This prospective study included 111 patients with 122 benign predominantly cystic thyroid nodules inducing pressure symptoms or cosmetic problems. The nodules were randomized to a single aspiration with (n = 61) or without (n = 61) subsequent PPI and followed up after 1, 3, 6, and 12 months. Ten patients (12 nodules) declined to follow up after aspiration in group 2. Nodule volumes, symptoms scores, and cosmetic scores were evaluated before and after treatment. The therapeutic success rate and safety of PPI for treatment of predominantly cystic thyroid nodules were also evaluated. RESULTS In the PPI group, the nodule volumes were reduced from 13.67 ± 9.90 to 2.60 ± 2.66 (p < .001). Therapeutic success rate (nodule volume reduction >50%) was obtained in 57 of 61 (93.44%) nodules in the PPI group, compared to seven of 49 (14.29%) in the aspiration group (p < .001). In the aspiration group, the nodule volume was not significantly reduced. The reduction in symptom scores was significantly higher in the PPI group (from 3.60 ± 1.65 to 1.60 ± 1.19) than in the aspiration group (from 3.62 ± 1.89 to 3.30 ± 1.06) (p < .001, between groups). The reduction in cosmetic scores showed a significant difference between groups (p < .001). In total, 4.92% of patients (3/61) in the PPI group and 85.71% (42/49) in the aspiration group showed recurrence during the follow-up period. There was a significant difference in the recurrence rate between groups (p < .001). No major side-effects occurred. CONCLUSIONS US-guided PPI of benign recurrent predominantly cystic thyroid nodules is effective and safe. PPI is an important alternative to benign recurrent predominantly cystic thyroid nodules.
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Affiliation(s)
- Xiaohua Gong
- a Department of Endocrinology and Metabolism , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
| | - Qi Zhou
- a Department of Endocrinology and Metabolism , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
| | - Shuoping Chen
- a Department of Endocrinology and Metabolism , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
| | - Fang Wang
- b Department of Pathology , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
| | - Wenjun Wu
- a Department of Endocrinology and Metabolism , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
| | - Xiaojun Chen
- a Department of Endocrinology and Metabolism , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
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218
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Pacella CM, Mauri G, Cesareo R, Paqualini V, Cianni R, De Feo P, Gambelunghe G, Raggiunti B, Tina D, Deandrea M, Limone PP, Mormile A, Giusti M, Oddo S, Achille G, Di Stasio E, Misischi I, Papini E. A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis. Int J Hyperthermia 2017; 33:911-919. [PMID: 28605944 DOI: 10.1080/02656736.2017.1332395] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To compare technique efficacy and safety of laser ablation (LA) and radiofrequency ablation (RFA) in treatment of benign thyroid nodules. MATERIALS AND METHODS Institutional review board approval was obtained, and patients' consent was waived. 601 nodules were treated from May 2009 to December 2014 at eight centres, 449 (309 females, age 57 ± 14 years) with LA and 152 (107 females, age 57 ± 14 years) with RFA. A matched cohort composed of 138 patients from each group was selected after adjustment with propensity score matching. Factors influencing volume reduction at 6 and 12 months and complications were evaluated. RESULTS No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. Mean nodule reduction at 6 and 12 months was -67 ± 19% vs. -57 ± 21% (p < 0.001) - 70 ± 19% vs. -62 ± 22% (p = 0.001) in LA group and in RFA group, respectively. Nodules with volume >30 mL had significantly higher percentage volume reduction at 6 and 12 months (-69 ± 19 vs. -50 ± 21, p = 0.001) and (-73 ± 18 vs. -54 ± 23 8, p = 0.001) in the LA group than in the RFA group, respectively. In both groups, operator's skills affected the results. Major complications occurred in 4 cases in each group (p = 0.116) Conclusions: LA and RFA showed nearly similar outcome but LA was slightly more effective than RFA in large nodules. Operator's skills could be crucial in determining the extent of nodule volume reduction regardless of the used technique.
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Affiliation(s)
| | - Giovanni Mauri
- b Department of Interventional Radiology , European Institute of Oncology , Milan , Italy
| | - Roberto Cesareo
- c Thyroid Disease Center "S.M. Goretti" Hospital , Latina , Italy
| | | | - Roberto Cianni
- c Thyroid Disease Center "S.M. Goretti" Hospital , Latina , Italy
| | - Pierpaolo De Feo
- d Department of Internal Medicine , University of Perugia , Perugia , Italy
| | | | | | - Doris Tina
- e Endocrinology Unit, Atri Hospital , Atri , Italy
| | - Maurilio Deandrea
- f Thyroid Disease Center "A. Costa" Mauriziano Hospital , Turin , Italy
| | - Pier Paolo Limone
- f Thyroid Disease Center "A. Costa" Mauriziano Hospital , Turin , Italy
| | - Alberto Mormile
- f Thyroid Disease Center "A. Costa" Mauriziano Hospital , Turin , Italy
| | - Massimo Giusti
- g Endocrinology Department , AOU-IST IRCSS San Martino University of Genoa , Genoa , Italy
| | - Silvia Oddo
- g Endocrinology Department , AOU-IST IRCSS San Martino University of Genoa , Genoa , Italy
| | - Gaetano Achille
- h Cervico-Facial Ultrasound Diagnostic and Interventional Unit , Institute of Oncology of Bari , Bari , Italy
| | - Enrico Di Stasio
- i Institute of Biochemistry and Clinical Biochemistry , Rome Catholic University "Sacro Cuore" , Rome , Italy
| | - Irene Misischi
- j Department of Endocrinology , "Regina Apostolorum" Hospital , Albano Laziale , Italy
| | - Enrico Papini
- j Department of Endocrinology , "Regina Apostolorum" Hospital , Albano Laziale , Italy
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219
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Kwon H, Oh HS, Kim M, Park S, Jeon MJ, Kim WG, Kim WB, Shong YK, Song DE, Baek JH, Chung KW, Kim TY. Active Surveillance for Patients With Papillary Thyroid Microcarcinoma: A Single Center's Experience in Korea. J Clin Endocrinol Metab 2017; 102:1917-1925. [PMID: 28323932 DOI: 10.1210/jc.2016-4026] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/28/2017] [Indexed: 12/24/2022]
Abstract
CONTEXT Papillary thyroid microcarcinoma (PTMC) usually has an excellent prognosis. OBJECTIVE To evaluate the three-dimensional structures of PTMCs, using serial neck ultrasonography (US) in patients under active surveillance. DESIGN AND SETTING A retrospective cohort study. PARTICIPANTS In total, 192 patients diagnosed with PTMC under active surveillance for >1 year were included in a median 30-month follow-up. Changes in tumor size were evaluated not only using the maximal tumor diameter but also the tumor volume. RESULTS The median age of patients was 51.3 years and 145 patients (76%) were female. The median initial maximal tumor diameter and tumor volume were 5.5 mm and 48.8 mm3, respectively. The tumor size increased in 27 patients (14%); 23 patients showed a tumor volume increase >50% without a maximal diameter increase of ≥3 mm. The other four patients had both an increasing tumor volume and increasing maximal tumor diameter ≥3 mm. One patient (0.5%) had newly appeared cervical lymph node (LN) metastasis at 3 years after the initial diagnosis. There were no significant risk factors associated with increased tumor size, such as age, sex, or Hashimoto thyroiditis. Twenty-four patients (13%) underwent delayed thyroid surgery at a median of 31.2 months and seven (29%) had cervical LN metastasis on pathologic examination. CONCLUSION Some PTMCs could grow significantly after a relatively short period of active surveillance. We also found that the change in tumor volume was more sensitive to detect tumor progression than the change in the maximal tumor diameter.
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Affiliation(s)
- Hyemi Kwon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Hye-Seon Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Mijin Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Suyeon Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Jung Hwan Baek
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
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220
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Ha SM, Sung JY, Baek JH, Na DG, Kim JH, Yoo H, Lee D, Whan Choi D. Radiofrequency ablation of small follicular neoplasms: initial clinical outcomes. Int J Hyperthermia 2017; 33:931-937. [PMID: 28545338 DOI: 10.1080/02656736.2017.1331268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In thyroid gland, radiofrequency ablation (RFA) has been applied to both recurrent cancers and benign nodules, although, according to the American Thyroid Association (ATA) and the Korean Society of Thyroid Radiology (KSThR) guidelines, surgery is the first-line treatment for follicular neoplasm. However, it has been argued that follicular neoplasm with lower risk of malignancy can be managed by close follow-up. In this study, we evaluated the effectiveness of RFA of small follicular neoplasms, examining reductions in volume and related clinical problems, and making observations over long-term follow-up. METHODS We evaluated 10 follicular neoplasms in 10 patients who were treated with RF ablation between 2009 and 2011. A RF generator and an 18-gauge internally cooled electrode were used to perform complete ablation of the whole nodules. Changes in nodules or ablated zones on follow-up ultrasound, and complications during and after RF ablation were evaluated. RESULTS The mean follow-up period was 66.4 ± 5.1 months (range: 60-76 months). In eight patients, single session of RF ablation was sufficient, while two patients required two sessions. There was a significant reduction in the mean volume (99.5 ± 1.0%) of lesions, with eight ablated lesions (8/10, 80%) disappearing completely on follow-up. No recurrences were found in any ablated zones at last follow-up. Transient mild neck pain (n = 6) occurred during the procedure without requiring any medication. CONCLUSION In addition to active surveillance, RF ablation may be an effective and safe alternative for the management of patients with small (<2 cm) follicular neoplasm suspected on thyroid biopsy and who strongly refuse surgery.
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Affiliation(s)
- Su Min Ha
- a Department of Radiology and Thyroid Center , Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul , Korea
| | - Jin Yong Sung
- b Department of Radiology and Thyroid Center , Daerim St. Mary's Hospital , Seoul , Korea
| | - Jung Hwan Baek
- c Department of Radiology and the Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
| | - Dong Gyu Na
- d Department of Radiology , GangNeung Asan Hospital , Seoul , Korea
| | - Ji-Hoon Kim
- e Department of Radiology , Seoul National University College of Medicine , Seoul , Korea
| | - Hyunju Yoo
- f Department of Pathology and Thyroid Center , Daerim St. Mary's Hospital , Seoul , Korea
| | - Ducky Lee
- g Department of Internal Medicine and Thyroid Center , Daerim St. Mary's Hospital , Seoul , Korea
| | - Dong Whan Choi
- h Department of Surgery and Thyroid Center , Daerim St. Mary's Hospital , Seoul , Korea
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221
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Park HS, Baek JH, Park AW, Chung SR, Choi YJ, Lee JH. Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques. Korean J Radiol 2017; 18:615-623. [PMID: 28670156 PMCID: PMC5447637 DOI: 10.3348/kjr.2017.18.4.615] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/09/2017] [Indexed: 12/21/2022] Open
Abstract
Radiofrequency ablation (RFA) is a well-known, effective, and safe method for treating benign thyroid nodules and recurrent thyroid cancers. Thyroid-dedicated devices and basic techniques for thyroid RFA were introduced by the Korean Society of Thyroid Radiology (KSThR) in 2012. Thyroid RFA has now been adopted worldwide, with subsequent advances in devices and techniques. To optimize the treatment efficacy and patient safety, understanding the basic and advanced RFA techniques and selecting the optimal treatment strategy are critical. The goal of this review is to therefore provide updates and analysis of current devices and advanced techniques for RFA treatment of benign thyroid nodules and recurrent thyroid cancers.
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Affiliation(s)
- Hye Sun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Auh Whan Park
- Department of Radiology, Vascular & Interventional Radiology Section, University of Virginia Health System, Charlottesville, VA 22908-0170, USA
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Sui WF, Li JY, Fu JH. Percutaneous laser ablation for benign thyroid nodules: a meta-analysis. Oncotarget 2017; 8:83225-83236. [PMID: 29137336 PMCID: PMC5669962 DOI: 10.18632/oncotarget.17928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/03/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate percutaneous laser ablation in treating benign thyroid nodules, we conducted a meta-analysis based on summarizing existing researches. Materials and Methods A literature search for clinical trial was performed in PubMed, Cochrane Library and Excerpt Medica Database. The qualities of included studies were evaluated. We calculated the indexes with mean difference. Heterogeneity and publication bias were tested and explored. We performed subgroup analyses and sensitivity analysis further. Results A total of 19 researches and 2137 patients were included in this meta-analysis. The pooled estimates of nodule volume were statistically significant after percutaneous laser ablation for 1 month, 3 month, 6month, 12month, 24month and 36month(P < 0.05). The pooled estimate of thyroid-stimulating hormone was statistically significant after percutaneous laser ablation for 1 and 12 month (P = 0.008 and P = 0.03). The pooled estimate of free triiodothyronine was no statistically significant after percutaneous laser ablation for all follow-up intervals. The pooled estimate of free tetraiodothyronin was statistically significant after percutaneous laser ablation1 month (P = 0.004). The pooled estimate of thyroglobulin was statistically significant after percutaneous laser ablation 24 month (P = 0.04). The heterogeneity was found and the source of heterogeneity was explored in nodule volume for 6 and 12 month. No publication bias was found. Conclusions This meta-analysis demonstrated that percutaneous laser ablation was safe and useful in shrinking benign thyroid nodules volume, improving thyroid function, relieving symptoms of pressure and esthetic, especial for hyper-vascular benign thyroid nodules. Larger number of high-quality prospective studies still needs to be performed.
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Affiliation(s)
- Wei Fan Sui
- Department of Interventional Radiology, The Affiliated Renmin Hospital of Jiangsu University, Zhenjiang, 212002, China
| | - Jian Yun Li
- Department of Interventional Radiology, The Affiliated Renmin Hospital of Jiangsu University, Zhenjiang, 212002, China
| | - Jian Hua Fu
- Department of Interventional Radiology, The Affiliated Renmin Hospital of Jiangsu University, Zhenjiang, 212002, China
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223
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Mader A, Mader OM, Gröner D, Korkusuz Y, Ahmad S, Grünwald F, Kranert WT, Happel C. Minimally invasive local ablative therapies in combination with radioiodine therapy in benign thyroid disease: preparation, feasibility and efficiency - preliminary results. Int J Hyperthermia 2017; 33:895-904. [PMID: 28540810 DOI: 10.1080/02656736.2017.1320813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Initial studies of combinations of radioiodine therapy (RIT) and local ablative procedures for the treatment of thyroid nodules have shown promising results. The goal of this study was to evaluate the effectiveness of RIT combined with radiofrequency ablation (RFA) in patients with goitres and to determine which ablative procedure is the most suitable for a combined therapy. METHODS Thirty patients with goitres were divided into two subgroups. A test group of 15 patients received combined therapy (RIT + RFA) and a control group of 15 patients received RIT mono therapy. All patients underwent assessments including ultrasound, laboratory evaluation (T3, T4, TSH, TG, TPOAb, TgAbTRAb) and scintigraphic imaging with Tc-99m-Pertechnetate. The 3-month volume reduction was used to evaluate therapy effectiveness. RESULTS Combined therapy (subgroup 1) resulted in a significant (p < 0.05) thyroid volume reduction (22.3 ± 54 ml/32.2 ± 58.2%) with better performance (p > 0.05) than the control group (20.2 ± 32.2 ml/29.6 ± 42.1%). All patients became euthyroid after treatment. No major discomfort or complications occurred. A review of the literature investigating combinations of other local ablative procedures with RIT was performed to determine the most promising combination. CONCLUSIONS The present study confirms the positive experiences with the combined therapy of RIT and local ablative procedures shown in the current literature and approves this approach for the treatment of goitres with RFA + RIT. These findings, when confirmed by further studies, should expand the indication of combined therapy as a minimally invasive alternative to surgery.
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Affiliation(s)
- Alexander Mader
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Oscar Maximilian Mader
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Daniel Gröner
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Yücel Korkusuz
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Shadi Ahmad
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Frank Grünwald
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - W Tilman Kranert
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Christian Happel
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
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Sim JS, Baek JH, Lee J, Cho W, Jung SI. Radiofrequency ablation of benign thyroid nodules: depicting early sign of regrowth by calculating vital volume. Int J Hyperthermia 2017; 33:905-910. [PMID: 28540795 DOI: 10.1080/02656736.2017.1309083] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE We evaluated long-term follow-up results of radiofrequency ablation of benign thyroid nodules to analyse the role of marginal vital tissue on nodule regrowth. MATERIALS AND METHODS We reviewed the medical records of 54 patients who underwent radiofrequency ablation between June 2008 and November 2013 with pressure symptoms, and/or cosmetic problems. All patients were followed up at least 12 months on three occasions. To evaluate an early sign of regrowth, three types of nodule volumes (total volume, ablated volume and vital volume) were measured and calculated using ultrasonography. Regrowth was defined as a more than a 50% increase in the total volume and vital volume increase was defined as a more than 50% increase compared to the previously reported smallest volume on ultrasonography. RESULTS The mean follow-up period was 39.4 ± 21.7 (range, 13-87) months. Vital volume increases occurred in 31 nodules (57.4%) and there was regrowth in 13 nodules (24.1%). The mean timing of the vital volume increase was 27.5 ± 18.5 months, and for regrowth it was 39.9 ± 17.5 months. Vital volume increase tended to precede regrowth. CONCLUSION Vital volume increase tended to occur earlier than regrowth and might be an early sign of regrowth in following-up after the radiofrequency ablation of benign thyroid nodules.
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Affiliation(s)
- Jung Suk Sim
- a Department of Radiology , Withsim Clinic , Bundang-gu, Seongnam-si , Republic of Korea
| | - Jung Hwan Baek
- b Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine , Asan Medical Center , Seoul , Republic of Korea
| | - Joongyub Lee
- c Division of Clinical Epidemiology, Medical Research Collaborating Center , Seoul National University Hospital , Jongno-gu , Republic of Korea
| | - Woojin Cho
- d Department of Otolaryngology and Head and Neck Surgery , Withsim Clinic , Bundang-gu, Seongnam-si , Republic of Korea
| | - Sung Il Jung
- e Department of Radiology , Konkuk University Medical Center, Konkuk University School of Medicine, Research Institute of Medical Science , Seoul , Republic of Korea
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Park HS, Baek JH, Choi YJ, Lee JH. Innovative Techniques for Image-Guided Ablation of Benign Thyroid Nodules: Combined Ethanol and Radiofrequency Ablation. Korean J Radiol 2017; 18:461-469. [PMID: 28458598 PMCID: PMC5390615 DOI: 10.3348/kjr.2017.18.3.461] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 10/16/2016] [Indexed: 12/31/2022] Open
Abstract
In the treatment of benign thyroid nodules, ethanol ablation (EA), and radiofrequency ablation (RFA) have been suggested for cystic and solid thyroid nodules, respectively. Although combining these ablation techniques may be effective, no guidelines for or reviews of the combination have been published. Currently, there are three ways of combining EA and RFA: additional RFA is effective for treatment of incompletely resolved symptoms and solid residual portions of a thyroid nodule after EA. Additional EA can be performed for the residual unablated solid portion of a nodule after RFA if it is adjacent to critical structures (e.g., trachea, esophagus, and recurrent laryngeal nerve). In the concomitant procedure, ethanol is injected to control venous oozing after aspiration of cystic fluid prior to RFA of the remaining solid nodule.
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Affiliation(s)
- Hye Sun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Guang Y, Luo Y, Zhang Y, Zhang M, Li N, Zhang Y, Tang J. Efficacy and safety of percutaneous ultrasound guided radiofrequency ablation for treating cervical metastatic lymph nodes from papillary thyroid carcinoma. J Cancer Res Clin Oncol 2017; 143:1555-1562. [DOI: 10.1007/s00432-017-2386-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/24/2017] [Indexed: 12/20/2022]
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First clinical use of the EchoTrack guidance approach for radiofrequency ablation of thyroid gland nodules. Int J Comput Assist Radiol Surg 2017; 12:931-940. [PMID: 28332158 DOI: 10.1007/s11548-017-1560-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Percutaneous radiofrequency ablation (RFA) of thyroid nodules is an alternative to surgical resection that offers the benefits of minimal scars for the patient, lower complication rates, and shorter treatment times. Ultrasound (US) is the preferred modality for guiding these procedures. The needle is usually kept within the US scanning plane to ensure needle visibility. However, this restricts flexibility in both transducer and needle movement and renders the procedure difficult, especially for inexperienced users. Existing navigation solutions often involve electromagnetic (EM) tracking, which requires placement of an external field generator (FG) in close proximity of the intervention site in order to avoid distortion of the EM field. This complicates the clinical workflow as placing the FG while ensuring that it neither restricts the physician's workspace nor affects tracking accuracy is awkward and time-consuming. METHODS The EchoTrack concept overcomes these issues by combining the US probe and the EM FG in one modality, simultaneously providing both real-time US and tracking data without requiring the placement of an external FG for tracking. We propose a system and workflow to use EchoTrack for RFA of thyroid nodules. RESULTS According to our results, the overall error of the EchoTrack system resulting from errors related to tracking and calibration is below 2 mm. Navigated thyroid RFA with the proposed concept is clinically feasible. Motion of internal critical structures relative to external markers can be up to several millimeters in extreme cases. CONCLUSIONS The EchoTrack concept with its simple setup, flexibility, improved needle visualization, and additional guidance information has high potential to be clinically used for thyroid RFA.
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Ultrasound-navigated radiofrequency ablation of thyroid nodules with integrated electromagnetic tracking: comparison with conventional ultrasound guidance in gelatin models. Int J Comput Assist Radiol Surg 2017; 12:1635-1642. [PMID: 28271358 DOI: 10.1007/s11548-017-1544-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/20/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE A thyroid-like gelatin model was used to determine potential superiority of a new navigation system for ultrasound (US)-guided electrode insertion called EchoTrack, featuring a US probe with an integrated electromagnetic field generator, in comparison with conventional US when performing radiofrequency ablation. METHODS In order to compare 20 navigated ablations with 20 ablations under conventional US guidance, a thyroid-like gelatin model was used. In each group, 10 in-plane and 10 out-of-plane punctures were performed. Metal seeds measuring 8.5 [Formula: see text] 1.8 mm served as ablation targets. The number of redirections until final electrode placement, targeting accuracy and electrode placement time were measured. RESULTS The number of redirections could be significantly ([Formula: see text]) reduced from 2.7 ± 1.3 in the conventional group to 0.2 ± 0.5 in the EchoTrack group. Accuracy increased from 3.9 ± 4.7 to 2.0 ± 1.9 mm. The total placement time increased from 39 ± 20.5 to 79.2 ± 26 s. CONCLUSIONS EchoTrack is able to reduce the redirections needed to place the electrode in comparison with conventional US and provides high placement accuracy. Our new navigation system has high potential to reduce the risk of harming critical structures and to improve guidance during ablation of difficult nodules, as treatment planning as well as the safety of out-of-plane punctures are improved.
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Tang X, Cui D, Chi J, Wang Z, Wang T, Zhai B, Li P. Evaluation of the safety and efficacy of radiofrequency ablation for treating benign thyroid nodules. J Cancer 2017; 8:754-760. [PMID: 28382137 PMCID: PMC5381163 DOI: 10.7150/jca.17655] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/27/2016] [Indexed: 01/04/2023] Open
Abstract
Background: Radiofrequency ablation (RFA) is a relatively new procedure for treating benign thyroid nodules. The purpose of this study was to evaluate the safety and efficacy of RFA for treating benign thyroid nodules so as to serve as a reference for future clinical practice. Methods: This study retrospectively analyzed the clinical data of patients receiving percutaneous RFA for treating thyroid nodules from November 2014 to July 2015 in our medical center. One hundred and eight patients with a total of 380 nodules received ultrasound-guided RFA for treating thyroid nodules. Comparisons of the volume change of thyroid nodules before and after RFA treatment, post-treatment complication, and change of thyroid function, were carried out afterwards. Results: Before treatments, all patients received fine needle aspiration biopsy (FNA) which supported the diagnosis of benign tumor. There were 13 males and 95 females included in the study. Twenty-six cases (24.07%) had single nodule, and 82 cases (75.93%) had multiple nodules. Before treatments, the thyroid functions (FT3, FT4, and TSH) were normal originally or adjusted to normal range by endocrinology treatment. The preoperative nodules had minimum volume of 0.01mL, maximum volume of 70.89 mL, and mean volume of 1.02 ± 4.24mL. The volume of nodules one month and three months after RFA were 0.29 ± 0.72mL and 0.15 ± 0.87mL, respectively. In addition, volume reduction ratio (VRR) of nodules one month and three months after RFA were 64.12% and 85.54%, respectively. Both volume of nodules and VRR had statistically significant differences for pre-operative and post-operative comparison (P<0.05). Thyroid functions were in normal range after treatments, and there was no serious complications. Conclusions: Ultrasound-guided RFA treating benign thyroid nodules had the advantages of definite efficacy, safety, strong in control ability, no incision, less damage to surrounding normal tissues and no effect on thyroid function. It can be used as one of the main treatment methods for treating benign thyroid nodules.
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Affiliation(s)
- Xiaoyin Tang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dan Cui
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiachang Chi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhi Wang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tao Wang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ping Li
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Cesareo R, Palermo A, Pasqualini V, Simeoni C, Casini A, Pelle G, Manfrini S, Campagna G, Cianni R. Efficacy and safety of a single radiofrequency ablation of solid benign non-functioning thyroid nodules. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:173-179. [PMID: 28226000 PMCID: PMC10118859 DOI: 10.1590/2359-3997000000246] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 11/11/2016] [Indexed: 11/22/2022]
Abstract
Objective The objective of our study is to evaluate the clinical outcomes and safety of radiofrequency thermal ablation (RFA) for benign thyroid nodules (BTNs) over a 1-year follow-up. Subjects and methods This is a monocentric retrospective study. Forty-eight patients with solid, non-functioning BTNs were treated by RFA using a 17G internally cooled electrode. We categorized thyroid nodules as small (≤ 12 mL), medium (12 to 30 mL), or large (over 30 mL). BTNs volume reduction, thyroid function, cosmetic and compressive score changes and side effect evaluation at 6 and 12 months were evaluated. Results BTN volume decreased significantly from baseline to 6 (mean percentage decrease of BTN volume was 66.8 ± 13.6%, p < 0.001). At 12 months, the mean percentage reduction of BTN volume compared to six months was 13.7 ± 17.1% (p < 0.001). At 6-month, symptom score had improved significantly (p < 0.001) while it does not change significantly between 6 and 12 months. In particular, symptom score improved significantly in the medium (p < 0.001) and large (p < 0.01) subgroups. Cosmetic score improved significantly between baseline and 6 months (p < 0.001) and between 6 and 12 months (p < 0.01). In all the subgroups, cosmetic score improved significantly between baseline and 6 months, while between 6 and 12 months it improved significantly only in the large group (p < 0.05). RFA was well tolerated. Only one patient experienced permanent right paramedian vocal cord palsy. Conclusions A single RFA treatment was effective in reducing BTNs volume, in particular small and medium nodules. Cosmetic score improved in all treated BTNs while symptom score only got better in the medium and large BTNs.
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Affiliation(s)
- Roberto Cesareo
- Department of Internal Medicine "S. M. Goretti" Hospital, Latina, Italy
| | - Andrea Palermo
- Department of Endocrinology, University Campus Bio-Medico, Rome, Italy
| | | | - Carla Simeoni
- Compensatory authority (INAIL), Monte Porzio Catone, Rome, Italy
| | - Alessandro Casini
- Department of Internal Medicine "S. M. Goretti" Hospital, Latina, Italy
| | - Giuseppe Pelle
- Department of Radiology, "S. M. Goretti" Hospital, Latina, Italy
| | - Silvia Manfrini
- Department of Endocrinology, University Campus Bio-Medico, Rome, Italy
| | - Giuseppe Campagna
- Department of Internal Medicine "S. M. Goretti" Hospital, Latina, Italy
| | - Roberto Cianni
- Department of Radiology, "S. M. Goretti" Hospital, Latina, Italy
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231
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Yue WW, Wang SR, Lu F, Sun LP, Guo LH, Zhang YL, Li XL, Xu HX. Radiofrequency ablation vs. microwave ablation for patients with benign thyroid nodules: a propensity score matching study. Endocrine 2017; 55:485-495. [PMID: 27905049 DOI: 10.1007/s12020-016-1173-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/05/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare the efficacy and the safety of radiofrequency ablation and microwave ablation for treatment of benign thyroid nodules using a propensity score matching study design. METHODS Two hundred and sixty patients with benign thyroid nodules were studied retrospectively, including 102 patients treated with radiofrequency ablation and 158 treated with microwave ablation. To reduce confounding bias due to retrospective assignment, propensity score matching was performed to balance the preablation data of the two groups. After matching, a total of 102 patient pairs (1:1) were created. The volume reduction ratio, therapeutic success rate, symptom and cosmetic score, and major complication were compared between the two groups at 1, 3, 6, and 12 months after treatment. RESULTS Between the well-matched groups, no significant differences were found in all nodule volume-related end points at 6 months (volume reduction ratio: 79.4 vs. 77.2 %, P = 0.108; symptom score: 2.1 vs. 1.9, P = 0.456; cosmetic score: 2.1 vs. 2.3, P = 0.119; therapeutic success rate: 99 vs. 97 %, P = 0.621) and 12 months (volume reduction ratio: 83.6 vs. 81.6 %, P = 0.144; symptom score: 1.5 vs. 1.5, P = 0.869; cosmetic score: 1.6 vs. 1.7, P = 0.409; therapeutic success rate: 100 vs. 100 %, P > 0.99) after treatment. No major complications occurred in either group (P > 0.99). CONCLUSIONS With well-matched groups and consistent procedure design, our results demonstrated that the volume reduction ratio, therapeutic success rate, symptom and cosmetic score, and complications related to treatment for the two techniques are equivalent. Radiofrequency ablation and microwave ablation are both effective and safe methods in treating benign thyroid nodules.
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Affiliation(s)
- Wen-Wen Yue
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Yantai, Shandong, 264100, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Yantai, Shandong, 264100, China.
| | - Feng Lu
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Yong-Lin Zhang
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Yantai, Shandong, 264100, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China.
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The Results of Ultrasonography-Guided Percutaneous Radiofrequency Ablation in Hyperparathyroid Patients in Whom Surgery Is Not Feasible. Cardiovasc Intervent Radiol 2017; 40:596-602. [DOI: 10.1007/s00270-016-1544-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/09/2016] [Indexed: 01/20/2023]
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Wu W, Gong X, Zhou Q, Chen X, Chen X. Ultrasound-Guided Percutaneous Microwave Ablation for Solid Benign Thyroid Nodules: Comparison of MWA versus Control Group. Int J Endocrinol 2017; 2017:9724090. [PMID: 29333159 PMCID: PMC5733153 DOI: 10.1155/2017/9724090] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/29/2017] [Accepted: 09/05/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The aim of this research is to investigate the feasibility of percutaneous ultrasound-guided microwave ablation (MWA) for benign solid thyroid nodules. METHODS Ultrasound-guided percutaneous microwave ablation was performed for 90 benign solid thyroid nodules in 75 patients. The volume changes of the nodules were evaluated before and after microwave ablation, and the cosmetic grading and clinical symptoms were assessed as well. RESULTS The volume of all the 90 benign thyroid nodules obviously decreased after microwave ablation at 3-, 6-, 9-, and 12-month follow-ups (p < 0.01), while that of the control group increased at the follow-up of 12 months (p < 0.01). The volume reduction rate (VRR) at 3-, 6-, 9-, and 12-month follow-ups was 55.98%, 69.31%, 76.65%, and 84.67% in the MWA group, respectively. The cosmetic problems and clinical symptoms were also improved in the MWA group. All the patients are well tolerated to the procedure. Hoarseness occurred in 2 cases (2.7%) and Horner syndrome in 1 case (1.3%), and 1 patient (1.3%) developed slight burn on cervical skin. CONCLUSIONS Ultrasound-guided percutaneous microwave ablation is a practical method for treating benign solid thyroid nodules, and the complications were acceptable. The trial is registered with clinicaltrials.gov with the registration number NCT03057925.
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Affiliation(s)
- Wenjun Wu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Xiaohua Gong
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Qi Zhou
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Xiong Chen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Xiaojun Chen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
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Complications encountered in ultrasonography-guided radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers. Eur Radiol 2016; 27:3128-3137. [DOI: 10.1007/s00330-016-4690-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 11/22/2016] [Accepted: 11/29/2016] [Indexed: 01/25/2023]
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Morelli F, Sacrini A, Pompili G, Borelli A, Panella S, Masu A, De Pasquale L, Giacchero R, Carrafiello G. Microwave ablation for thyroid nodules: a new string to the bow for percutaneous treatments? Gland Surg 2016; 5:553-558. [PMID: 28149799 DOI: 10.21037/gs.2016.12.07] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Thyroid nodules are a fairly common finding in general population and, even if most of them are benign, a treatment can be however necessary. In the last years, non surgical minimally invasive techniques have been developed to treat this pathology, starting from percutaneous ethanol injection (PEI), to laser ablation (LA), radiofrequency ablation (RFA) and, most recently, microwave ablation (MWA). METHODS We reviewed all medical literature searching in pubmed.gov the terms "microwave" & "thyroid". We found three original studies concerning MWA treatment, for a total of 263 patients (mean age 51.0 years; range, 15-80 years; male to female ratio 2.55) and 522 nodules. RESULTS A total of 522 nodules (338 solid, 22 cystic, 162 mixed) in 263 patients were treated. Studies have shown a mean reduction in volume of thyroid nodules ranging from 45.9% to 65%. No study reported a significant and definitive change in laboratory parameters, except for one case (Heck et al.). No studies have reported major complications after procedure. CONCLUSIONS MWA is a new, promising technique among the minimally invasive treatments of thyroid nodules. Actually, the larger diameter of MW antenna seems to be the major limiting factor in the use of this technique. More studies are necessary to evaluate feasibility, safety and efficacy of the procedure.
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Affiliation(s)
| | - Andrea Sacrini
- Department of Radiology, San Paolo Hospital, Milan, Italy
| | | | - Anna Borelli
- Department of Radiology, San Paolo Hospital, Milan, Italy
| | - Silvia Panella
- Department of Radiology, San Paolo Hospital, Milan, Italy
| | - Annamaria Masu
- Department of Endocrinology, San Paolo Hospital, Milan, Italy
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Mauri G, Sconfienza LM. Image-guided thermal ablation might be a way to compensate for image deriving cancer overdiagnosis. Int J Hyperthermia 2016; 33:489-490. [DOI: 10.1080/02656736.2016.1262969] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Giovanni Mauri
- Istituto Europeo di Oncologia, Division of Interventional Radiology, Milano, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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Branovan I, Fridman MV, Lushchyk ML, Drozd VM, Krasko OV, Nedzvedz OV, Shiglik NA, Danilova LI. Experimental morphological evaluation of the effectiveness of bipolar radiofrequency ablation for thyroid nodules. CYTOL GENET+ 2016. [DOI: 10.3103/s0095452716060037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mauri G, Cova L, Monaco CG, Sconfienza LM, Corbetta S, Benedini S, Ambrogi F, Milani V, Baroli A, Ierace T, Solbiati L. Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA). Int J Hyperthermia 2016; 33:295-299. [PMID: 27701923 DOI: 10.1080/02656736.2016.1244707] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To evaluate the reduction over time of benign thyroid nodules treated using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA) by the same equipe. MATERIALS AND METHODS Ninety patients (age 55.6 ± 14.1 years) underwent ablation for benign thyroid nodule causing compression/aesthetic dissatisfaction from 2011. Fifty-nine (age 55.8 ± 14.1 years) underwent RFA and 31 (age 55.2 ± 14.2 years) PLA, ultrasound guided. Technical success, complications, duration of ablation and treatment, energy deployed, volumetric percentage reduction at 1, 6 and 12 months were derived. A regression model for longitudinal measurements was used with random intercept and random slope. Values are expressed as mean ± standard deviation or N (%). RESULTS Technical success was always obtained. No major complications occurred. Mean ablation time was 30.1 ± 13.8 vs. 13.9 ± 5.9 min (p < .0001) and mean energy deployment was 5422.3 ± 2484.5 J vs. 34 662.7 ± 15 812.3 J in PLA vs. RFA group. Mean volume reduced from 20.3 ± 16.4 ml to 13.17 ± 10.74 ml (42% ± 17% reduction) at 1st month, 8.7 ± 7.4 ml (60% ± 15% reduction) at 6th month and 7.1 ± 7.7 ml (70%% ± 16% reduction) at 12th month, in PLA group, and from 32.7 ± 19.5 ml to 17.2 ± 12.9 ml (51%±15% reduction) at 1st month, 12.8 ± 9.6 ml (64 ± 14% reduction) at 6th month and 9.9 ± 9.2 ml (74% ± 14% reduction) at 12th month in RFA group. No difference in time course of the relative volume reduction between the two techniques was found. CONCLUSIONS RFA and PLA are similarly feasible, safe and effective in treating benign thyroid nodules when performed by the same equipe. RFA is faster than PLA but require significantly higher energy.
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Affiliation(s)
- Giovanni Mauri
- a Division of Interventional Oncology , European Institute of Oncology , Milan , Italy.,b Radiology Service, IRCCS Policlinico San Donato , Milan , Italy
| | - Luca Cova
- c Interventional Oncology Service, Azienda Socio-Sanitario Territoriale (ASST) della Valle Olona , Varese , Italy
| | | | - Luca Maria Sconfienza
- b Radiology Service, IRCCS Policlinico San Donato , Milan , Italy.,e Department of Biomedical Sciences for Health , University of Milan , Milan , Italy
| | - Sabrina Corbetta
- e Department of Biomedical Sciences for Health , University of Milan , Milan , Italy.,f Endocrinology Unit, IRCCS Policlinico San Donato , Milano , Italy
| | - Stefano Benedini
- f Endocrinology Unit, IRCCS Policlinico San Donato , Milano , Italy
| | - Federico Ambrogi
- g Department of Clinical Sciences and Community Health, University of Milan, IRCCS Policlinico San Donato , Milan , Italy
| | - Valentina Milani
- g Department of Clinical Sciences and Community Health, University of Milan, IRCCS Policlinico San Donato , Milan , Italy
| | - Alberto Baroli
- h Department of Nuclear Medicine, Azienda Socio-Sanitario Territoriale (ASST) della Valle Olona , Varese , Italy
| | - Tiziana Ierace
- i Unit of Interventional Radiology, Istituto Clinico Humanitas , Milano , Italy
| | - Luigi Solbiati
- i Unit of Interventional Radiology, Istituto Clinico Humanitas , Milano , Italy.,j Humanitas University, Istituto Clinico Humanitas , Milano , Italy
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239
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Zhang M, Luo Y, Zhang Y, Tang J. Efficacy and Safety of Ultrasound-Guided Radiofrequency Ablation for Treating Low-Risk Papillary Thyroid Microcarcinoma: A Prospective Study. Thyroid 2016; 26:1581-1587. [PMID: 27445090 DOI: 10.1089/thy.2015.0471] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Papillary thyroid microcarcinoma (PTMC) has a high incidence and a good prognosis. Surgical operation for all PTMC might be an overtreatment. The objective of this study was to evaluate the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for treating low-risk PTMC. METHODS Ninety-eight PTMC in 92 patients were included in this study. US and contrast-enhanced ultrasound (CEUS) examinations were performed before ablation. RFA was performed using the moving-shot technique. The ablation area exceeded the tumor edge to prevent marginal residue and recurrence. Patients were followed at 1, 3, 6, and 12 months and every six months thereafter. US and CEUS examinations were used to evaluate the ablation area. At three months after ablation, US-guided core-needle biopsy (CNB) was performed in the center, at the edge of the ablation area, and in the surrounding thyroid parenchyma to exclude recurrence. RESULTS The mean tumor volume was 118.8 ± 106.9 mm3. The mean volume reduction ratio (VRR) was 0.47 ± 0.27, 0.19 ± 0.16, 0.08 ± 0.11, 0.04 ± 0.10, and 0 at 1, 3, 6, 12, and 18 months after RFA, respectively. Significant differences in the VRR were found between every two follow-up times before six months (p < 0.01), and no significant differences in the VRR were found between six months and after 12 months (p = 0.42). Of all the nodules, 10 (41.7%) resolved in six months, and 23 (95.8%) resolved in 12 months. No residual or recurrent tumor tissue was detected in RFA area or in residual thyroid tissue during follow-up. No suspicious metastatic lymph nodes were detected. The histological pathology results of US-guided CNB confirmed the absence of residual or recurrent tumor. No major complications were encountered. CONCLUSIONS RFA can effectively eliminate low-risk PTMC with a very small complication rate. RFA may be an alternative strategy for the treatment of PTMC.
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Affiliation(s)
- Mingbo Zhang
- Department of Ultrasound, General Hospital of Chinese PLA , Beijing, China
| | - Yukun Luo
- Department of Ultrasound, General Hospital of Chinese PLA , Beijing, China
| | - Yan Zhang
- Department of Ultrasound, General Hospital of Chinese PLA , Beijing, China
| | - Jie Tang
- Department of Ultrasound, General Hospital of Chinese PLA , Beijing, China
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240
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Mainini AP, Monaco C, Pescatori LC, De Angelis C, Sardanelli F, Sconfienza LM, Mauri G. Image-guided thermal ablation of benign thyroid nodules. J Ultrasound 2016; 20:11-22. [PMID: 28298940 DOI: 10.1007/s40477-016-0221-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/22/2016] [Indexed: 12/22/2022] Open
Abstract
Benign thyroid nodules are a common disease in the general population. Most often, they are completely asymptomatic and discovered occasionally during routine ultrasound examinations, and do not require any treatment. When thyroid nodules become symptomatic, surgical excision is still considered standard treatment. In the last few years, several experiences in the treatment of benign thyroid nodules through image-guided percutaneous thermal ablation have been reported with encouraging results, so that currently, these treatments are often proposed as first-choice options for patients with symptomatic benign thyroid nodules. In this paper, we discuss the present literature on the topic, focusing on different techniques available for image-guided percutaneous ablation, particularly radiofrequency (RFA), laser (LA), microwave (MWA), and high-intensity-focus ultrasound (HIFU). Little evidence about the efficacy of MWA and HIFU is now available. According to the literature, good results have been obtained with RFA and LA. Regarding RFA, volume reduction after ablative treatment has been found to range from 47 to 84 % at 3-6 months, and from 62 to 93 % at 1 year; LA also seems to be effective in achieving shrinkage of thyroid nodules, with volume reduction from 37 to 81 % at 3-6 months, and from 13 to 82 % at 1-year follow-up. Moreover, applications of advanced image-guidance modality, such as contrast-enhanced ultrasound and virtual navigation with fusion imaging, are discussed.
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Affiliation(s)
- Anna Pisani Mainini
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Cristian Monaco
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Lorenzo Carlo Pescatori
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Chiara De Angelis
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100 Milan, Italy.,Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097 Milan, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100 Milan, Italy.,Radiologia/Diagnostica per immagini con servizio di radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Giovanni Mauri
- Dipartimento di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20100 Milan, Italy
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241
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Papini E, Gugliemi R, Pacella CM. Laser, radiofrequency, and ethanol ablation for the management of thyroid nodules. Curr Opin Endocrinol Diabetes Obes 2016; 23:400-6. [PMID: 27504993 DOI: 10.1097/med.0000000000000282] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The majority of benign thyroid nodules are nearly asymptomatic, remain stable in size, and do not require treatment. However, a minority of patients with growing nodules may complain of local symptoms or have cosmetic concerns, and thus seek surgical consultation. RECENT FINDINGS The timely use of ultrasound-guided minimally invasive procedures can change the natural history of benign enlarging thyroid nodules. The procedures produce persistent shrinkage of thyroid nodules and are associated with improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first-line treatment for relapsing thyroid cysts. In solid nonfunctioning nodules, laser and radiofrequency ablation produces a more than 50% reduction in nodular volume that remains persistent over several years. For hyperfunctioning nodules, thermal ablation techniques are not appropriate unless radioactive iodine is contraindicated or not accessible. SUMMARY MITs are best suited for the management of medium or large-sized nodules that are sonographically well visualized. Conversely, large nodules or nodular goiters that extend into the chest are difficult to treat. MITs are performed in outpatient clinics, are less expensive, and have a lower risk of complications, compared to surgery, and usually do not induce thyroid dysfunction. However, malignancy should be ruled out with a dedicated ultrasound neck assessment and repeat fine needle aspiration of the lesion before treatment.
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Affiliation(s)
- Enrico Papini
- aDepartment of Endocrinology and Metabolism bDepartment of Diagnostic Imaging, Regina Apostolorum Hospital, Via San Francesco, Albano, Rome, Italy
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242
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Bernardi S, Stacul F, Zecchin M, Dobrinja C, Zanconati F, Fabris B. Radiofrequency ablation for benign thyroid nodules. J Endocrinol Invest 2016; 39:1003-13. [PMID: 27098804 DOI: 10.1007/s40618-016-0469-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
Benign thyroid nodules are an extremely common occurrence. Radiofrequency ablation (RFA) is gaining ground as an effective technique for their treatment, in case they become symptomatic. Here we review what are the current indications to RFA, its outcomes in terms of efficacy, tolerability, and cost, and also how it compares to the other conventional and experimental treatment modalities for benign thyroid nodules. Moreover, we will also address the issue of treating with this technique patients with cardiac pacemakers (PM) or implantable cardioverter-defibrillators (ICD), as it is a rather frequent occurrence that has never been addressed in detail in the literature.
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Affiliation(s)
- S Bernardi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Medicina Clinica, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy.
- SS Endocrinologia (UCO Medicina Clinica), Azienda Ospedaliero-Universitaria di Trieste, Cattinara Teaching Hospital, Strada di Fiume, Trieste, Italy.
| | - F Stacul
- SC Radiologia, Azienda Ospedaliero-Universitaria di Trieste, Maggiore Hospital, Piazza dell'Ospitale, Trieste, Italy
| | - M Zecchin
- UCO Cardiologia, Azienda Ospedaliero-Universitaria di Trieste, Cattinara Teaching Hospital, Strada di Fiume, Trieste, Italy
| | - C Dobrinja
- UCO Chirurgia Generale, Azienda Ospedaliero-Universitaria di Trieste, Cattinara Teaching Hospital, Strada di Fiume, Trieste, Italy
| | - F Zanconati
- Department of Medical, Surgical and Health Sciences, University of Trieste, Medicina Clinica, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy
- UCO Anatomia e Istologia Patologica, Azienda Ospedaliero-Universitaria di Trieste, Cattinara Teaching Hospital, Strada di Fiume, Trieste, Italy
| | - B Fabris
- Department of Medical, Surgical and Health Sciences, University of Trieste, Medicina Clinica, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy
- SS Endocrinologia (UCO Medicina Clinica), Azienda Ospedaliero-Universitaria di Trieste, Cattinara Teaching Hospital, Strada di Fiume, Trieste, Italy
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243
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Kim DW. Usefulness of two-stage ethanol ablation in the treatment of benign predominantly cystic thyroid nodules. Endocr Pract 2016; 20:548-55. [PMID: 24449678 DOI: 10.4158/ep13458.or] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The management of benign predominantly cystic thyroid nodules (PCTNs) differs depending on the institution or practitioner. This study aimed to assess the efficacy of two-stage ultrasound (US)-guided ethanol ablation (EA) in treating PCTNs. METHODS Over a 1-year period, two-stage EA was performed on benign PCTNs for 25 patients. After EA, each patient was followed up with thyroid US. The two-stage EA treatment consisted of an initial EA for the cystic component of the PCTN and subsequent treatment for the remaining solid component, if needed. RESULTS All 25 patients underwent EA for the cystic component of a PCTN and showed complete collapse of the cystic component on the follow-up US. Twenty patients were subsequently treated with one or more EA sessions because of the presence of a vascularized solid component, whereas 5 patients underwent no additional EA sessions because no vascularized solid component was detected on follow-up US. Of the 20 patients who underwent additional EA for a remaining solid component, complete ablation (n = 9), incomplete ablation (n = 7), and no response (n = 4) were observed on follow-up US. Of the 7 patients with incomplete ablation despite repeated EA, only 4 underwent radiofrequency ablation, and they showed complete ablation on follow-up US. CONCLUSION Two-stage EA may be useful for the treatment of benign PCTNs.
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Affiliation(s)
- Dong Wook Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
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244
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Zhao Q, Tian G, Kong D, Jiang T. Meta-analysis of radiofrequency ablation for treating the local recurrence of thyroid cancers. J Endocrinol Invest 2016; 39:909-16. [PMID: 26980591 DOI: 10.1007/s40618-016-0450-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/17/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Our aim was to evaluate the efficacy of ultrasound-guided radiofrequency ablation (RFA) for localized recurrent thyroid cancers. METHODS We did a systematic review and meta-analysis of the scientific literature by searching the PubMed, Embase, Web of Science,Scopus and the Cochrane Library up to November 26, 2015. We assessed the pooled standard mean difference (SMD) of nodule volume, largest diameter and serum thyroglobulin (Tg) level by comparing pre-RFA with post-RFA using fixed or random-effects model. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of the included studies, risk of bias in the selective populations, comparability of groups and exposure. RESULTS We finally identified nine articles including 189 patients (male: 54 and female: 135) with 255 tumor lesions, who underwent ultrasound (US)-guided RFA beyond the mean 6 months of follow-up. The results showed that tumor volume (SWD: 0.77, 95 % CI: 0.57-0.97, I (2) = 25.9 %, p = 0.231), largest diameter (SWD: 1.56, 95 % CI: 0.94-2.17, I (2) = 82.6 %, p < 0.001) and Tg level (SWD: 0.52, 95 % CI: 0.30-0.73, I (2) = 0 %, p = 0.493) were decreased and no significant publication bias was detectable. CONCLUSIONS The pooled data indicated that the prognosis improved for patients with localized recurrent thyroid cancers and RFA is a promising treatment for these patients with infeasible surgery.
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Affiliation(s)
- Q Zhao
- Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - G Tian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - D Kong
- Department of Mathematics, Zhejiang University, Hangzhou, 310027, China
| | - T Jiang
- Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
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245
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Chen F, Tian G, Kong D, Zhong L, Jiang T. Radiofrequency ablation for treatment of benign thyroid nodules: A PRISMA-compliant systematic review and meta-analysis of outcomes. Medicine (Baltimore) 2016; 95:e4659. [PMID: 27559968 PMCID: PMC5400335 DOI: 10.1097/md.0000000000004659] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Thyroid nodules (TNs) usually appearing in the general population have the potential possibility of malignant transformation and common problems of jugular oppression such as dyspnea and hoarseness. We performed this meta-analysis to evaluate the efficiency of radiofrequency ablation (RFA) for the treatment of benign TNs in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements. METHODS Published literatures were retrieved from PubMed, Embase, Web of Science, and Scopus up to January 27, 2016. Pooled standard mean difference with 95% confidence interval was estimated by fixed- or random-effects model depending on heterogeneity, which was calculated using the Cochran Q, τ, and I statistics. The quality of the articles was evaluated by the Newcastle-Ottawa scale. RESULTS Meta-analysis of data from 1090 patients with 1406 benign TNs in 20 articles showed that with the subgroup stratified by nodule volume, they were significantly decreased at 1, 3, 6, 12, and the last follow-up months, when comparing post-RFA with the initial nodule volume. In addition, the volume also notably declined by cold and hot nodules. By subgrouping into the largest diameter, symptom score, cosmetic score, thyrotropin, triiodothyronine, free thyroxine level, and vascularity, the pooled data indicated that there was a decrease in largest diameter, symptom score, cosmetic score, triiodothyronine level, and vascular scale, an unchanged free thyroxine, and an increased thyrotropin level after RFA. The publication bias for this particular study is presented in the following groups: nodule volume reduction at 6 months and last follow-up month after RFA and symptom score. CONCLUSION In summary, by pooling of these studies we recommended that RFA indeed has the advantages in improving outcomes and providing better prognosis for patients with benign TNs.
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Affiliation(s)
- Fen Chen
- Hepatobiliary and Pancreatic Intervention Center
| | - Guo Tian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine
| | | | - Liyun Zhong
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Tian’an Jiang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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246
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Kohlhase KD, Korkusuz Y, Gröner D, Erbelding C, Happel C, Luboldt W, Grünwald F. Bipolar radiofrequency ablation of benign thyroid nodules using a multiple overlapping shot technique in a 3-month follow-up. Int J Hyperthermia 2016; 32:511-6. [PMID: 27126512 DOI: 10.3109/02656736.2016.1149234] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose The aim of this study was to evaluate the decrease of benign thyroid nodules after bipolar radiofrequency ablation (RFA) in a 3-month follow-up using a multiple overlapping shot technique ('MOST'). Methods A total of 18 patients with 20 symptomatic benign thyroid nodules (17 cold nodules, 3 hyperfunctioning nodules) were treated in one single session by bipolar RFA. Bipolar ablation was performed using MOST. The nodule volumes were measured prior to ablation and 3 months after the procedure using ultrasound. The population consisted of either solid (>80% solid tissue within the volume of interest), complex, or cystic nodules (<20% solid tissue within the volume of interest). Results Bipolar RFA resulted in a highly significant (p < 0.0001) decrease of nodule volume (ΔV), median 5.3 mL (range 0.13-43.1 mL), corresponding to a relative reduction in mean of 56 ± 17.9%. Median initial volume was 8 mL (range 0.48-62 mL); 3 months after ablation a median volume of 2.3 mL (range 0.3-32 mL) was measured. Nodule growth ≥50% occurred in 70% (14 nodules). At the follow-up no complications such as infections, persisting pain, nerve injuries or immunogen stimulation occurred. Patients with cold nodules (15) remained euthyroid, with hyperfunctioning nodules either euthyroid (2) or latent hypofunctional (1). Conclusion The use of bipolar RFA is an effective, safe and suitable thermoablative technique to treat benign thyroid nodules. Combined with the multiple overlapping shot technique it allows sufficient ablation.
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Affiliation(s)
| | - Yücel Korkusuz
- a Department of Nuclear Medicine , University Hospital , Frankfurt , Germany
| | - Daniel Gröner
- a Department of Nuclear Medicine , University Hospital , Frankfurt , Germany
| | - Christian Erbelding
- a Department of Nuclear Medicine , University Hospital , Frankfurt , Germany
| | - Christian Happel
- a Department of Nuclear Medicine , University Hospital , Frankfurt , Germany ;,b German Centre for Thermoablation of Thyroid Nodules, University Hospital , Frankfurt , Germany
| | - Wolfgang Luboldt
- c Department of Diagnostic and Interventional Radiology , University Hospital , Frankfurt , Germany
| | - Frank Grünwald
- a Department of Nuclear Medicine , University Hospital , Frankfurt , Germany ;,b German Centre for Thermoablation of Thyroid Nodules, University Hospital , Frankfurt , Germany
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247
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Koo HJ, Lee JH, Kim GY, Choi YJ, Baek JH, Choi SH, Nam SY, Kim SY, Suh DC. Ethanol and/or radiofrequency ablation to treat venolymphatic malformations that manifest as a bulging mass in the head and neck. Clin Radiol 2016; 71:1070.e1-1070.e7. [PMID: 27076254 DOI: 10.1016/j.crad.2016.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/13/2016] [Accepted: 03/14/2016] [Indexed: 12/18/2022]
Abstract
AIM To evaluate the efficacy of ultrasound (US)-guided ethanol ablation (EA) and radiofrequency ablation (RFA) for treating venolymphatic malformations (VLM) of the head and neck. MATERIALS AND METHODS US-guided EA and/or RFA were performed on 17 patients with VLM of the head and neck. Computed tomography (CT) or magnetic resonance imaging (MRI) was used to locate the cranial nerves and salivary gland ducts that were close to targets, and these were avoided during the procedures. Treatment response was assessed using volume reduction and cosmetic grading scoring. RESULTS Nine VLMs were located close to the functional structures: Stensen's duct (n=3), cranial nerve branch (n=3), or both (n=3). All patients demonstrated >50% volume reduction, except one patient with a microcystic lymphatic malformation that was abutting the facial nerve. Median cosmetic grading scores improved from 4 to 1 (p<0.001). CONCLUSION US-guided EA and/or RFA are effective and safe treatment methods in patients with VLMs of the head and neck. Treatment selection of EA and/or RFA could be performed based on the composition of VLMs as assessed at CT and MRI.
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Affiliation(s)
- H J Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - J H Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - G Y Kim
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Y J Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - J H Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - S-H Choi
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - S Y Nam
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - S Y Kim
- Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - D C Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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248
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Aysan E, Idiz UO, Akbulut H, Elmas L. Single-session radiofrequency ablation on benign thyroid nodules: a prospective single center study : Radiofrequency ablation on thyroid. Langenbecks Arch Surg 2016; 401:357-63. [PMID: 27013327 DOI: 10.1007/s00423-016-1408-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The activity of the application of single-session ultrasonography (US)-guided percutaneous radio frequency ablation (RFA) in benign thyroid nodules was investigated in this prospective clinical study. METHODS RFA treatment was applied to 100 nodules in 100 patients (78 women, 22 men; average age 44.5 years old; age range 18-71) who had euthyroid condition, nodule size larger than 1 cm in the ultrasonography, proven to be benign by fine needle aspiration cytology. The nodules were separated into three groups according to the content: solid, cystic and mixed. In first 73 cases, the process performed under local anesthesia and the other 27 cases were performed under general anesthesia. RFA process was standardized to 70 W in all of the patients, and a moving shot technique was used. The results acquired in the third and sixth months of the controls were evaluated, and the volume of the nodules was screened. RESULTS No differences between the thyroid function tests performed before and after RFA were detected (p > 0.05). The mean volume of the nodules before the process, in the third month after the process, and in the sixth month were 16.8, 4.8, and 2.6 ml, respectively (p < 0.001). The decrease in cystic nodules was greater than solid and mixed structures. Temporary hoarseness occurred in one case and skin edema was detected in a patient at the isthmus. CONCLUSIONS RFA is an option for treatment, with minimal invasiveness and a low complication rate, and it is effective primarily in cases with benign nodules and nodular goiter. In cases with good compliance, the likelihood of success is greater. General anesthesia can be a good option for anxious cases to gather better results.
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Affiliation(s)
- Erhan Aysan
- Department of General Surgery, Bezmialem Vakif University, Faculty of Medicine, Fatih, Istanbul, Turkey
| | - Ufuk Oguz Idiz
- Department of General Surgery, Bezmialem Vakif University, Faculty of Medicine, Fatih, Istanbul, Turkey. .,Sisli Etfal Training and Research Hospital, Department of General Surgery, Istanbul, Turkey.
| | - Huseyin Akbulut
- Department of General Surgery, Bezmialem Vakif University, Faculty of Medicine, Fatih, Istanbul, Turkey
| | - Leyla Elmas
- Department of General Surgery, Bezmialem Vakif University, Faculty of Medicine, Fatih, Istanbul, Turkey
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249
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Ahn HS, Kim SJ, Park SH, Seo M. Radiofrequency ablation of benign thyroid nodules: evaluation of the treatment efficacy using ultrasonography. Ultrasonography 2016; 35:244-52. [PMID: 27101983 PMCID: PMC4939722 DOI: 10.14366/usg.15083] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 02/01/2023] Open
Abstract
Purpose: The aim of this study was to evaluate the efficacy of radiofrequency (RF) ablation for benign thyroid nodules and assess the usefulness of internal factors (ultrasonographic findings) and external factors (treatment-related findings) in prediction of treatment efficacy. Methods: We evaluated 22 benign thyroid nodules from 19 patients treated with RF ablation between March 2010 and January 2013. The internal and external factors of these nodules were retrospectively reviewed and correlated with the therapeutic success and the volume reduction ratio (VRR). The volume and size of the nodules were determined before treatment, and the VRR was calculated at 6-month and 1-year follow-up examinations after RF ablation. Therapeutic success was defined as a >50% volume reduction. Results: The mean VRRs were 66.1±18.7% at 6 months and 74.3±16.7% at 1 year. The therapeutic success rate after 6 months and 1 year was 81.8% and 90.9%, respectively. At the 1-year follow-up, the margin of the nodule correlated with therapeutic success. Most of the successfully ablated nodules showed well-defined margins on initial ultrasonography (18/20, 90%) (P=0.026). In addition, nodules with ill-defined margins showed a tendency toward having a low VRR at the 6-month and 1-year follow-up examinations. Conclusion: RF ablation was effective in decreasing the volume of benign thyroid nodules. Thyroid nodules with well-defined margins tended to show successful outcomes at the 1-year follow-up examination after RF ablation.
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Affiliation(s)
- Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, New Korea Hospital/Human Medical Imaging and Intervention Center, Gimpo, Korea
| | - Sung Hee Park
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Mirinae Seo
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
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250
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Lee MT, Wang CY. Case Experience of Radiofrequency Ablation for Benign Thyroid Nodules: From an Ex Vivo Animal Study to an Initial Ablation in Taiwan. J Med Ultrasound 2016. [DOI: 10.1016/j.jmu.2016.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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