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Ji X, Sun W, Lv C, Huang J, Zhang H. Meta-analysis of the efficacy and safety of thermal ablation for treating large benign thyroid nodules. Clin Endocrinol (Oxf) 2022; 97:654-663. [PMID: 35170792 DOI: 10.1111/cen.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Many large benign thyroid nodules have symptoms and cosmetic problems. This study consisted of a meta-analysis to accurately assess the effect of thermal ablation on these nodules. METHODS The PubMed, Embase, Web of Science, and Scopus databases were systematically searched for retrospective or prospective studies of thermal ablation since June 1, 2021. The weighted mean differences of the measures were analysed before and after treatment. RESULTS A total of 10 eligible studies were included. By comparing the initial nodule volume with the nodular volume after thermal ablation, we found that the volume reduction rate was increased significantly after 1 month (SMD = 0.453, 95% CI: 0.323-0.583, p < .001), 3 months (SMD = 0.655, 95% CI: 0.563-0.747, p < .001), 6 months (SMD = 0.691, 95% CI: 0.607-0.774, p < .001), and 12 months (SMD = 0.694, 95% CI: 0.583-0.803), p < .001). The nodular volume was also found to decrease significantly, after 1 month (SMD = 2.381, 95% CI: 1.278-3.485, p < .001), 3 months (SMD = 5.071, 95% CI: 2.386-7.756, p < .001), 6 months (SMD = 5.363, 95% CI: 2.765-7.962, p < .001), and 12 months (SMD = 8.194, 95% CI: 2.113-14.274), p < .001). Symptom score (SMD = 4.419, 95% CI: 2.573-6.265, p < .001)and cosmetic score (SMD = 4.245, 95% CI: 2.566-5.359, p < .001) were reduced after thermal ablation. CONCLUSIONS Thermal ablation could become an alternative to manage large benign thyroid nodules.
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Affiliation(s)
- Xiaoyu Ji
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Chengzhou Lv
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Jiapeng Huang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
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2
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Jasim S, Patel KN, Randolph G, Adams S, Cesareo R, Condon E, Henrichsen T, Itani M, Papaleontiou M, Rangel L, Schmitz J, Stan MN. American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions. Endocr Pract 2022; 28:433-448. [PMID: 35396078 DOI: 10.1016/j.eprac.2022.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE The objective of this disease state clinical review is to provide clinicians with a summary of the nonsurgical, minimally invasive approaches to managing thyroid nodules/malignancy, including their indications, efficacy, side effects, and outcomes. METHODS A literature search was conducted using PubMed and appropriate key words. Relevant publications on minimally invasive thyroid techniques were used to create this clinical review. RESULTS Minimally invasive thyroid techniques are effective and safe when performed by experienced centers. To date, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Both ultrasound-guided laser and radiofrequency ablation can be safely used for symptomatic solid nodules, both toxic and nontoxic. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. Despite limited data, encouraging results suggest that minimally invasive techniques can also be used in small-size primary and locally recurrent thyroid cancer. CONCLUSION Surgery and radioiodine treatment remain the conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective alternatives when used appropriately and by trained professionals to treat symptomatic or enlarging thyroid masses.
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Affiliation(s)
- Sina Jasim
- Division of Endocrinology, Metabolism and Lipid Research, School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
| | | | - Gregory Randolph
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Adams
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, Florida
| | - Roberto Cesareo
- Unit of Metabolic Diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leonardo Rangel
- Head and Neck Surgery Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - John Schmitz
- Mayo Clinic Department of Radiology, Rochester, Minnesota
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
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3
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Squarcia M, Mora M, Aranda G, Carrero E, Martínez D, Jerez R, Valero R, Berenguer J, Halperin I, Hanzu FA. Long-Term Follow-Up of Single-Fiber Multiple Low-Intensity Energy Laser Ablation Technique of Benign Thyroid Nodules. Front Oncol 2021; 11:584265. [PMID: 34950572 PMCID: PMC8691264 DOI: 10.3389/fonc.2021.584265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Aim The short-term and long-term efficacy of different thermal percutaneous ablation techniques remains a topical issue. Our group implemented percutaneous laser ablation (LA), a moving-shot technique to increase efficiency and reduce costs and variability of LA by applying multiple lower-intensity energy illuminations (MLIEI) covering the nodular volume (V) through changes in position of a single laser fiber within the thyroid nodule. The aim of the present study was to evaluate the efficacy of the single-fiber LA-MLIEI during a 5-year follow-up and to identify possible predictors of the final outcome. Methods Prospective study: Thirty outpatients (23 women and seven men) with benign symptomatic thyroid nodules were assigned to single-fiber LA-MLIEI, between 2012 and 2015. A single LA session was performed under real-time ultrasound (US) guidance using a 1,064-nm continuous-wave laser at 3 W. A 400-µm optical fiber was inserted through a 21-gauge needle, and 3–10 illuminations were performed per nodule, administering between 400 and 850 J/illumination. The total administered energy was calculated on the initial V of the nodule and the estimated ablation area. US evaluation was performed after LA-MLIEI at 1 week and 1, 3, 6, and 12 months and after that annually up to 5 years. Clinical symptoms, laboratory thyroid function during follow-up, and acute and chronic complications of treatment were registered. Results On follow-up, 67% (n: 20) were responders to single-fiber LA-MLIEI, while 33% (n: 10) were non-responders. The responder group initiated V reduction (ΔV) at 1 month, with remission of symptoms, and presented a 50% ΔV at 3 months of treatment; the maximum response was achieved at 24 months and remained stable until the end of the study. The non-responder group presented a ΔV of less than 50% at 12 months; though a tendency to >50% ΔV was observed at 24–36 months, there was subsequent regrowth, and 40% of this group required surgery. ΔV was positively correlated with the total administered energy/V (J/V) and inversely with nodule V. No severe adverse effects were observed. Thyroid function remained normal in all patients. Remission of symptoms occurred rapidly after 1 month. Conclusions LA with multiple fractional discharges employing a single fiber in a unique session is a safe and inexpensive technique that allows rapid reduction of thyroid nodules, with a stable response up to 5 years, similarly to what has been reported with the conventional LA. Total nodule volume appears as a predictive factor of the reduction.
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Affiliation(s)
- Mattia Squarcia
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain.,Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mireia Mora
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Gloria Aranda
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Enrique Carrero
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Daniel Martínez
- Department of Pathology and Anatomy, Hospital Clinic, Barcelona, Spain
| | - Ramona Jerez
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Ricard Valero
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Joan Berenguer
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain
| | - Irene Halperin
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Felicia A Hanzu
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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4
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Fu QQ, Kang S, Wu CP, Wang SY, Liu YY, Tian JW, Jiang SQ. A study on the efficacy of microwave ablation for benign thyroid nodules and related influencing factors. Int J Hyperthermia 2021; 38:1469-1475. [PMID: 34620026 DOI: 10.1080/02656736.2021.1988151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To explore the efficacy of microwave ablation (MWA) in the treatment of benign thyroid nodules, and analyze related influencing factors. METHODS The clinical and ultrasound data of 115 patients with 115 benign thyroid nodules treated with MWA were retrospectively analyzed. The volume of nodules at 1, 3, 6, and 12 months after the procedure was obtained, and the volume reduction rate (VRR) at each time point was calculated. With VRR > 90% as the criterion for nodule cure, binary logistic regression was employed to screen the factors that affect the efficacy. RESULTS ① At 1, 3, 6, and 12 months after the procedure, the volume of nodules continued to decrease, the VRR gradually increased, and the differences at each time point were statistically significant (p < 0.05). A total of 29 (25.21%) nodules disappeared completely at 12 months after the procedure; ② Multivariate stepwise logistic regression showed that there was a statistically significant difference for the internal component of nodules, enhancement mode, and immediate volume after the procedure in determining the ablation efficacy (p < 0.05); ③ The ROC curve was plotted for predicting the efficacy of MWA, with the results showing that the AUC, sensitivity, specificity, and accuracy were 0.82, 67.50, 88.00, 79.10%, respectively; ④ 11 cases (9.56%) had side effects, 10 cases (8.70%) had minor complications, and three cases (2.61%) had major complications. CONCLUSION MWA is safe and effective in the treatment of benign thyroid nodules. The internal component of nodules, enhancement mode, and immediate volume after the procedure are independent factors that affect the efficacy of ablation.
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Affiliation(s)
- Qian-Qian Fu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,Daqing People's Hospital, Ultrasound Room, Daqing, Heilongjiang, China
| | - Song Kang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Cui-Ping Wu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shi-Yu Wang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ying-Ying Liu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jia-Wei Tian
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shuang-Quan Jiang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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5
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Muhammad H, Tehreem A, Russell JO, Tufano RP. Radiofrequency Ablation and Autonomous Functioning Thyroid Nodules: Review of the Current Literature. Laryngoscope 2021; 132:906-914. [PMID: 34375454 DOI: 10.1002/lary.29811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Autonomously functioning thyroid nodules (AFTNs) have long been treated with either surgery or radioactive iodine (RAI). Being an invasive procedure, even thyroid lobectomy for this condition is associated with complications such as anesthesia side effects, scarring, iatrogenic hypothyroidism, and injury to other structures. Similarly, RAI is associated with hypothyroidism and may require multiple courses. Therefore, minimally invasive techniques such as radiofrequency ablation (RFA) are being advocated as an alternative treatment for AFTNs. To date, only few studies have been published on this topic and are largely on European and Asian populations. The aim of this review is to assess the efficacy and safety of RFA as a potential alternative for treatment of AFTNs compared to conventional surgery and radioiodine. METHODS/STUDY DESIGN Comprehensive PubMed and Embase searches were performed using the following terms such as (autonomously functioning thyroid nodules and radiofrequency ablation), (radiofrequency ablation and hyperthyroidism), and (radiofrequency ablation and toxic thyroid nodule). Both prospective and retrospective studies were included based on the inclusion and exclusion criteria specified in the text. RESULTS Initially, 57 studies were identified and after excluding 47 studies, finally 10 studies were included in the review. CONCLUSION Although surgery remains the first line treatment for AFTN. However, RFA is a safe option compared to RAI or surgery, especially in patients who are high-risk surgical candidates or have absolute contraindications to RAI. Currently, trials with follow-up greater than or equal to 5 years are warranted. It will aid in formulating a standardized surveillance protocol and also generalize RFA's use for AFTN. Laryngoscope, 2021.
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Affiliation(s)
- Haris Muhammad
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, Maryland, U.S.A
| | - Aniqa Tehreem
- Department of Internal Medicine, Sinai Hospital, Baltimore, Maryland, U.S.A
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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6
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Kim HJ, Cho SJ, Baek JH, Suh CH. Efficacy and safety of thermal ablation for autonomously functioning thyroid nodules: a systematic review and meta-analysis. Eur Radiol 2020; 31:605-615. [PMID: 32816198 DOI: 10.1007/s00330-020-07166-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/29/2020] [Accepted: 08/06/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although thermal ablation has been regarded as an alternative treatment option for autonomously functioning thyroid nodules (AFTNs), the efficacy of this treatment in patients with AFTNs has not yet been systematically evaluated. In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of thermal ablation in the treatment of AFTN, and identify the factors affecting the effectiveness of the treatment. METHODS Ovid-MEDLINE and Embase databases were searched for studies reporting the efficacy and safety of thermal ablation for patients with AFTN published up until January 6, 2020. Data extraction and quality assessment were performed by two radiologists according to PRISMA guidelines. The primary and secondary outcomes were to yield the pooled proportions of thyroid-stimulating hormone (TSH) normalization and pooled estimates of volume reduction rate (VRR), respectively. Subgroup analyses were performed to identify factors affecting the treatment efficacy. RESULTS This systematic review identified 411 AFTNs treated by thermal ablation in 391 patients in 14 studies. TSH normalization was achieved in 71.2% of patients and the volume reduction rate was 69.4% at a mean follow-up period of 12.8 months. No patients experienced hypothyroidism or a life-threatening complication during follow-up. Subgroup analyses according to nodule volume did not find a significant difference in TSH normalization (p = 0.54) or VRR (p = 0.94). CONCLUSIONS Thermal ablation is an effective and safe treatment method for patients with AFTNs. The nodule volume did not affect the efficacy of thermal ablation, and this result should be considered in future thermal ablation guidelines. KEY POINTS • Thermal ablation has good efficacy and safety in the treatment of autonomously functioning thyroid nodule. • The efficacy of thermal ablation was not affected by nodule volume.
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Affiliation(s)
- Hyun Jin Kim
- Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Freitas RMC, Miazaki AP, Tsunemi MH, Araujo Filho VJF, Marui S, Danilovic DLS, Buchpiguel CA, Chammas MC. Laser Ablation of Benign Thyroid Nodules: A Prospective Pilot Study With a Preliminary Analysis of the Employed Energy. Lasers Surg Med 2020; 52:323-332. [DOI: 10.1002/lsm.23144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Ricardo Miguel Costa Freitas
- Department of RadiologyInstituto do Cancer do Estado de Sao Paulo Octavio Frias de OliveiraAvenida Dr. Arnaldo, 251, Cerqueira César CEP 01246‐000 Sao Paulo Brazil
- Department of RadiologyUniversidade de São Paulo Faculdade de Medicina Hospital das ClínicasAv. Dr. Enéas de Carvalho Aguiar, s/n˚ ‐ Rua 1 – Cerqueira César 05403‐900 Sao Paulo Brazil
| | - Aline Paterno Miazaki
- Department of Head and Neck SurgeryUniversidade de São Paulo Faculdade de Medicina Hospital das ClínicasRua Dr. Ovídio Pires de Campos, 225, Cerqueira César CEP 05403‐010 Sao Paulo Brazil
| | - Miriam Harumi Tsunemi
- Department of BiostatisticsUniversidade Estadual Paulista Julio de Mesquita Filho Instituto de Biociencias Campus de BotucatuDist. Rubião Jr CEP 18618‐970 Botucatu Brazil
| | - Vergilius José Furtado Araujo Filho
- Department of Head and Neck SurgeryUniversidade de São Paulo Faculdade de Medicina Hospital das ClínicasRua Dr. Ovídio Pires de Campos, 225, Cerqueira César CEP 05403‐010 Sao Paulo Brazil
| | - Suemi Marui
- Department of Endocrinology/Thyroid UnitUniversidade de Sao Paulo Faculdade de Medicina Hospital das ClinicasRua Dr. Ovídio Pires de Campos, 225, Cerqueira César 05403‐010 Sao Paulo Brazil
| | - Debora Lucia Seguro Danilovic
- Department of EndocrinologyUniversidade de Sao Paulo Faculdade de Medicina Hospital das ClinicasRua Dr. Ovídio Pires de Campos, 225, Cerqueira César 05403‐010 Sao Paulo Brazil
| | - Carlos Alberto Buchpiguel
- Department of Radiology/Nuclear MedicineUniversidade de Sao Paulo Faculdade de Medicina Hospital das ClinicasAv. Dr. Enéas de Carvalho Aguiar, s/n˚ ‐ Rua 1 – Cerqueira César 05403‐900 Sao Paulo Brazil
| | - Maria Cristina Chammas
- Department of RadiologyUniversidade de São Paulo Faculdade de Medicina Hospital das ClínicasAv. Dr. Enéas de Carvalho Aguiar, s/n˚ ‐ Rua 1 – Cerqueira César 05403‐900 Sao Paulo Brazil
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8
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Mauri G, Pacella CM, Papini E, Solbiati L, Goldberg SN, Ahmed M, Sconfienza LM. Image-Guided Thyroid Ablation: Proposal for Standardization of Terminology and Reporting Criteria. Thyroid 2019; 29:611-618. [PMID: 30803397 DOI: 10.1089/thy.2018.0604] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Image-guided tumor ablation is commonly performed in clinical practice. Trying to standardize terminology and data collection to enable a more reliable comparison among the different studies, in 2003, a document entitled "Image-Guided Tumor Ablation: Proposal for Standardization of Terms and Reporting Criteria" was published by the International Working Group on Image-Guided Tumor Ablation. Since then, ablations have evolved significantly, with the development of new technology and techniques and applications. This has included benign thyroid nodules, and their ablation has become increasingly accessible, not only among radiologists but also among other specialists involved in thyroid care, including endocrinologists and surgeons. This has resulted in further inhomogeneity in how data are presented and reported among different studies, resulting in a need for standardization to homogenize language and data reporting on the topic. Summary: In February 2018 in Milano, Italy, a meeting involving specialists concerned with minimally invasive treatments of thyroid lesions was organized, and the Italian Working Group on Minimally Invasive Treatments of the Thyroid was founded with the aim of establishing a collaborative network among all clinicians working in this field. The first work of this group is to present a proposal for standardization of terminology and reporting criteria on image-guided ablations to treat benign thyroid nodules. Conclusion: This proposal was drafted with the goal of providing guidance for standardized reporting of results in studies regarding image-guided thyroid ablations. We encourage adoption of this terminology worldwide, anticipating that this will facilitate improved communication and understanding within the field and stimulate further discussion on the topic over the next years.
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Affiliation(s)
- Giovanni Mauri
- 1 Divisione di Radiologia Interventistica, IEO, IRCCS Istituto Europeo di Oncologia, Milan, Italy
| | - Claudio Maurizio Pacella
- 2 Dipartimento di Diagnostica per Immagini and Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Enrico Papini
- 3 Dipartimento di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Luigi Solbiati
- 4 Dipartimento di Scienze Biomediche, Humanitas University, and Dipartmento di Radiologia, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Shraga Nahum Goldberg
- 5 Department of Radiology, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
- 6 Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Muneeb Ahmed
- 6 Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Luca Maria Sconfienza
- 7 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
- 8 IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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9
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Papini E, Pacella CM, Solbiati LA, Achille G, Barbaro D, Bernardi S, Cantisani V, Cesareo R, Chiti A, Cozzaglio L, Crescenzi A, De Cobelli F, Deandrea M, Fugazzola L, Gambelunghe G, Garberoglio R, Giugliano G, Luzi L, Negro R, Persani L, Raggiunti B, Sardanelli F, Seregni E, Sollini M, Spiezia S, Stacul F, Van Doorne D, Sconfienza LM, Mauri G. Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid (MITT) group. Int J Hyperthermia 2019; 36:376-382. [PMID: 30909759 DOI: 10.1080/02656736.2019.1575482] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Benign thyroid nodules are a common clinical occurrence and usually do not require treatment unless symptomatic. During the last years, ultrasound-guided minimally invasive treatments (MIT) gained an increasing role in the management of nodules causing local symptoms. In February 2018, the Italian MIT Thyroid Group was founded to create a permanent cooperation between Italian and international physicians dedicated to clinical research and assistance on MIT for thyroid nodules. The group drafted this list of statements based on literature review and consensus opinion of interdisciplinary experts to facilitate the diffusion and the appropriate use of MIT of thyroid nodules in clinical practice. (#1) Predominantly cystic/cystic symptomatic nodules should first undergo US-guided aspiration; ethanol injection should be performed if relapsing (level of evidence [LoE]: ethanol is superior to simple aspiration = 2); (#2) In symptomatic cystic nodules, thermal ablation is an option when symptoms persist after ethanol ablation (LoE = 4); (#3) Double cytological benignity confirmation is needed before thermal ablation (LoE = 2); (#4) Single cytological sample is adequate in ultrasound low risk (EU-TIRADS ≤3) and in autonomously functioning nodules (LoE = 2); (#5) Thermal ablation may be proposed as first-line treatment for solid, symptomatic, nonfunctioning, benign nodules (LoE = 2); (#6) Thermal ablation may be used for dominant lesions in nonfunctioning multinodular goiter in patients refusing/not eligible for surgery (LoE = 5); (#7) Clinical and ultrasound follow-up is appropriate after thermal ablation (LoE = 2); (#8) Nodule re-treatment can be considered when symptoms relapse or partially resolve (LoE = 2); (#9) In case of nodule regrowth, a new cytological assessment is suggested before second ablation (LoE = 5); (#10) Thermal ablation is an option for autonomously functioning nodules in patients refusing/not eligible for radioiodine or surgery (LoE = 2); (#11) Small autonomously functioning nodules can be treated with thermal ablation when thyroid tissue sparing is a priority and ≥80% nodule volume ablation is expected (LoE = 3).
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Affiliation(s)
- Enrico Papini
- a Dipartimento di Endocrinologia , Ospedale Regina Apostolorum , Albano Laziale , Italy
| | - Claudio Maurizio Pacella
- b Dipartimento di Imaging Diagnostico e Radiologia Interventistica , Ospedale Regina Apostolorum , Albano Laziale , Italy
| | - Luigi Alessandro Solbiati
- c Humanitas University, Pieve Emanuele , Milan , Italy.,d Humanitas Clinical and Research Center IRCCS , Rozzano , Italy
| | - Gaetano Achille
- e Unità Operativa ORL, IRCCS Oncologico "Giovanni Paolo II" , Bari , Italy
| | - Daniele Barbaro
- f U.O. Endocrinologia ASL Nordovest Toscana , Toscana , Italy
| | - Stella Bernardi
- g Azienda Sanitaria Universitaria Integrata Trieste , Trieste , Italy.,h Università degli Studi di Trieste , Trieste , Italy
| | - Vito Cantisani
- i Policlinico Umberto I, Università Sapienza , Roma , Italy
| | - Roberto Cesareo
- j Thyroid and metabolic bone diseases center, Ospedale Santa Maria Goretti , Latina , Italy
| | - Arturo Chiti
- c Humanitas University, Pieve Emanuele , Milan , Italy.,d Humanitas Clinical and Research Center IRCCS , Rozzano , Italy
| | - Luca Cozzaglio
- d Humanitas Clinical and Research Center IRCCS , Rozzano , Italy
| | - Anna Crescenzi
- k UOC Anatomia Patologica, Policlinico Universitario Campus Bio-Medico , Roma , Italy
| | | | | | - Laura Fugazzola
- n Istituto Auxologico Italiano IRCCS , Milano , Italy.,o Università degli Studi di Milano , Milano , Italy
| | | | - Roberto Garberoglio
- q Ospedale Città della Salute Torino, Dipartimento Universitario di Endocrinologia e Malattie Metaboliche , Torino , Italy
| | - Gioacchino Giugliano
- r Department of Head and Neck , Istituto Europeo di Oncologia, IRCCS , Milano , Italy
| | - Livio Luzi
- o Università degli Studi di Milano , Milano , Italy.,s IRCCS Policlinico San Donato, UOC Endocrinologia e Malattie Metaboliche , San Donato Milanese , Italy
| | | | - Luca Persani
- n Istituto Auxologico Italiano IRCCS , Milano , Italy.,o Università degli Studi di Milano , Milano , Italy
| | | | - Francesco Sardanelli
- o Università degli Studi di Milano , Milano , Italy.,v IRCCS Policlinico San Donato , San Donato Milanese , Italy
| | - Ettore Seregni
- w Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Stefano Spiezia
- x Unità Operativa di Chirurgia Endocrina ed Ecoguidata , Ospedale del Mare, ASL Napoli1 centro , Napoli , Italy
| | - Fulvio Stacul
- g Azienda Sanitaria Universitaria Integrata Trieste , Trieste , Italy
| | | | - Luca Maria Sconfienza
- o Università degli Studi di Milano , Milano , Italy.,z IRCCS Istituto Ortopedico Galeazzi , Milano , Italy
| | - Giovanni Mauri
- aa Division of Interventional Radiology , IEO, European Institute of Oncology IRCCS , Milan , Italy
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10
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Guang Y, He W, Luo Y, Zhang H, Zhang Y, Ning B, Yu T. Patient satisfaction of radiofrequency ablation for symptomatic benign solid thyroid nodules: our experience for 2-year follow up. BMC Cancer 2019; 19:147. [PMID: 30760229 PMCID: PMC6375217 DOI: 10.1186/s12885-019-5338-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/31/2019] [Indexed: 11/21/2022] Open
Abstract
Background The patient satisfaction of symptoms improvement and disease factors that may affect long-term treatment efficacy of radiofrequency ablation (RFA) for non-functioning solid benign thyroid nodules (TNs) over a 2-year follow up study was investigated. Methods This retrospective study evaluated 194 non-functioning solid benign TNs of 103 patients. The TNs were categorized as small (≤5 ml), medium (5.1 to 13 ml), intermediate (13.1 to 30 ml) and large (over 30 ml) according to the initial volume of TNs before ablation. Clinical evaluation and contrast-enhanced ultrasound (CEUS) were carried out before ablation and the follow up at 1, 3, 6 months and every 6 months after ablation. All patients were asked to assess the cosmetic score (1–4 scores) and symptom score (0–10 scores) before ablation and every follow up after ablation. Results All patients underwent RFA without any major complications. The mean treatment sessions were 1.5 ± 0.6. 98 nodules required a single session (98/194, 50.5%), 87 required two sessions (87/194, 44.9%), 9 required three sessions (9/194, 4.6%). The average follow up months were 16.3 ± 5.6 (range, 6–24 months) and no nodule regrew in our study. After RFA treatment, the TNs volume significantly decreased (P < 0.001). The small group of nodules shrunk larger compared to the medium, intermediate and large groups (P < 0.001). Cosmetic signs and pressure symptoms were significantly improved, particularly in the intermediate and large groups (P < 0.05). Conclusions RFA is effective for treating non-functioning solid benign TNs and controlling clinical symptoms with a low complication rate during 2 years follow up. The reduction rate was related to the initial volume of nodules. Patients were satisfied with cosmetic signs and pressure symptoms improvement, particularly in the intermediate and large groups. However, multiple RFA treatments should be used in larger nodules to achieve the desired clinical outcomes.
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Affiliation(s)
- Yang Guang
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China
| | - Wen He
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China.
| | - Yukun Luo
- Department of Ultrasound, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hongxia Zhang
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China
| | - Yukang Zhang
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China
| | - Bin Ning
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China
| | - Tengfei Yu
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119 West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China
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11
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Negro R, Greco G. Quality of life and outcomes in patients with a large toxic adenoma undergoing laser ablation plus radioiodine vs lobectomy. Int J Hyperthermia 2018; 36:191-195. [PMID: 30556434 DOI: 10.1080/02656736.2018.1549335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Patients with toxic adenomas (TAs) that are too large to undergo radioactive iodine (RAI) treatment aimed at resolving hyperthyroidism and/or relieving mechanical pressure symptoms are referred to surgery. This prospective study aimed to assess the outcomes of combining laser ablation (LA) plus RAI vs lobectomy to treat large TAs in terms of clinical efficacy and the health-related quality of life (HRQoL). PATIENTS AND METHODS Patients with TAs of volumes greater than 20 mL and a calculated therapeutic activity exceeding 600 Mbq were randomly assigned to undergo LA + RAI (Group A) or lobectomy (Group B). The HRQoL was assessed using 12-item Short Form Health Survey questionnaire before and 6 months after treatment. RESULTS Twenty-seven patients entered the study. After completing treatment, patients in Group A showed a TA reduction by a mean of 68% compared to baseline. Two of 14 patients (14.3%) in Group A and 2 of 13 (15.4%) in Group B became subclinically hypothyroid, whereas the remaining patients were euthyroid. HRQoL significantly improved in both groups after treatment. CONCLUSIONS For patients with large TAs, a combination of LA and RAI is a feasible alternative to surgery. Similar to surgery, LA + RAI resolves the mechanical discomfort induced by nodule pressure and effectively treats the hyperthyroidism. This procedure also avoids the potential complications associated with surgery while guaranteeing a similar HRQoL benefit.
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Affiliation(s)
- Roberto Negro
- a Division of Endocrinology , "V. Fazzi" Hospital, Piazza F. Muratore , Lecce , Italy
| | - Gabriele Greco
- a Division of Endocrinology , "V. Fazzi" Hospital, Piazza F. Muratore , Lecce , Italy
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12
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Mauri G, Nicosia L, Della Vigna P, Varano GM, Maiettini D, Bonomo G, Giuliano G, Orsi F, Solbiati L, De Fiori E, Papini E, Pacella CM, Sconfienza LM. Percutaneous laser ablation for benign and malignant thyroid diseases. Ultrasonography 2018; 38:25-36. [PMID: 30440161 PMCID: PMC6323312 DOI: 10.14366/usg.18034] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive image-guided thermal ablation is becoming increasingly common as an alternative to surgery for the treatment of benign thyroid nodules. Among the various techniques for thermal ablation, laser ablation (LA) is the least invasive, using the smallest applicators available on the market and enabling extremely precise energy deposition. However, in some cases, multiple laser fibers must be used simultaneously for the treatment of large nodules. In this review, the LA technique is described, and its main clinical applications and results are discussed and illustrated.
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Affiliation(s)
- Giovanni Mauri
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Luca Nicosia
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Paolo Della Vigna
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Gianluca Maria Varano
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Daniele Maiettini
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Guido Bonomo
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | | | - Franco Orsi
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Luigi Solbiati
- Department of Radiology, Humanitas University, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Elvio De Fiori
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Enrico Papini
- Endocrinology Department, Regina Apostolorum Hospital, Albano Laziale, Italy
| | - Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Rome, Italy
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
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13
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Pacella CM, Mauri G. Is there a role for minimally invasive thermal ablations in the treatment of autonomously functioning thyroid nodules? Int J Hyperthermia 2018; 34:636-638. [DOI: 10.1080/02656736.2018.1462537] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Claudio M. Pacella
- Dipartimento di Diagnostica per Immagini, “Regina Apostolorum” Hospital, Albano, Laziale, Italy
| | - Giovanni Mauri
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Milano, Italy
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14
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Gambelunghe G, Stefanetti E, Colella R, Monacelli M, Avenia N, De Feo P. A single session of laser ablation for toxic thyroid nodules: three-year follow-up results. Int J Hyperthermia 2018; 34:631-635. [PMID: 29409365 DOI: 10.1080/02656736.2018.1437931] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To confirm the effectiveness of laser ablation on toxic nodules in a large population with three years of follow-up. MATERIAL AND METHODS Between 2009 and 2014, we treated 82 patients with hyperthyroidism related to the presence of a toxic nodular goitre. Patients were pre-treated pharmacologically with methimazole prior to single session of laser ablation (LA) and then followed up every 3 months with FT4 and TSH blood tests as well as ultrasound examination of the nodules treated. RESULTS All patients responded to the treatment. The median nodule volume decreased from 12 ml (range 5-118 ml) to 5 ml (range 1.2-40 ml) after three years (p < 0.001). The percentage of patients who discontinued methimazole therapy was reduced by increasing the initial volume of the toxic nodule. In nodules with a volume less than 5 ml, all patients were able to suspend methimazole; this percentage was reduced to 90.2% in nodules with a volume between 5 and 15 ml, 61.1% in those with volume 15-25 ml and only 28.5% in nodules larger than 25 ml. We had no major complications but only moderate pain and fever in the evening, a few hours after ablation therapy in 10% of treated patients. CONCLUSIONS Single session of LA of toxic thyroid nodules is effective and safe, especially in nodules with a volume under 15 ml.
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Affiliation(s)
- Giovanni Gambelunghe
- a Department of Internal Medicine , Azienda Ospedaliero-Universitaria di Perugia , Perugia , Italy
| | | | - Renato Colella
- c Institute of Pathological Anatomy , Azienda Ospedaliero-Universitaria di Perugia , Perugia , Italy
| | - Massimo Monacelli
- d Department of Endocrine Surgery , Azienda Ospedaliero-Universitaria di Perugia , Perugia , Italy
| | - Nicola Avenia
- e Department of Endocrine Surgery , Azienda Ospedaliero-Universitaria di Terni , Perugia , Italy
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15
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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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16
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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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17
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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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18
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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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19
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Lee J, Jung JH, Kim WW, Hwang SO, Park JY, Jeong JY, Kim C, Sohn IB, Lee H, Park HY. Ultrasound-Guided Laser Ablation Using Multidirectional-Firing Fiber for Papillary Thyroid Carcinoma: An Ex Vivo Study with Evaluation of Tumor Cell Viability. Photomed Laser Surg 2016; 34:300-4. [DOI: 10.1089/pho.2016.4088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Jin Hyang Jung
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Wan Wook Kim
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Seung Ook Hwang
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Ji Young Park
- Department of Pathology, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Ji Yun Jeong
- Department of Pathology, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Changhwan Kim
- School of Mechanical Design & Manufacturing, Busan Institute of Science and Technology, Busan, Republic of Korea
| | - Ik-Bu Sohn
- Advanced Photonics Research Institute (APRI), Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
| | - Ho Lee
- School of Mechanical Design & Manufacturing, Busan Institute of Science and Technology, Busan, Republic of Korea
| | - Ho Yong Park
- Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
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Abstract
Thermal ablation therapies for benign thyroid nodules have been introduced in recent years to avoid the complications of traditional methods such as surgery. Despite the little complications and the reportedly acceptable efficacy of thermal ablation methods, quite few medical centers have sought the potential benefits of employing them. This paper provides an introduction to the literature, principles and advances of Percutaneous Laser Ablation therapy of thyroid benign nodules, as well as a discussion on its efficacy, complications and future. Several clinical research papers evaluating the thermal effect of laser on the alleviation of thyroid nodules have been reviewed to illuminate the important points. The results of this research can help researchers to advance the approach and medical centers to decide on investing in these novel therapies.
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Affiliation(s)
- Mohammad Karim Shahrzad
- Laser Application in Medical Sciences Research Center, Shohada Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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21
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Achille G, Zizzi S, Di Stasio E, Grammatica A, Grammatica L. Ultrasound-guided percutaneous laser ablation in treating symptomatic solid benign thyroid nodules: Our experience in 45 patients. Head Neck 2015; 38:677-82. [DOI: 10.1002/hed.23957] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Gaetano Achille
- Cervico-Facial Ultrasound Diagnostic and Interventional Unit; Institute of Oncology; Bari Italy
| | - Stefania Zizzi
- Ear, Nose, and Throat Unit (ENTU), Institute of Oncology; Bari Italy
| | - Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Sacred Heart; Rome Italy
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22
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Korkusuz H, Fehre N, Sennert M, Happel C, Grünwald F. Volume reduction of benign thyroid nodules 3 months after a single treatment with high-intensity focused ultrasound (HIFU). J Ther Ultrasound 2015; 3:4. [PMID: 25763185 PMCID: PMC4355001 DOI: 10.1186/s40349-015-0024-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/06/2015] [Indexed: 01/06/2023] Open
Abstract
Background High-intensity focused ultrasound (HIFU) is a promising, non-invasive technique in treating benign thyroid nodules (TNs). The aim of this study was to evaluate the efficacy of HIFU to induce clinically meaningful shrinkage in benign predominantly solid TNs and to identify variables that influence or predict the magnitude of TN volume reduction. Methods For each of ten subjects, HIFU treatment was conducted on a single nodule. Nodular volume was measured sonographically at baseline and at 3 months post-procedure. Nodular function and early treatment assessment was done scintigraphically. Results Median nodular volume reduction was 0.7 ml absolute and 48.8% relative to pre-interventional size (p < 0.05). Absolute shrinkage was negatively correlated with the average treatment depth (τ = −0.61, p < 0.05). Absolute nodular volume was positively correlated with the scintigraphic nodular uptake reduction (τ = 0.66, p < 0.05). Conclusions HIFU treatment of benign predominantly solid TNs appears to be safe and effective for inducing nodular shrinkage. Despite potential for improvement, a single treatment session with HIFU is already a viable alternative to more standard methods. The feasibility of multiple HIFU treatments requires further investigation. Due to the small sample size, the findings of this analysis need conformation by larger studies.
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Affiliation(s)
- Huedayi Korkusuz
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,German Center for Thermoablation of Thyroid Nodules (Deutsches Zentrum für Thermoablation von Schilddrüsenknoten), 60590 Frankfurt am Main, Germany
| | - Niklas Fehre
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Michael Sennert
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,German Center for Thermoablation of Thyroid Nodules (Deutsches Zentrum für Thermoablation von Schilddrüsenknoten), 60590 Frankfurt am Main, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,German Center for Thermoablation of Thyroid Nodules (Deutsches Zentrum für Thermoablation von Schilddrüsenknoten), 60590 Frankfurt am Main, Germany
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23
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Sung JY, Baek JH, Jung SL, Kim JH, Kim KS, Lee D, Kim WB, Na DG. Radiofrequency ablation for autonomously functioning thyroid nodules: a multicenter study. Thyroid 2015; 25:112-7. [PMID: 25320840 DOI: 10.1089/thy.2014.0100] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this study is to validate the generalizability of the efficacy and safety of radiofrequency (RF) ablation for treating autonomously functioning thyroid nodules (AFTN) in a large population multicenter study. METHODS This study included 44 patients from 5 institutions who refused or were not suitable for surgery or radioiodine therapy. Twenty-three patients were affected by a toxic nodule and 21 by a pretoxic nodule. RF ablation was performed using an 18-gauge, internally cooled electrode. Nodule volume, thyroid function, scintigraphy, symptom/cosmetic scores, and complications were evaluated before treatment and during each follow-up. RESULTS The mean follow-up period was 19.9±12.6 months. The mean nodule volume was initially 18.5±30.1 mL and significantly decreased after treatment at 1 month (11.8±26.9 mL, p<0.001) and the last month (4.5±9.8 mL, p<0.001). Significant improvement of triiodothyronine, free thyroxine, and thyrotropin was observed at the last follow-up. Regarding scintigraphy, 35 hot nodules became cold or were normal when scanned and 9 decreased uptake, although they remained hot nodules. The mean symptom and cosmetic scores were significantly reduced at the last follow-up. No major complications were encountered. CONCLUSIONS This multicenter study validated the efficacy and safety of RF ablation for treating AFTN; RF ablation can be considered an alternative to surgery or radioiodine therapy.
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Affiliation(s)
- Jin Yong Sung
- 1 Department of Radiology, Thyroid Center, Daerim St. Mary's Hospital , Seoul, Korea
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24
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Papini E, Rago T, Gambelunghe G, Valcavi R, Bizzarri G, Vitti P, De Feo P, Riganti F, Misischi I, Di Stasio E, Pacella CM. Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules. Results of a three-year multicenter prospective randomized trial. J Clin Endocrinol Metab 2014; 99:3653-9. [PMID: 25050903 DOI: 10.1210/jc.2014-1826] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of the present trial on ultrasound (US)-guided laser ablation therapy (LAT) of solid thyroid nodules is to assess long-term clinical efficacy, side effects, and predictability of outcomes in different centers operating with the same procedure. PATIENTS Two hundred consecutive patients were randomly assigned to a single LAT session (group 1, 101 cases) or to follow-up (group 2, 99 cases) at four thyroid referral centers. Entry criteria were: solid thyroid nodule with volume of 6-17 mL, repeat benign cytological findings, normal thyroid function, no autoimmunity, and no thyroid gland treatment. METHODS Group 1: LAT was performed in a single session with two optical fibers, a 1064 nm Nd-YAG laser source, and an output power of 3 W. Volume and local symptom changes were evaluated 1, 6, 12, 24, and 36 months after LAT. Side effects and tolerability of treatment were registered. Group 2: Follow-up with no treatment. RESULTS One patient was lost to follow-up in each group. Group 1: Volume decrease after LAT was -49 ± 22%, -59 ± 22%, -60 ± 24%, and -57 ± 25% at 6, 12, 24, and 36 months, respectively (P < .001 vs baseline). LAT resulted in a nodule reduction of >50% in 67.3% of cases (P < .001). Local symptoms decreased from 38 to 8% of cases (P = .002) and cosmetic signs from 72 to 16% of cases (P = .001). Baseline size, presence of goiter (P = .55), or US findings (fluid component ≤ 20% [P = .84], halo [P = .46], vascularization [P = .98], and calcifications [P = .06]) were not predictive factors of a volume decrease > 50%. The procedure was well tolerated in most (92%) cases. No changes in thyroid function or autoimmunity were observed. In group 2, nodule volume increased at 36 months (25 ± 42%; P = .04). The efficacy and tolerability of the procedure were similar in different centers. CONCLUSIONS A single LAT treatment of solid nodules results in significant and persistent volume reduction and local symptom improvement, in the absence of thyroid function changes.
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Affiliation(s)
- E Papini
- Department of Endocrinology (E.P., I.M.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56126 Pisa, Italy; Department of Medicine (G.G., P.D.F.), University of Perugia, Perugia, 06126 Italy; Thyroid Disease Center (R.V., F.R.), Arcispedale Santa Maria Nuova, 42123 Reggio Emilia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00185 Rome, Italy; and Department of Diagnostic Imaging (G.B., C.M.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy
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25
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Papini E, Pacella CM, Misischi I, Guglielmi R, Bizzarri G, Døssing H, Hegedus L. The advent of ultrasound-guided ablation techniques in nodular thyroid disease: towards a patient-tailored approach. Best Pract Res Clin Endocrinol Metab 2014; 28:601-18. [PMID: 25047209 DOI: 10.1016/j.beem.2014.02.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Surgery is the long-established therapeutic option for benign thyroid nodules, which steadily grow and become symptomatic. The cost of thyroid surgery, the risk of temporary or permanent complications, and the effect on quality of life, however, remain relevant concerns. Therefore, various minimally invasive treatments, directed towards office-based management of symptomatic nodules, without requiring general anaesthesia, and with negligible damage to the skin and cervical tissues, have been proposed during the past two decades. Today, ultrasound-guided percutaneous ethanol injection and thermal ablation with laser or radiofrequency have been thoroughly evaluated, and are accessible procedures in specialized centres. In clinical practice, relapsing thyroid cysts are effectively managed with percutaneous ethanol injection treatment, which should be considered therapy of choice. In solid non-functioning thyroid nodules that grow or become symptomatic, trained operators may safely induce, with a single session of laser ablation treatment or radiofrequency ablation, a 50% volume decrease and, in parallel, improve local symptoms. In contrast, hyperfunctioning nodules remain best treated with radioactive iodine, which results in a better control of hyperthyroidism, also in the long-term, and fewer side-effects. Currently, minimally invasive treatment is also investigated for achieving local control of small size neck recurrences of papillary thyroid carcinoma in patients who are poor candidates for repeat cervical lymph node dissection. This particular use should still be considered experimental.
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Affiliation(s)
- Enrico Papini
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy.
| | - Claudio M Pacella
- Department of Diagnostic Imaging, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Irene Misischi
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Giancarlo Bizzarri
- Department of Diagnostic Imaging, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Helle Døssing
- Department of ENT Surgery, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedus
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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26
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Papini E, Pacella CM, Hegedus L. Diagnosis of endocrine disease: thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications. Eur J Endocrinol 2014; 170:R133-46. [PMID: 24459238 DOI: 10.1530/eje-13-0917] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In patients with thyroid nodules, ultrasound (US) imaging represents an indispensable tool for assessment of the risk of malignancy. Over approximately four decades, innovative technology and successive improvements have facilitated its entry into the routine management and greatly improved its predictive value. When US features cannot reliably rule out thyroid cancer, US guidance allows a correct and safe sampling also of small or deeply located thyroid lesions. Obtained in this way, cytological or microhistological specimens may reliably define the nature of most thyroid nodules, and the information from histochemical or molecular markers shows promise in the classification of the remaining indeterminate cases. While a prompt surgical treatment can be offered in the minority of suspicious or definitely malignant cases, most individuals warrant only a follow-up. However, at initial evaluation, or over the years, a fraction of these benign lesions may grow and/or become symptomatic. Such cases may benefit from US-guided minimally invasive procedures as an alternative to surgery. Image-guided percutaneous treatments most often achieve relief of neck complaints, are inexpensive, and can be performed on an outpatient basis. The risk of major complications, after adequate training, is very low. Importantly, thyroid function is preserved. Currently, percutaneous ethanol injection for cystic lesions and thermal ablation, with laser or radiofrequency, for solid nodules are increasingly used and disseminated beyond the initial core facilities. In centres with expertise and high patient volume, their use should be considered as first-line treatment alternatives to surgery for selected patients with benign enlarging or symptomatic thyroid lesions.
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27
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Park HY, Choi HH, Lee JJ, Hwang SO, Jung JH, Sohn IB, Lee H, Kim WW. Comparison of Laser Ablation Using Multidirectional and Forward-Firing Fiber in Human Thyroid Gland. Otolaryngol Head Neck Surg 2013; 149:689-91. [DOI: 10.1177/0194599813499895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this study is to evaluate the differences between forward-firing and multidirectional lasers and to evaluate the effects of exposure times and power on laser ablation of thyroid tissue. This is an experimental, ex vivo study. The experiments were conducted on 3 thyroid glands using 2 power levels (3 and 5 W) and exposure times (3 and 5 minutes) with forward-firing and multidirectional lasers. The length and width of the demarcated zone were measured to assess the size of thermal effect. NADPH staining was performed to determine tissue viability. Thermal transformation caused by the forward-firing laser produced oval necrotic zones, whereas thermal transformation caused by the multidirectional-firing laser produced clear round necrotic zones, which clearly demarcated in both hematoxylin and eosin staining and NADH staining.
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Affiliation(s)
- Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyang Hee Choi
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Ju Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Ook Hwang
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Hyang Jung
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ik-Bu Sohn
- Advanced Photonics Research Institute (APRI), Gwangju Institute of Science and Technology (GIST), Gwangju, Korea
| | - Ho Lee
- School of Mechanical Engineering, Kyungpook National University, Daegu, Korea
| | - Wan Wook Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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