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Javid M, Mirdamadi A, Sheida F, Nayak SS, Borkar R, Hegde R, Javid M, Amirian B, Keivanlou MH, Amini-Salehi E, Hassanipour S. Efficacy of Radiofrequency Ablation in Autonomous Functioning Thyroid Nodules: A Comprehensive Systematic Review and Meta-analysis. Acad Radiol 2024:S1076-6332(24)00383-0. [PMID: 39068094 DOI: 10.1016/j.acra.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is a minimally invasive outpatient procedure that has recently emerged as a treatment option for autonomous functioning thyroid nodules (AFTNs), offering a less invasive alternative to surgery. The objective of this systematic review and meta-analysis is to evaluate the efficacy of RFA for AFTNs. METHOD Global databases of PubMed, Scopus, Embase, Web of Science, and Cochrane Library were systematically searched from 1990 until January 5, 2024, for studies on AFTNs undergoing RFA that presented volume reduction ratio (VRR) for at least one of 1, 3, 6 or 12 months post-operative follow-up with the results presented as means. The primary outcomes were VRR and TSH normalization rate, and the secondary outcomes were the cosmetic score, symptom score, and post-procedure complications. Heterogeneity was assessed by Cochrane and I2 statistics, and a random-effects model was used for meta-analysis. The study protocol was registered on PROSPERO (CRD42024499932). RESULTS A total of 10 eligible studies with a total sample size of 254 were included. The pooled VRR after 1, 3, 6, and 12 months of follow-up post-treatment with RFA was 46.6% (95% CI: 40.3-52.9%), 62% (95% CI: 57.6-66.4%), 67.4% (95% CI:62.3-72.6%), and 77.2% (95% CI: 79.2-81.5%), respectively. The overall rate of TSH normalization was 76.4% (95% CI: 58.1-88.4%). Based on included studies the overall rate of subclinical hypothyroidism as one of the most important side effects of this method was 4% (95% CI: 1.9%-8.1%). CONCLUSION RFA emerges as a promising non-surgical treatment for AFTNs, showing high rates of TSH normalization, tumor size reduction, and improved cosmetic and symptom scores. However, further research is needed to compare RFA with surgical methods and assess long-term outcomes.
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Affiliation(s)
- Mona Javid
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Arian Mirdamadi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fateme Sheida
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran; Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sandeep Samethadka Nayak
- Division of Hospital Medicine, Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, USAĪ
| | - Rachana Borkar
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Rahul Hegde
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mohammadreza Javid
- Department of Radiology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Bita Amirian
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Ehsan Amini-Salehi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
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Wang YH, Chiang PL, Lin AN, Wang CK, Lee CY, Chou CK, Chang YH, Chi SY, Luo SD, Lin WC. Long-term outcomes of radiofrequency ablation for intrathoracic goiter up to 5 years: evaluated by computed tomography/magnetic resonance imaging and ultrasound. Int J Hyperthermia 2024; 41:2378865. [PMID: 39004424 DOI: 10.1080/02656736.2024.2378865] [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: 04/09/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVES This study evaluated the long-term efficacy and safety of radiofrequency ablation (RFA) for intrathoracic goiter (ITG) over a follow-up period exceeding six months. METHODS From 2017 to 2022, 22 patients (6 males, 16 females) with 24 ITGs treated with RFA at a single medical center were evaluated. All patients underwent ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI) before RFA. Follow-up CT/MRI was performed six months after the initial RFA and then every 6-12 months. The primary outcomes measured were the degree of extension, goiter volume, volume reduction rate (VRR), tracheal deviation, and tracheal lumen. Additionally, we assessed the outcomes of single-session RFA (n = 16) vs. multiple sessions (n = 8) on goiters and explored the correlation between ITG volume measurements obtained using ultrasonography and CT/MRI. RESULTS The median follow-up period was 12 months (interquartile range: 6-36.8 months). At the last follow-up, the nodule volume measured by CT/MRI had significantly decreased (76.2 vs. 24.6 mL; p < 0.05), with a VRR of 64.6%. Patients who underwent multiple RFA sessions showed a significantly higher VRR than the single-session patients (63.8 vs. 80.1%, p < 0.05). The intraclass correlation between goiter volumes measured using US and CT/MRI was moderate. CONCLUSION This study affirms the long-term efficacy and safety of RFA for ITG, providing an alternative treatment for nonsurgical candidates. Multiple RFA sessions may be beneficial for achieving better volume reduction. Sole reliance on ultrasonography is inadequate; therefore, integrating CT/MRI is essential for accurate pre-RFA and follow-up assessments.
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Affiliation(s)
- Yu-Hsin Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Ying Lee
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Kai Chou
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Radiology, Jen-Ai Hospital, Dali Branch, Taichung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Giovanella L, Garo ML, Campenní A, Ovčariček PP. Radioiodine versus radiofrequency ablation to treat autonomously functioning thyroid nodules: a systematic review and comparative meta-analysis. Eur J Nucl Med Mol Imaging 2024; 51:2050-2066. [PMID: 38305893 DOI: 10.1007/s00259-024-06625-w] [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: 12/07/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Radioiodine (RAI) is a well-established first-line therapy for autonomously functioning thyroid nodules (AFTN). Radiofrequency ablation (RFA) is a minimally invasive procedure that has been proposed as an alternative treatment option for hyperthyroidism caused by AFTN. Although RFA has been shown to be useful for reducing nodule volume and improving TSH levels in AFTN, no comprehensive comparative clinical studies have been proposed to evaluate the overall response to RFA treatment. The aim of this comparative systematic review and meta-analysis was to evaluate the response of RAI and RFA treatments in AFTN. METHODS A systematic search strategy was applied in PubMed, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov until July 2023 without time or language restrictions. Studies investigating the response to RAI and/or RFA treatment in AFTN patients 6 and/or 12 months after treatment were included. The risk of bias was assessed based on the study design. Random-effect models were used for the meta-analysis. RESULTS Twenty-three articles (28 reports) met the inclusion criteria and were included in the study. Overall, RAI therapy was found to have a significantly higher treatment response (94%) than RFA (59%), although the volume of AFTNs was reduced to a similar extent. In the direct comparison (n = 3 studies), RFA showed a higher risk of non-response than RAI (RR, 1.24; 95% CI, 0.94-1.63; z = 1.55; p = 0.12). CONCLUSIONS Our results demonstrate the superiority of RAI over RFA in terms of success rates and safety profile and confirm RAI as the first choice for the treatment of AFTNs.
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Affiliation(s)
- Luca Giovanella
- Department of Nuclear Medicine, Gruppo Ospedaliero Moncucco SA, Clinica Moncucco, Via Soldino 10, 6900, Lugano, Switzerland.
- Clinic for Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland.
| | | | - Alfredo Campenní
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000, Zagreb, Croatia
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García C, Solis-Pazmino P, Pilatuna E, Perez A, Figueroa LA. Radiofrequency ablation as a novel modality in Ecuador for treating toxic thyroid nodules: a case series. Gland Surg 2024; 13:426-432. [PMID: 38601294 PMCID: PMC11002494 DOI: 10.21037/gs-23-425] [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: 10/17/2023] [Accepted: 01/23/2024] [Indexed: 04/12/2024]
Abstract
Background Treating hyperthyroidism induced by autonomously functioning thyroid nodules (AFTNs) through radioactive iodine and surgery often results in undesirable hypothyroidism. Radiofrequency ablation (RFA) has arisen as a favorable option. European guidelines recommend RFA for small AFTN in young patients, aiming to restore normal thyroid function and avoid irradiation. The procedure, costing between 500 and 1,000 euros, is conducted in outpatient clinics and takes 15 to 40 minutes. We aimed to describe the clinical outcomes of AFTN patients treated with RFA in Ecuador. Case Description We included eight patients with toxic thyroid nodules suppressed thyroid-stimulating hormone (TSH), with symptomatic hyperthyroidism. The mean age was 41.63 years [standard deviation (SD): 14.97 years]. The median follow-up time was 8 months. Nodules were solid (37.5%) or predominantly solid (62.5%). The mean volume pre-RFA was 5.27 mL [interquartile range (IQR), 0.70-9.66 mL]. After ablation, the median volumes at 1, 3, and 6 months were [2.25 (SD: 1.67; P<0.12), 1.28 (SD: 1.1; P=0.013), and 1.37 (SD: 1; P=0.23) mL], respectively. The volume reduction (VR) was 45.8%, 75.1%, and 69.7% at 1-, 3-, and 6-month follow-up, respectively. Conclusions RFA holds promise as a potential therapeutic approach for managing AFTNs. The success and the feasibility of RFA in this series are consistent with other studies as a treatment option in young patients with small AFTN. However, more research is needed to establish comprehensive guidelines and protocols to maximize the benefits of RFA in AFTNs.
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Affiliation(s)
- Cristhian García
- Institute of Thyroid and Head and Neck Diseases (ITECC), Quito, Ecuador
| | - Paola Solis-Pazmino
- Institute of Thyroid and Head and Neck Diseases (ITECC), Quito, Ecuador
- Head and Neck Surgery Department, Surgery Group of Los Angeles, Los Angeles, CA, USA
- General Surgery Department, Santa Casa de Misericordia, Porto Alegre, Brazil
| | - Eduardo Pilatuna
- Institute of Thyroid and Head and Neck Diseases (ITECC), Quito, Ecuador
| | - Ana Perez
- Institute of Thyroid and Head and Neck Diseases (ITECC), Quito, Ecuador
| | - Luis A. Figueroa
- Institute of Thyroid and Head and Neck Diseases (ITECC), Quito, Ecuador
- Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
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