1
|
Clark RDE, Luo X, Issa PP, Tufano RP, Kandil E. A clinical practice review of percutaneous ethanol injection for thyroid nodules: state of the art for benign, cystic lesions. Gland Surg 2024; 13:108-116. [PMID: 38323234 PMCID: PMC10839701 DOI: 10.21037/gs-22-568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 04/21/2023] [Indexed: 02/08/2024]
Abstract
Percutaneous ethanol injection (PEI) is a widely used treatment option for cystic and predominantly cystic thyroid nodules. It has several advantages over other treatment modalities. Compared to surgery, PEI is less painful, can be performed in the outpatient setting, and carries less risk of transient or permanent side effects. Compared to other minimally invasive techniques such as radiofrequency ablation (RFA), PEI is less expensive and does not require specialized equipment. PEI performs well in the context of cystic nodules. PEI does not perform as well as other techniques in solid nodules, so its use as a primary treatment is limited to cystic and predominantly cystic thyroid nodules. However, PEI is also being explored as an adjunct treatment to improve ablation of solid nodules with other techniques. Here, we provide a clinical review discussing the genesis, mechanism of action, and patient selection with respect to ethanol ablation, as well as the procedure itself. Predictors of operative success, failure, and common adverse events are also summarized. Altogether, PEI allows impressive volume reduction rates with minimal complications. Several recent studies have also evaluated the long-term impact of PEI up to 10 years after treatment and revealed maintenance of robust treatment efficacy with no undesirable long-term sequelae. Thus, PEI remains the treatment of choice for benign but symptomatic cystic and predominantly cystic thyroid nodules.
Collapse
Affiliation(s)
| | - Xinyi Luo
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Peter P. Issa
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Ralph P. Tufano
- Sarasota Memorial Health Care System Multidisciplinary Thyroid and Parathyroid Center, Sarasota, FL, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| |
Collapse
|
2
|
Min X, Zhang Z, Chen Y, Zhao S, Ge J, Zhao H, Cai Y, Chen H, Shao J, Jing Y, Chen B. Comparison of the effectiveness of lauromacrogol injection for ablation and microwave ablation in the treatment of predominantly cystic thyroid nodules: a multicentre study. BMC Cancer 2023; 23:785. [PMID: 37612615 PMCID: PMC10464182 DOI: 10.1186/s12885-023-11301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE To compare the therapeutic efficacy and safety of microwave ablation (MWA) and lauromacrogol injection for ablation (LIA) for benign predominantly cystic thyroid nodules. MATERIALS AND METHODS In this retrospective study, 85 patients with predominantly cystic thyroid nodules (PCTNs) who underwent microwave ablation (MWA) or lauromacrogol injection for ablation (LIA) between June 2019 and August 2022 at three hospitals were included in our research. Forty-six patients were treated with microwave ablation, and thirty-nine patients were treated with lauromacrogol injection for ablation. The baseline characteristics, nodal volume, volume reduction rate (VRR), and incidence of postoperative complications were compared between these two groups. RESULTS After treatment, there were significant differences in the thyroid nodule volume and the volume reduction rate (VRR) at different follow-up times between the groups (p < 0.001). There were no significant differences in the nodal volume or the volume reduction rate (VRR) between the MWA group and the LIA group at 1, 3, 6, and 12 months (p > 0.05). Of note, no serious intraoperative or postoperative complications occurred in the corresponding group. CONCLUSION MWA and LIA are very effective and safe strategies for the treatment of predominantly cystic thyroid nodules. However, LIA is more advantageous in that it is less expensive and has a shorter length of hospital stay than MWA.
Collapse
Affiliation(s)
- Xin Min
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Zheng Zhang
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Yanwei Chen
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Shuangshuang Zhao
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Jingwen Ge
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Huajiao Zhao
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Yun Cai
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Hui Chen
- Department of Medical Ultrasound, Changzhou First People’s Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003 China
| | - Jun Shao
- Department of Medical Ultrasound, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, 215132 China
| | - Yanfei Jing
- Department of Medical Ultrasound, The Fifth People’s Hospital of Wuxi, The Medical School of Jiangnan University, Wuxi, 214000 Jiangsu China
| | - Baoding Chen
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| |
Collapse
|
3
|
Xia B, Yu B, Wang X, Ma Y, Liu F, Gong Y, Zou X, Lei J, Su A, Wei T, Zhu J, Lu Q, Li Z. Conspicuousness and recurrence related factors of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules. BMC Surg 2021; 21:317. [PMID: 34344330 PMCID: PMC8336359 DOI: 10.1186/s12893-021-01312-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Objective Microwave ablation (MWA) is a minimally invasive technique for the treatment of benign thyroid nodules. The purpose of this study was to evaluate efficacy and safety of ultrasound-guided MWA in the treatment of benign thyroid nodules, and to find out the recurrence related factors, so as to provide reference for future clinical work. Methods This study retrospectively analyzed the patients who received ultrasound-guided MWA for benign thyroid nodules in our hospital from October 2018 to March 2020. A total of 214 patients were included in the study. We assessed thyroid volume changes (represented by volume reduction ratio VRR), the energy per 1 mL reduction in nodular volume (represented by energy volume ratio ΔE), the serum levels of free triiodide thyroid hormone (FT3), free thyroxine (FT4), thyrotropin (TSH) and complications after MWA treatment. Results There were a total of 306 nodules in 214 patients, including 183 (85.51%) females and 31 (14.49%) males. The median diameter and volume of the nodule were 33 mm and 8.01 mL. The VRR at 1 month, 3 months, 6 months and 12 months were 40.79%, 60.37%, 74.59% and 85.60%, respectively. In addition, MWA had a better ablation effect for small nodules (initial volume ≤ 10 mL). In recurrent studies, we found that ΔE was an independent risk factor for benign thyroid nodules (P < 0.05). Conclusions Ultrasound-guided MWA is effective and safe in the treatment of benign thyroid nodules. In addition, it has little damage to surrounding tissues and no effect on thyroid function. Especially, the nodules with smaller initial volume, the treatment is better. On the other hand, the energy per 1 mL reduction ΔE in nodular volume may be associated with nodular recurrence, which requires further follow-up for longer periods. At this stage, we consider that ultrasound-guided MWA can be used as one of the main clinical treatment methods for benign thyroid nodules.
Collapse
Affiliation(s)
- Baoying Xia
- Department of Thyroid, Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Boyang Yu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaofei Wang
- Department of Thyroid, Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yu Ma
- Department of Thyroid, Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Feng Liu
- Department of Thyroid, Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yanping Gong
- Department of Thyroid, Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiuhe Zou
- Department of Thyroid, Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jianyong Lei
- Department of Thyroid, Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Anping Su
- Department of Thyroid, Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tao Wei
- Department of Thyroid, Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jingqiang Zhu
- Department of Thyroid, Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiang Lu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Zhihui Li
- Department of Thyroid, Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
4
|
Nguyen VB, Nguyen TX, Nguyen VVH, Nguyen HT, Nguyen DT, Le CV. Efficacy and Safety of Single-Session Radiofrequency Ablation in Treating Benign Thyroid Nodules: A Short-Term Prospective Cohort Study. Int J Endocrinol 2021; 2021:7556393. [PMID: 34552630 PMCID: PMC8452432 DOI: 10.1155/2021/7556393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/15/2021] [Accepted: 09/02/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The aims of this study are to evaluate the safety and efficacy of RFA in the treatment of benign thyroid nodule(s) and to find independent factors related to the volume reduction rate of the nodule(s). MATERIALS AND METHODS This short-term prospective study from a single medical center was conducted on 93 benign thyroid nodules in 93 patients treated with RFA. Two basic techniques were used: the trans-isthmic approach and moving-shot technique. Clinical and ultrasonography examinations were performed at 1- and 3-month follow-up after the treatment session. Primary outcomes included volume reduction ratio (VRR) at 1-month and 3-month follow-ups; secondary outcomes were therapeutic success rate and complications. Multiple linear regression analysis was used to determine independent factors associated with VRR. RESULTS A final sample of 78 patients with 78 nodules, given participant rate 83.8% (including 60 solid nodules, 16 predominantly cystic nodules, and 2 thyroid cysts), was followed up for 3 months. The mean volume reduction ratio was 41.47% and 64.72% after 1-month and 3-month follow-ups, respectively. The therapeutic success rate was 30.8% at 1-month and 84.6% at 3-month follow-ups. Symptom score and cosmetic score improved significantly. There was no change in thyroid function tests. Two minor complications (transient voice change) were found. The multiple linear regression analysis showed that the internal component of the nodules significantly related to the VRR during the 3-month follow-up (β = 23.00; 95%CI (7.59-38.45)). CONCLUSION RFA was demonstrated as a safe and effective option for benign thyroid nodules treatment. It can be used as an alternative treatment with encouraging results.
Collapse
Affiliation(s)
- Van Bang Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Thi Xuan Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Van Vy Hau Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Hai Thuy Nguyen
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Dinh Toan Nguyen
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Chi Van Le
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| |
Collapse
|
5
|
Dong P, Wu XL, Sui GQ, Luo Q, Du JR, Wang H, Teng DK. The efficacy and safety of microwave ablation versus lobectomy for the treatment of benign thyroid nodules greater than 4 cm. Endocrine 2021; 71:113-121. [PMID: 32419083 DOI: 10.1007/s12020-020-02338-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the safety and effectiveness of microwave ablation (MWA) versus lobectomy for the treatment of benign thyroid nodules > 4 cm. METHODS We retrospectively analyzed the data of 48 patients who underwent MWA and 53 patients who underwent lobectomy to treat benign thyroid nodules > 4 cm. The patients were followed up for 12 months. The volume reduction ratio (VRR) was calculated. The operation time, incision length, hospitalization time, complications, thyroid function, symptoms, and cosmetic improvement were analyzed and compared between the two groups. RESULTS During the 12-month follow-up, the mean nodule volume in the MWA group was reduced from 36.1 ± 23.1 to 4.0 ± 4.1 ml, and the mean VRR of the nodules was 90 ± 5% in the MWA group, which was comparable with that in the surgery group. No significant postoperative change in thyroid function was observed in the MWA group. Compared with the surgery group, the incidence of complications and postoperative pain in the MWA group were lower, the operation time, incision length, and hospitalization time in the MWA group were shorter, and satisfaction with the esthetic results in the MWA group was greater. CONCLUSION MWA is safe and effective for the treatment of benign thyroid nodules > 4 cm. Moreover, MWA is associated with a faster recovery, fewer complications, better protection of thyroid function, and superior esthetic results relative to thyroid lobectomy.
Collapse
Affiliation(s)
- Peng Dong
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130000, Jilin, China
| | - Xiao-Li Wu
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, 130000, Jilin, China
| | - Guo-Qing Sui
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130000, Jilin, China
| | - Qiang Luo
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130000, Jilin, China
| | - Jia-Rui Du
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130000, Jilin, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130000, Jilin, China.
| | - Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130000, Jilin, China.
| |
Collapse
|
6
|
Guan SH, Wang H, Teng DK. Comparison of ultrasound-guided thermal ablation and conventional thyroidectomy for benign thyroid nodules: a systematic review and meta-analysis. Int J Hyperthermia 2020; 37:442-449. [PMID: 32369708 DOI: 10.1080/02656736.2020.1758802] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To compare the safety and efficacy of ultrasound-guided thermal ablation and conventional thyroidectomy for benign thyroid nodules (TNs) by performing a systematic review and meta-analysis.Methods: We searched PubMed, Embase, Web of Science and Cochrane Library databases for clinical trials from the date of their inception to 1 April 2019. Two investigators independently examined the trials to select qualified studies, extracted relevant information and assessed the risk of bias according to the Cochrane Collaboration checklist (Oxford, UK). The primary study outcomes were safety (hoarseness, hypothyroidism and postoperative pain) and efficacy (symptom improvement, postoperative cosmetic effects and hospitalization time). This study is registered with PROSPERO (CRD42019125643).Results: Seven studies involving 1289 patients were included. The results demonstrated that the incidences of hoarseness [odds ratio (OR) 0.33, 95% confidence interval (95% CI) (0.14, 0.79)], hypothyroidism [risk difference (RD) -0.31, 95% CI (-0.34, -0.28)] and postoperative pain [OR 0.35, 95% CI (0.25, 0.49)] were lower, and the hospitalization time was shorter [standard mean difference (SMD) -4.01, 95% CI (-4.22, -3.81)], in the thermal ablation group than in the conventional thyroidectomy group, and postoperative cosmetic effects were better [relative risk (RR) ratio 1.12, 95% CI (1.01, 1.24)] (p < 0.05). For symptom improvement, the difference was not statistically significant.Conclusions: This study shows that for benign TNs, ultrasound-guided thermal ablation may have potential advantages in terms of safety, cosmetic effects and shorter hospitalization time compared with conventional thyroidectomy, while symptom improvement is the same.
Collapse
Affiliation(s)
- Shi-Hui Guan
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| |
Collapse
|
7
|
Lee J, Shin JH, Hahn SY, Park KW, Choi JS. Feasibility of Adjustable Electrodes for Radiofrequency Ablation of Benign Thyroid Nodules. Korean J Radiol 2020; 21:377-383. [PMID: 32090530 PMCID: PMC7039717 DOI: 10.3348/kjr.2019.0724] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/29/2019] [Indexed: 02/06/2023] Open
Abstract
Objective The purpose of this study was to evaluate a novel radiofrequency ablation (RFA) application utilizing an adjustable electrode for treatment of benign thyroid nodules. Materials and Methods From April 2011 to December 2018, 21 patients underwent RFA treatment on 21 thyroid nodules, utilizing an 18-gauge internally cooled electrode equipped with a size adjustable active tip. The peripheral nodule portions were ablated with the moving-shot technique and a shorter active tip, and the nodule centers were ablated with the fixed technique and a longer active tip. We assessed parameters including characteristics of the treated nodules, use of variablesized active tips, volume reduction rate, therapeutic success rate, and post-procedural complications. The therapeutic success rate was defined as a > 50% volume reduction of the initial nodule volume at the 6- or 12-month follow-up. Results The treated thyroid nodules were large enough to cause symptoms (mean volume, 29.6 mL). Two types of active tips per session were used for all nodules. The mean volume reduction rate at the last follow-up was 68.3 ± 4.4% and our therapeutic success rate was 90.5%. Both symptoms and cosmetic scores decreased significantly. Minor complications in three patients were recorded during and after the procedure. Conclusion This initial study demonstrated that an adjustable electrode for RFA of benign thyroid nodules effectively and safely resulted in volume reduction.
Collapse
Affiliation(s)
- Jiyeong Lee
- 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.
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ko Woon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Soo Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Liao LJ, Wang CT, Huang TW, Cheng PW, Lo WC. Ultrasound-guided-fine-needle Aspiration Drainage and Percutaneous Ethanol Injection for Benign Neck Cysts. J Med Ultrasound 2020; 28:225-229. [PMID: 33659161 PMCID: PMC7869730 DOI: 10.4103/jmu.jmu_111_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/10/2020] [Accepted: 02/12/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Ultrasound-guided-fine-needle aspiration drainage (US-FNAD) and US-percutaneous ethanol injection (US-PEI) have been widely used in the management of benign neck cysts. However, the long-term results of US-FNAD and US-PEI are not well elucidated. Methods: We retrospectively collated patients under neck US examinations from March 2007 to December 2017 and investigated the recurrence after US-FNAD and US-PEI. Univariate and multivariate Cox regression analyses were used to assess significant risk factors for recurrence after US-FNAD. Results: A total of 1075 patients were recruited, and their age was 50 ± 15 (mean ± standard deviation) years. A total of 862 patients had thyroid cysts, 118 patients had thyroglossal duct cysts (TGDC), twenty patients had branchial cleft cysts, 64 patients had parotid sialocysts, and 11 patients had plunging ranulas. Majority of the patients (97%, 1037/1075) reported significant symptom improvement immediately. However, 38% of the patients had recurrence with a median 3-year follow-up period. In a multivariate Cox regression analysis with adjustment for age and gender, plunging ranula (hazard ratio [HR]: 2.44, 95% confidence interval [CI]: 1.19–4.99) and lateral dimension size ≥ 0.8 cm (HR: 1.32, 95% CI: 1.04–1.67) after US-FNAD were independent risk factors for recurrence. There were 15 male and 19 female patients who received US-PEI therapy after repeated US-FNAD, of whom 23 patients had thyroid cysts, 6 had plunging ranulas, 4 had TGDC, and one had a branchial cleft cyst. The overall success rate was 94% (32/34), with a median follow-up period of 1.6 years. Two recurrent symptomatic patients had plunging ranulas. Some patients stated mild pain (21%, 7/34) and swelling sensation (26%, 9/34) after the injection. No major complications, such as vocal fold paresis or airway compression, were found. Conclusion: US-FNAD is an effective tool in the management of benign neck cysts with a 38% recurrence rate. Plunging ranulas have the highest rate of recurrence after FNAD. US-PEI is effective for most recurrent neck cysts after repeated US-FNAD.
Collapse
Affiliation(s)
- Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan.,Biomedical Engineering Office, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Biomedical Engineering Office, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Tsung-Wei Huang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
| |
Collapse
|
9
|
Hegedüs L, Frasoldati A, Negro R, Papini E. European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules. Eur Thyroid J 2020; 9:194-204. [PMID: 32903971 PMCID: PMC7445736 DOI: 10.1159/000506513] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/14/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Image-guided interventional ultrasound (US) techniques represent diagnostic and therapeutic tools for non-surgical management of thyroid nodular disease. We sought to investigate the attitude of European Thyroid Association (ETA) members towards the use of minimally invasive techniques (MIT) in diagnosis/therapy of symptomatic nodular goitre. METHODS ETA members were invited to participate in an online survey investigating the use of MIT in benign and malignant thyroid nodular disease. Of 865 invited members, 221 (25.5%) completed the survey. The respondents were from 40 countries; 139 (74.7%) were from European countries. RESULTS Respondents personally performed thyroid US (91.6%), Fine needle aspiration (FNA; 75.3%), ethanol ablation (EA; 22.1%), core needle biopsy (CNB; 11%) and thermal treatments (4.8%). When skills and/or technology were unavailable, only 13.4% referred patients "often" or "always" to other centres with specific expertise in this field. Surgery was the preferred first option in patients with recurrent cysts, 4.0 cm benign nodules, local (radioiodine-avid or non-avid) lymph node metastases, or papillary cancers <1.0 cm. For autonomously functioning nodules radioactive iodine treatment was the preferred choice, followed by surgery. Thermal ablation (TA) was the preferred option only for a 4 cm benign nodule in old patients with comorbidities. CONCLUSIONS US, US-guided FNA and surgery were available to nearly all respondents, while MIT was not. CNB and EA were employed only by about 1/3 of the respondents and TA procedures were available and personally performed only by a minority. For most thyroid lesions, surgery was the preferred option versus thermal therapies. The ETA needs to develop guidelines and establish teaching to overcome geographic inequality and promote the use of MIT as a valid therapy option in appropriate cases.
Collapse
Affiliation(s)
- Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Andrea Frasoldati
- Division of Endocrinology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Roberto Negro
- Division of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy
- *Roberto Negro, MD, Division of Endocrinology, “V. Fazzi” Hospital, Piazza Muratore, 1, IT–73100 Lecce (Italy),
| | - Enrico Papini
- Division of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Italy
| |
Collapse
|
10
|
Xu C, Su X, Ma S, Shu Y, Zhang Y, Hu Y, Mo X. Effects of Exercise Training in Postoperative Patients With Congenital Heart Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2020; 9:e013516. [PMID: 32070206 PMCID: PMC7335558 DOI: 10.1161/jaha.119.013516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The purpose of this meta‐analysis is to assess the effects of exercise training on quality of life, specific biomarkers, exercise capacity, and vascular function in congenital heart disease (CHD) subjects after surgery. Methods and Results We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE from the date of the inception of the database through April 2019. Altogether, 1161 records were identified in the literature search. Studies evaluating outcomes before and after exercise training among postoperative patients with congenital heart disease were included. The assessed outcomes were exercise capacity, vascular function, serum NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels and quality of life. We analyzed heterogeneity by using the I2 statistic and evaluated the evidence quality according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. Nine randomized controlled trials were included. The evidence indicated that exercise interventions increased the one of the quality of life questionnaire score (mean difference=3.19 [95% CI, 0.23, 6.16]; P=0.03; I2=39%) from the score before the interventions. However, no alterations in exercise capacity, vascular function, NT‐proBNP or quality of life were observed after exercise training. The results of the subgroup analysis showed that NT‐proBNP levels were lower in the group with exercise training than in the group without exercise training over the same duration of follow‐up. The evidence quality was generally assessed to be low. Conclusions In conclusion, there is insufficient evidence to suggest that physical exercise improves long‐term follow‐up outcomes of congenital heart disease, although it has some minor effects on quality of life.
Collapse
Affiliation(s)
- Cheng Xu
- Department of Cardiothoracic Surgery Children's Hospital of Nanjing Medical University Nanjing China
| | - Xiaoqi Su
- Department of Cardiothoracic Surgery Children's Hospital of Nanjing Medical University Nanjing China
| | - Siyu Ma
- Department of Cardiothoracic Surgery Children's Hospital of Nanjing Medical University Nanjing China
| | - Yaqin Shu
- Department of Cardiothoracic Surgery Children's Hospital of Nanjing Medical University Nanjing China
| | - Yuxi Zhang
- Department of Cardiothoracic Surgery Children's Hospital of Nanjing Medical University Nanjing China
| | - Yuanli Hu
- Department of Cardiothoracic Surgery Children's Hospital of Nanjing Medical University Nanjing China
| | - Xuming Mo
- Department of Cardiothoracic Surgery Children's Hospital of Nanjing Medical University Nanjing China
| |
Collapse
|
11
|
Kiel S, Ittermann T, Völzke H, Chenot JF, Angelow A. Frequency of thyroid function tests and examinations in participants of a population-based study. BMC Health Serv Res 2020; 20:70. [PMID: 32000765 PMCID: PMC6993310 DOI: 10.1186/s12913-020-4910-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thyroid disorders are common in the adult German population. Little is known about guideline implementation in clinical practice and the prevalence of diagnostic procedures in ambulatory care. The study aims to investigate the use of thyroid hormone measurements, thyroid ultrasound, thyroid scintiscan and associated costs in ambulatory care at population level. METHODS Data were derived from two independent population-based cohorts of the Study of Health In Pomerania (SHIP). Ambulatory billing data from the Association of Statutory Health Insurance Physicians Mecklenburg-Vorpommern were individually linked for the period 2002-2016 with SHIP data. The main outcomes were the frequency of outpatient ultrasound, scintiscan, serum TSH level measurement, free triiodothyronine (fT3) and free thyroxine (fT4) measurement, TSH-receptor-antibodies and microsomal antibodies measurement within 1 year and 3 years prior to the study entrance of the participants. Multinomial logistic regression models were used to assess the association of age, sex, thyroid medication intake and Charlson-Comorbidity-Index with frequency of TSH measurements and ultrasound examinations. RESULTS A total of 5552 participants (47% male, median age 55) were included in the analysis. 25% (1409/5552) had a diagnosed thyroid disorder or treatment, 40% (2191/5552) had clinical findings based on ultrasound or laboratory testing in SHIP only and 35% (1952/5552) neither a coded thyroid disorder or clinical finding nor thyroid medication. In the total study population 30% (1626/5552) received at least one TSH measurement, 6.8% (378/5552) at least one thyroid ultrasound and 2.6% (146/5552) at least one scintiscan within the past year before the study examination. Tests were performed more frequently in patients with thyroid medication and coded thyroid disorders. Hence, this group caused the highest expenditures. CONCLUSIONS Given the high prevalence of thyroid disorders, diagnostic and monitoring tests should be used rationally with regard to costs. TSH levels should be monitored regularly in patients on thyroid medication. A consensus on monitoring frequency and iteration of monitoring of morphological thyroid disorders with TSH and ultrasound and specific guideline recommendations are needed. TRIAL REGISTRATION Versorgungsforschung Deutschland (VfD_17_003880).
Collapse
Affiliation(s)
- Simone Kiel
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Fleischmannstraße 6, 17475, Greifswald, Germany.
| | - Till Ittermann
- Department of SHIP/ Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Department of SHIP/ Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jean-François Chenot
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Fleischmannstraße 6, 17475, Greifswald, Germany
| | - Aniela Angelow
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Fleischmannstraße 6, 17475, Greifswald, Germany
| |
Collapse
|
12
|
Singh Ospina N, Iñiguez-Ariza NM, Castro MR. Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment. BMJ 2020; 368:l6670. [PMID: 31911452 DOI: 10.1136/bmj.l6670] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient's values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.
Collapse
Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Nicole M Iñiguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - M Regina Castro
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
13
|
Vuong NL, Dinh LQ, Bang HT, Thuy TTM, Bac NH, Vy TT. Radiofrequency Ablation for Benign Thyroid Nodules: 1-Year Follow-Up in 184 Patients. World J Surg 2019; 43:2447-2453. [PMID: 31165252 DOI: 10.1007/s00268-019-05044-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benign thyroid nodules are common, and must be treated when symptomatic. Non-surgical minimally invasive modalities, including radiofrequency ablation (RFA), have been widely used with good results. The factors related to the efficacy of RFA are still debated. This study was to evaluate the safety, efficacy and related factors of RFA in the treatment of benign thyroid nodules. METHODS A retrospective single-center study was conducted on 251 benign thyroid nodules in 184 patients treated with RFA. The procedure was performed under ultrasound (US) guidance using the trans-isthmic approach and the moving-shot technique. Clinical and US examinations were performed at 1, 3, 6, 12 months, and then at 6 month intervals. Study outcomes were volume reduction ratio (VRR) and complications. RESULTS There were 153 women and 31 men included in the study. The mean age was 43.9 years. The median initial largest diameter and volume of nodules were 30 mm and 6.18 ml. The median length of follow-up was 12 months. Two minor complications were found. The mean VRR was 66.8; 74.3; and 81% after 3, 6, and 12 months, respectively. Initial solidity was a factor related to the efficacy: cystic nodules had higher VRR compared to solid ones. CONCLUSIONS RFA is safe, effective and can be used as a routine treatment for benign thyroid nodules. More prospective multicenter studies with long-term follow-up are required to improve the safety and efficacy of RFA.
Collapse
Affiliation(s)
- Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Quang Dinh
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ho Tat Bang
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Thi Mai Thuy
- Department of Medical Imaging, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Bac
- University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Thanh Vy
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
| |
Collapse
|
14
|
He X, Wu D, Hu C, Xu T, Liu Y, Liu C, Xu B, Tang W. Role of Metformin in the Treatment of Patients with Thyroid Nodules and Insulin Resistance: A Systematic Review and Meta-Analysis. Thyroid 2019; 29:359-367. [PMID: 30595105 DOI: 10.1089/thy.2017.0707] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Metformin is the most-prescribed oral medication to lower blood glucose worldwide. Some data suggest that metformin may have a role in the treatment of patients with thyroid nodules, but contrasting results are reported in different settings. This study explores and critically reevaluates the knowledge on this topic. METHODS A literature search identified 250 records. Studies evaluating the size of thyroid nodules before and after metformin treatment were included. Assessed outcomes were the size of thyroid nodules, thyrotropin (TSH) level, thyroid gland volume, and insulin resistance index (HOMA-IR). After screening and full-text assessment, five studies were included in the systematic review. Random-effects meta-analyses of the standardized mean difference (SMD) were performed for the four outcomes of interest. Heterogeneity was estimated using I2, and the quality of evidence was assessed for each outcome using the Grading of Recommendations Assessment, Development, and Evaluation guidelines. RESULTS A total of 189 patients were included in the final analysis. After metformin treatment, a slight but significant reduction in thyroid nodule size was found in four studies, which included a total of 167 patients (SMD 0.46 [confidence interval (CI) 0.00-0.93]; p = 0.05). Similarly, in four studies reporting on a total of 146 patients, significant reductions in TSH level (SMD 0.30 [CI 0.07-0.53]; p = 0.01) and HOMA-IR level (SMD 0.90 [CI 0.12-1.67]; p = 0.02) were reported after treatment with metformin. In two studies, which included 114 patients, no change in thyroid gland volume was discovered after treatment with metformin (SMD 0.21 [CI -0.05 to 0.47]; p = 0.11). Quality of evidence was generally assessed as low or very low. CONCLUSIONS Metformin induces reductions in thyroid nodule size and TSH and HOMA-IR levels in patients with thyroid nodules and insulin resistance. In contrast, no change in thyroid gland volumes was found. Whether metformin treatment for thyroid nodules has clinical significance remains to be demonstrated.
Collapse
Affiliation(s)
- Xiaowei He
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
| | - Dan Wu
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
| | - Cuining Hu
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
| | - Ting Xu
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
| | - Yuanxin Liu
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
| | - Chao Liu
- 2 Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R. China
- 3 Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, P.R. China
| | - Bo Xu
- 4 School of Public Health, Nanjing Medical University, Nanjing, P.R. China
| | - Wei Tang
- 1 Department of Endocrinology and Metabolism, Diabetes Care & Research Center, Nanjing Medical University Affiliated Geriatric Hospital, Jiangsu Province Geriatric Hospital, Jiangsu Province Institute of Geriatrics, Nanjing, P.R. China
| |
Collapse
|
15
|
Kim JH, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, Choi YJ, Chung SR, Ha EJ, Hahn SY, Jung SL, Kim DS, Kim SJ, Kim YK, Lee CY, Lee JH, Lee KH, Lee YH, Park JS, Park H, Shin JH, Suh CH, Sung JY, Sim JS, Youn I, Choi M, Na DG. 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology. Korean J Radiol 2018; 19:632-655. [PMID: 29962870 PMCID: PMC6005940 DOI: 10.3348/kjr.2018.19.4.632] [Citation(s) in RCA: 363] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023] Open
Abstract
Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology (KSThR) developed recommendations for the optimal use of radiofrequency ablation for thyroid tumors in 2012. As new meaningful evidences have accumulated, KSThR decided to revise the guidelines. The revised guideline is based on a comprehensive analysis of the current literature and expert consensus.
Collapse
Affiliation(s)
- Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea
| | - Hye Shin Ahn
- Department of Radiology and Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea
| | - Seon Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan 48101, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul 03181, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul 06351, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Dae Sik Kim
- Department of Radiolgy, Incheon Medical Center, Incheon 22532, Korea.,Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea
| | - Soo Jin Kim
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea.,Department of Radiology, New Korea Hospital, Kimpo 10086, Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kwang Hwi Lee
- Department of Radiology, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, UAE
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul 04763, Korea
| | - Hyesun Park
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul 06351, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jin Yong Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam 13590, Korea
| | - Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul 03181, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul 04554, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea.,Department of Radiology, GangNeung Asan Hospital, Gangneung 25440, Korea
| | | |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Rossi M, Lupo S, Rossi R, Franceschetti P, Trasforini G, Bruni S, Tagliati F, Buratto M, Lanza G, Damiani L, Degli Uberti E, Zatelli MC. Proposal for a novel management of indeterminate thyroid nodules on the basis of cytopathological subclasses. Endocrine 2017; 57:98-107. [PMID: 27623969 DOI: 10.1007/s12020-016-1105-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/25/2016] [Indexed: 01/19/2023]
Abstract
Indeterminate thyroid nodules include heterogeneous lesions that could benefit from a differential management. Our aim is to better define the management of the Bethesda System for Reporting Thyroid Cytopathology class III and IV nodules, by identifying cytological subcategories among Bethesda System for Reporting Thyroid Cytopathology class III associated with different clinical risk, by means of ultrasound, repeated FNAB, and BRAFV600E molecular analysis. We also evaluated the outcome of nodules not operated, over a 5-year follow-up. Out of 460 nodules (269 Bethesda System for Reporting Thyroid Cytopathology class III and 191 Bethesda System for Reporting Thyroid Cytopathology class IV), 344 were operated on surgical group and 116 followed-up conservatively (follow-up group). Bethesda System for Reporting Thyroid Cytopathology class III was divided into four subcategories on the basis of cytomorphological features (III-1, III-2, III-3, III-4). Clinical risk was defined on the basis of histological, cytological, and ultrasound data. Malignancy was higher in Bethesda System for Reporting Thyroid Cytopathology class III vs. Bethesda System for Reporting Thyroid Cytopathology class IV (34.4 vs. 26.2 %; p < 0.01). Papillary thyroid carcinoma was the most frequent cancer in each Bethesda System for Reporting Thyroid Cytopathology class (35 %). BRAFV600E diagnostic accuracy was 87 %. Repeated FNAB reclassified as benign nearly 40 % of nodules, selecting patients where surgery could be spared. Significant nodule growth occurred in 13.7 % of nodules, belonging mostly to Bethesda System for Reporting Thyroid Cytopathology class III-2 and Bethesda System for Reporting Thyroid Cytopathology class IV. Overall clinical risk was higher in Bethesda System for Reporting Thyroid Cytopathology III-1, III-4, and IV classes. We propose a differential management of Bethesda System for Reporting Thyroid Cytopathology III and IV classes and related subcategories: surgery may be indicated in Bethesda System for Reporting Thyroid Cytopathology class III-1, III-4, and IV; a conservative follow-up avoiding repeated FNAB may be appropriated in class III-3, while repeated FNAB may be useful in class III-2.
Collapse
Affiliation(s)
- Martina Rossi
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Sabrina Lupo
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Roberta Rossi
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Paola Franceschetti
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Giorgio Trasforini
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Stefania Bruni
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Federico Tagliati
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Mattia Buratto
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Giovanni Lanza
- Section of Pathology and Biomolecular Diagnostics, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Luca Damiani
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Ettore Degli Uberti
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy.
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy.
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Lang BHH, Wu ALH. High intensity focused ultrasound (HIFU) ablation of benign thyroid nodules - a systematic review. J Ther Ultrasound 2017; 5:11. [PMID: 28523127 PMCID: PMC5434558 DOI: 10.1186/s40349-017-0091-1] [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: 01/06/2017] [Accepted: 02/09/2017] [Indexed: 12/13/2022] Open
Abstract
Background With an increasing number of imaging studies being done nowadays, the number of incidentally discovered thyroid nodules is expected to rise. Although many of these nodules are small and benign in nature, some do grow and may cause pressure and/or thyrotoxic symptoms. Surgical resection has traditionally been recommended for symptomatic nodules but is associated with risk of hypothyroidism, bleeding, infection, and nerve damage. High intensity focused ultrasound (HIFU) is one of the non-surgical thermal ablation techniques that may serve as an alternative in the treatment of benign thyroid nodules. The present review is to systematically evaluate the efficacy and safety of HIFU ablation. Methods We comprehensively searched all studies that evaluated the use of HIFU ablation as a treatment of benign thyroid nodules from Medline (PubMed) and Cochrane Library electronic databases using specific keywords. All titles identified by the search strategy were independently screened by two authors. Case reports, animal studies, editorials, expert opinions, reviews without original data and studies on pediatric population were excluded. Multiple reports of the same dataset were assessed and the most representative and updated report of a study was included. Results Five original studies were found. All treated thyroid nodules were confirmed to be benign cytologically and either appeared solid or predominantly (>70%) solid on ultrasonography. Only one type of commercially available US-guided device with an extracorporeal probe (3 MHz) was used in all the reported treatments. No major complications including recurrent laryngeal nerve injury, skin burn or haematoma were reported in all of the studies. The overall nodule volume reduction after single session of HIFU ablation ranged between 45 and 68%, depending on nodule size and length of follow-up. Conclusions Despite the few number of studies, our review appeared to suggest that HIFU is a safe and efficacious method of treating symptomatic benign thyroid nodules. However, larger-scale, prospective trials with longer follow-up period are indeed required to confirm this. In terms of the ablation itself, relative to other ablation techniques, there are still much room for improvements in shortening treatment duration and expanding the range of treatable nodules.
Collapse
Affiliation(s)
- Brian Hung-Hin Lang
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR China.,Department of Surgery, Division of Endocrine Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, SAR China
| | - Arnold L H Wu
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR China
| |
Collapse
|
20
|
Negro R, Attanasio R, Grimaldi F, Frasoldati A, Guglielmi R, Papini E. A 2016 Italian Survey about Guidelines and Clinical Management of Thyroid Nodules. Eur Thyroid J 2017; 6:75-81. [PMID: 28589088 PMCID: PMC5422755 DOI: 10.1159/000453032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/28/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND While thyroid nodules are frequent in endocrine clinical practice, patients are often asymptomatic and euthyroid, and death is rare in cases of malignancy. OBJECTIVES To evaluate the perception of current international guidelines regarding thyroid nodule management among Italian endocrinologists, and to compare daily clinical practice with suggested recommendations. METHODS Italian Association of Clinical Endocrinologists (AME) members were invited to participate in a Web-based survey. RESULTS A total of 566 physicians responded. About 50% had read the full text of the guidelines. Over half appreciated the suggested ultrasound (US) risk categories. Fine-needle aspiration (FNA) was obtained more frequently than recommended. Follow-up of a cytologically benign nodule was largely performed according to the guidelines. Molecular testing would be most commonly requested when cytology reports showed atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (TIR3A for Italian System). Iodine and/or levothyroxine were largely prescribed for cytologically benign asymptomatic nodules. Laser/radiofrequency ablation and percutaneous ethanol injection were commonly considered as alternatives to surgery (46.2 and 71.4%, respectively). CONCLUSIONS Efforts are needed to make the guidelines more user-friendly and to encourage the use of codified risk categories in thyroid US reports. FNA indications remain a matter of debate as FNA is obtained in clinical practice more often than is recommended. Current US follow-up modalities for a benign nodule are correct, but probably could be performed less frequently without any harm. Molecular testing, if accessible, would be helpful in guiding clinicians' strategies in cases of AUS/FLUS-TIR3A cytologic results. Nonsurgical procedures are favorably embraced.
Collapse
Affiliation(s)
- Roberto Negro
- Division of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy
- *Roberto Negro, MD, FACE, Division of Endocrinology, “V. Fazzi” Hospital, Piazza Muratore 1, IT-73100 Lecce (Italy), E-Mail
| | | | - Franco Grimaldi
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia,” Udine, Italy
| | - Andrea Frasoldati
- Division of Endocrinology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Italy
| | - Enrico Papini
- Department of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Italy
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Reverter JL, Alonso N, Avila M, Lucas A, Mauricio D, Puig-Domingo M. Evaluation of efficacy, safety, pain perception and health-related quality of life of percutaneous ethanol injection as first-line treatment in symptomatic thyroid cysts. BMC Endocr Disord 2015; 15:73. [PMID: 26610707 PMCID: PMC4661972 DOI: 10.1186/s12902-015-0069-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 11/16/2015] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND To evaluate the efficacy, safety, pain perception and health-related quality of life (QoL) of percutaneous ethanol injection treatment (PEIT) as an alternative to thyroid surgery in symptomatic thyroid cysts. METHODS Thirty consecutive patients (46 ± 10 years; 82% women) with symptomatic benign thyroid cysts relapsed after drainage were included. In all cases, cytology prior to treatment, maximum cyst diameter and volume were determined. PEIT was conducted using the established procedure, and the volume of fluid removed and pain perceived by the patient were assessed. In each procedure, the volume of alcohol instilled was <2 ml. After follow-up, final cyst diameter and volume were determined and the persistence of symptoms and QoL were assessed by a questionnaire (SF-36). RESULTS Mean symptom duration was 10 ± 20 months. A single session of PEIT was required to complete the procedure in 45% of patients, two in 31% and three in 13%. Mean initial maximum cyst diameter was 3.5 ± 1.0 cm and mean extracted liquid volume 61 ± 36 ml. During PEIT, 39% of patients experienced virtually no pain, 43% mild pain and 17% moderate pain. No complications of PEIT were observed. After 12.1 ± 1.4 months of follow-up, cysts were reduced more than 70% in volume in 86.3% of patients, more than 80% in 61.9% and more than 90% in 42%. On the health-related QoL SF-36 questionnaire, patient scores 6 months post-PEIT did not differ significantly from those of the healthy Spanish population. With respect to cosmetic complaints or local symptoms of compression, PEIT-treated patients presented an initial score of 22 ± 8 and 13 ± 5 after treatment (p < 0.05). CONCLUSIONS In our experience, percutaneous ethanol injection has prove to be an effective, safe and well-tolerated first-line treatment of symptomatic thyroid cysts.
Collapse
Affiliation(s)
- Jordi L Reverter
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and Hospital, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Universitat Autònoma de Barcelona, Carretera de Canyet s/n, 08916, Badalona, Spain.
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and Hospital, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Universitat Autònoma de Barcelona, Carretera de Canyet s/n, 08916, Badalona, Spain
| | - Marta Avila
- Department of Pathology, Germans Trias i Pujol Health Science Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Anna Lucas
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and Hospital, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Universitat Autònoma de Barcelona, Carretera de Canyet s/n, 08916, Badalona, Spain
| | - Dídac Mauricio
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and Hospital, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Universitat Autònoma de Barcelona, Carretera de Canyet s/n, 08916, Badalona, Spain
| | - Manel Puig-Domingo
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and Hospital, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Universitat Autònoma de Barcelona, Carretera de Canyet s/n, 08916, Badalona, Spain
| |
Collapse
|
23
|
Garberoglio R, Aliberti C, Appetecchia M, Attard M, Boccuzzi G, Boraso F, Borretta G, Caruso G, Deandrea M, Freddi M, Gallone G, Gandini G, Gasparri G, Gazzera C, Ghigo E, Grosso M, Limone P, Maccario M, Mansi L, Mormile A, Nasi PG, Orlandi F, Pacchioni D, Pacella CM, Palestini N, Papini E, Pelizzo MR, Piotto A, Rago T, Riganti F, Rosato L, Rossetto R, Scarmozzino A, Spiezia S, Testori O, Valcavi R, Veltri A, Vitti P, Zingrillo M. Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement. J Ultrasound 2015; 18:423-30. [PMID: 26550079 DOI: 10.1007/s40477-015-0169-y] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/16/2015] [Indexed: 02/04/2023] Open
Affiliation(s)
- Roberto Garberoglio
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Camillo Aliberti
- Division of Interventional Radiology, IRCCS Istituto Oncologico Veneto, Padua, Italy
| | | | - Marco Attard
- Division of Endocrinology, Cervello Hospital, Palermo, Italy
| | - Giuseppe Boccuzzi
- Oncological Endocrinology Unit, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | | | - Giorgio Borretta
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Giuseppe Caruso
- Section of Radiological Sciences, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Maurilio Deandrea
- Division of Endocrinology, Diabetology and Metabolism, Mauriziano Umberto I Hospital, Turin, Italy
| | - Milena Freddi
- Endocrine Surgical Unit, Department of Surgery, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | | | - Giovanni Gandini
- Department of Radiology, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Guido Gasparri
- Endocrine Surgical Unit, Department of Surgery, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Carlo Gazzera
- Department of Radiology, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Ezio Ghigo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Maurizio Grosso
- Department of Radiology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Paolo Limone
- Division of Endocrinology, Diabetology and Metabolism, Mauriziano Umberto I Hospital, Turin, Italy
| | - Mauro Maccario
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Luigi Mansi
- Nuclear Medicine Unit, Department Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | - Alberto Mormile
- Division of Endocrinology, Diabetology and Metabolism, Mauriziano Umberto I Hospital, Turin, Italy
| | | | - Fabio Orlandi
- Division of Internal Medicine, Department of Medical Sciences, Gradenigo Hospital, University of Turin, Turin, Italy
| | - Donatella Pacchioni
- Pathology Unit, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | | | - Nicola Palestini
- Endocrine Surgical Unit, Department of Surgery, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Enrico Papini
- Division of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Rome
| | - Maria Rosa Pelizzo
- Division of Surgical Pathology, Department of Medical and Surgical Sciences, University of Padova, Padua, Italy
| | - Andrea Piotto
- Division of Surgical Pathology, Department of Medical and Surgical Sciences, University of Padova, Padua, Italy
| | - Teresa Rago
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | - Fabrizio Riganti
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Lodovico Rosato
- Endocrine Surgical Unit, Department of Surgery, Ivrea Hospital ASL TO4, School of Medicine, University of Turin, Turin, Italy
| | - Ruth Rossetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Scarmozzino
- Department of Health Management, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Stefano Spiezia
- Department of General and Endocrine Surgery, San Gennaro Hospital, Naples, Italy
| | - Ornella Testori
- Nuclear Medicine Unit, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Roberto Valcavi
- Endocrinology Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Andrea Veltri
- Department of Radiology, San Luigi Gonzaga Hospital, Orbassano, University of Turin, Turin, Italy
| | - Paolo Vitti
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | | |
Collapse
|