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Sun X, Chen J, Zou Y, Lei J, Liu W. Assessing the relative effectiveness of various ultrasound-guided ablation techniques for treating benign thyroid nodules: A systematic review and network meta-analysis. Medicine (Baltimore) 2024; 103:e38014. [PMID: 38701262 PMCID: PMC11062690 DOI: 10.1097/md.0000000000038014] [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: 08/30/2023] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Benign thyroid nodules (BTNs) represent a prevalent clinical challenge globally, with various ultrasound-guided ablation techniques developed for their management. Despite the availability of these methods, a comprehensive evaluation to identify the most effective technique remains absent. This study endeavors to bridge this knowledge gap through a network meta-analysis (NMA), aiming to enhance the understanding of the comparative effectiveness of different ultrasound-guided ablation methods in treating BTNs. METHODS We comprehensively searched PubMed, Embase, Cochrane, Web of Science, Ovid, SCOPUS, and ProQuest for studies involving 16 ablation methods, control groups, and head-to-head trials. NMA was utilized to evaluate methods based on the percentage change in nodule volume, symptom score, and cosmetic score. This study is registered in INPLASY (registration number 202260061). RESULTS Among 35 eligible studies involving 5655 patients, NMA indicated that RFA2 (radiofrequency ablation, 2 sessions) exhibited the best outcomes at 6 months for percentage change in BTN volume (SUCRA value 74.6), closely followed by RFA (SUCRA value 73.7). At 12 months, RFA was identified as the most effective (SUCRA value 81.3). Subgroup analysis showed RFA2 as the most effective for solid nodule volume reduction at 6 months (SUCRA value 75.6), and polidocanol ablation for cystic nodules (SUCRA value 66.5). CONCLUSION Various ablation methods are effective in treating BTNs, with RFA showing notable advantages. RFA with 2 sessions is particularly optimal for solid BTNs, while polidocanol ablation stands out for cystic nodules.
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Affiliation(s)
- Xiangmei Sun
- Department of Ultrasound, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Jiaojiao Chen
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Ultrasound, Shenzhen Futian District Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yan Zou
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Jiahao Lei
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Weizong Liu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
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Fan KY, Loh EW, Tam KW. Efficacy of HIFU for the treatment of benign thyroid nodules: a systematic review and meta-analysis. Eur Radiol 2024; 34:2310-2322. [PMID: 37792080 DOI: 10.1007/s00330-023-10253-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/17/2023] [Accepted: 08/03/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Thyroid nodules are common and sometimes associated with cosmetic issues. Surgical treatment has several disadvantages, including visible scarring. High-intensity focused ultrasound (HIFU) is a recent noninvasive treatment for thyroid nodules. The present study aims to evaluate the effectiveness and safety of HIFU for the treatment of benign thyroid nodules. METHODS We searched PubMed, Embase, and Cochrane Library for studies evaluating the outcomes of HIFU for patients with benign thyroid nodules. We conducted a meta-analysis by using a random effects model and evaluated the volume reduction ratio, treatment success rate, and incidence of treatment-related complications. RESULTS Thirty-two studies were included in the systematic review. Only 14 studies were used in the meta-analysis because the other 18 involved data collected during overlapping periods. The average volume reduction ratios at 3, 6, and 12 months after treatment were 39.02% (95% CI: 27.57 to 50.47%, I2: 97.9%), 48.55% (95% CI: 35.53 to 61.57%, I2: 98.2%), and 55.02% (95% CI: 41.55 to 68.48%, I2: 99%), respectively. Regarding complications, the incidences of vocal cord paresis and Horner's syndrome after HIFU were 2.1% (95% CI: 0.2 to 4.1%, I2: 14.6%) and 0.7% (95% CI: 0 to 1.9%, I2: 0%), respectively. CONCLUSIONS HIFU is an effective and safe treatment option for patients with benign thyroid nodules. However, the effects of HIFU on nodules of large sizes and with different properties require further investigation. Additional studies, particularly randomized controlled trials involving long-term follow-up, are warranted. CLINICAL RELEVANCE STATEMENT Surgical treatment for thyroid nodules often results in permanent visible scars and is associated with a risk of bleeding, nerve injury, and hypothyroidism. High-intensity focused ultrasound may be an alternative for patients with benign thyroid nodules. KEY POINTS • The success rate of HIFU treatment for thyroid nodules is 75.8% at 6 months. Average volume reduction ratios are 48.55% and 55.02% at 6 and 12 months. • The incidence of complications such as vocal fold paresis, Horner's syndrome, recurrent laryngeal nerve palsy, hypothyroidism, and skin redness is low. • HIFU is both effective and safe as a treatment for benign thyroid nodules.
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Affiliation(s)
- Kang-Yun Fan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - El-Wui Loh
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Imaging, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Benaim EH, Nieri C, Mamidala M, Herr MJ, Sheyn A, Gillespie MB. High-intensity focused ultrasound for benign thyroid nodules: Systemic review and meta-analysis. Am J Otolaryngol 2023; 44:103999. [PMID: 37478539 DOI: 10.1016/j.amjoto.2023.103999] [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: 04/12/2023] [Accepted: 07/08/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is a less invasive option offered for the treatment of large, compressive, benign thyroid nodules. METHODS Observational studies of more than five participants using HIFU in the management of benign thyroid nodules from 2000 to 2021 were identified using predefined inclusion criteria. The primary outcome was an estimate of the effectiveness of HIFU. RESULTS Out of 158 studies reviewed, 8 articles were included with 297 patients and 300 nodules. HIFU significantly reduced nodule volume from 1 to 24 months following therapy (weighted mean difference [WMD], 47.68, 95 % confidence interval [CI], 34.13-59.66, p < 0.0001) and achieved favorable success rates (risk ratio [RR], 1.49, 95 % CI, 1.15-1.84, p < 0.001) for 50 % volume reduction. CONCLUSIONS HIFU appears to be a feasible, safe, and effective treatment modality for patients with benign thyroid nodules. Future research, including randomized controlled trials, is needed to determine therapy optimization, and patient selection to identify the potential role of this new therapy.
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Affiliation(s)
- Ezer H Benaim
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America
| | - Chad Nieri
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America
| | - Madhu Mamidala
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America
| | - Michael J Herr
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America
| | - Anthony Sheyn
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America
| | - M Boyd Gillespie
- University of Tennessee Health Science Center-Department of Otolaryngology-Head & Neck Surgery, United States of America.
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Hu MJ, Wang S, Zhang Q, He JL, Zhao HH, Hu WL, Huang F. Associations between environmental exposure to polybrominated diphenyl ethers and nodular goiter risk: A case-control study. ENVIRONMENTAL RESEARCH 2022; 212:113345. [PMID: 35469855 DOI: 10.1016/j.envres.2022.113345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
Polybrominated diphenyl ethers (PBDEs) are widespread and persistent environmental contaminants, but their association with nodular goiter (NG) remains unknown. The present case-control study of 179 NG cases and 358 matched normal controls aimed to investigate the association between PBDEs and risk of NG. The plasma concentrations of 8 PBDEs congeners (BDE-28, -47, -99, -100, -153, -154, -183, and -209) were determined by gas chromatograph-mass spectrometer. Conditional logistic regression model was used to evaluate the odds ratio (OR) and 95% confidence interval (CI) for the association between each PBDEs congener and NG. Bayesian kernel machine regression (BKMR) was used to evaluate the association between overall levels of 8 PBDEs mixture and NG. The results of logistic model suggested that increased risk of NG was associated with elevated concentrations of all PBDEs congeners, except for BDE-209. In BKMR model, the risk of NG increased with the increase in overall exposure level of 8 PBDEs mixture. Compared to when all PBDEs mixture were at their median value, the risk of exposure-response function for NG increased by 0.34 units when all PBDEs were at their 75th percentile. In women, the results showed similar trends after additional adjustment for age at menarche and menopausal status. These findings provide novel epidemiological evidence for the prevention of NG. However, larger prospective studies are required to address the associations between PBDEs exposure and NG risk.
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Affiliation(s)
- Ming-Jun Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Sheng Wang
- The Center for Scientific Research of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Qian Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, China
| | - Jia-Liu He
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Huan-Huan Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Wen-Lei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Fen Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Key Laboratory for Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230032, China.
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Safety and Efficacy of Single-Session Radiofrequency Ablation Treatment for Benign Non-toxic Multinodular Goiter. World J Surg 2022; 46:1704-1710. [PMID: 35313358 DOI: 10.1007/s00268-022-06527-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is an effective treatment for benign thyroid nodules. However, it remains unclear if ablating multiple nodules in single-session offers comparable safety and efficacy to ablating single nodule. Our study compared early complication rate and 6-month nodule shrinkage between multiple-nodules ablation and single-nodule ablation by RFA. METHODS Among the 174 eligible patients undergoing RFA of one or more benign thyroid nodules, 85 (48.8%) had single-nodule ablation (group I) while 89 (51.1%) had two or three nodules ablation (group II). The 6-month nodule shrinkage of each nodule (by volume reduction ratio) (VRR) was calculated by (Baseline volume - volume at 6-month)/(Baseline volume)*100 and compared between two groups. To determine independent predictors for VRR, a multivariate analysis was done by logistic regression analysis. RESULTS Patients in group II reported significantly higher pain scores during and 2-h after treatment than group I (42.31 vs. 29.66, p = 0.029 and 38.21 vs. 26.18, p = 0.037, respectively). Two vocal cord paresis occurred in each group. 3- and 6-month VRR of the largest nodule were comparable between two groups (67.39% vs. 63.89%, p = 0.248 and 77.29% vs. 73.38%, p = 0.182). Similar 3- and 6-month VRR were observed for 2 and 3 largest nodules in group II. In multivariate analysis, total energy given per nodule volume (OR = 1.007, 95% CI = 1.001-1.012, p = 0.036) was the only independent predictor for 6-month VRR. CONCLUSION In the presence of multinodular goiter, ablating two or more nodules by RFA within one session appears to offer a comparable level of safety and efficacy to ablating single nodule.
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Chung SR, Baek JH, Suh CH, Choi YJ, Lee JH. Efficacy and safety of high-intensity focused ultrasound (HIFU) for treating benign thyroid nodules: a systematic review and meta-analysis. Acta Radiol 2020; 61:1636-1643. [PMID: 32202137 DOI: 10.1177/0284185120909339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is an emerging thermal ablation technique that has been successfully applied to various benign thyroid nodules. PURPOSE To evaluate the efficacy and safety of HIFU for the treatment of benign thyroid nodules. MATERIAL AND METHODS The Ovid-MEDLINE and EMBASE databases were searched up to 9 July 2018 for studies describing the use of HIFU to treat benign thyroid nodules. We included studies that have outcomes with sufficient detail to evaluate the volume reduction rate (VRR). The pooled proportions of VRR ≥50% and pooled VRR at one, three, and six months after HIFU were assessed using random-effects modeling. Heterogeneity among studies was determined using Chi-square statistics for pooled estimates and the inconsistency index I2. RESULTS Seven studies were included in the systematic review and four in the meta-analysis. The pooled VRR at one, three, and six months after HIFU were 17.59 (95% confidence interval [CI] 12.56-22.62), 48.93 (95% CI 42.20-55.66), and 60.43 (95% CI 51.88-68.98). The pooled proportions of VRR ≥50% at six months after HIFU were 75% (95% CI 53-89; I2=73.6%). There were no major complications of HIFU. CONCLUSION HIFU may be a safe and effective treatment modality for benign thyroid nodules, especially for small nodules.
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Affiliation(s)
- Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Guan SH, Wang H, Teng DK. Comparison of ultrasound-guided thermal ablation and conventional thyroidectomy for benign thyroid nodules: a systematic review and meta-analysis. Int J Hyperthermia 2020; 37:442-449. [PMID: 32369708 DOI: 10.1080/02656736.2020.1758802] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To compare the safety and efficacy of ultrasound-guided thermal ablation and conventional thyroidectomy for benign thyroid nodules (TNs) by performing a systematic review and meta-analysis.Methods: We searched PubMed, Embase, Web of Science and Cochrane Library databases for clinical trials from the date of their inception to 1 April 2019. Two investigators independently examined the trials to select qualified studies, extracted relevant information and assessed the risk of bias according to the Cochrane Collaboration checklist (Oxford, UK). The primary study outcomes were safety (hoarseness, hypothyroidism and postoperative pain) and efficacy (symptom improvement, postoperative cosmetic effects and hospitalization time). This study is registered with PROSPERO (CRD42019125643).Results: Seven studies involving 1289 patients were included. The results demonstrated that the incidences of hoarseness [odds ratio (OR) 0.33, 95% confidence interval (95% CI) (0.14, 0.79)], hypothyroidism [risk difference (RD) -0.31, 95% CI (-0.34, -0.28)] and postoperative pain [OR 0.35, 95% CI (0.25, 0.49)] were lower, and the hospitalization time was shorter [standard mean difference (SMD) -4.01, 95% CI (-4.22, -3.81)], in the thermal ablation group than in the conventional thyroidectomy group, and postoperative cosmetic effects were better [relative risk (RR) ratio 1.12, 95% CI (1.01, 1.24)] (p < 0.05). For symptom improvement, the difference was not statistically significant.Conclusions: This study shows that for benign TNs, ultrasound-guided thermal ablation may have potential advantages in terms of safety, cosmetic effects and shorter hospitalization time compared with conventional thyroidectomy, while symptom improvement is the same.
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Affiliation(s)
- Shi-Hui Guan
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
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Spartalis E, Karagiannis SP, Plakopitis N, Theodori MA, Chrysikos D, Paschou SA, Boutzios G, Schizas D, Spartalis M, Troupis T, Nikiteas N. Single-session high-intensity focused ultrasound (HIFU) ablation for benign thyroid nodules: a systematic review. Expert Rev Med Devices 2020; 17:759-771. [PMID: 32749167 DOI: 10.1080/17434440.2020.1806053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Thyroid nodules are common; the majority of them are benign and asymptomatic. Thyroidectomy might be an option; however, the frequency of post-operative complications mandates the development of alternative approaches, such as high-intensity focused ultrasound ablation (HIFU). HIFU induces thermal destruction without penetrating the skin. The present systematic review aims to synthesize all available data, evaluating studies with single-session HIFU therapy and investigating its efficacy. MATERIALS AND METHODS This systematic review was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and MetaAnalyses). Eligible articles were identified by a search of Medline bibliographic database (PubMed) and Cochrane Library. Out of 39 results, 11 articles were considered to meet the inclusion criteria. RESULTS All eligible studies included patients with solid or predominantly solid benign thyroid nodules. All patients were treated with the same HIFU device. The success rate of the method was defined in the majority, with the volume reduction rate (VRR) over 50% from baseline. The mean or median VRR ranged from 48.7 to 70.41%, depending on the last follow-up date. No major complications were observed. CONCLUSION Single-session HIFU is safe and effective for the treatment of benign thyroid nodules.
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Affiliation(s)
- Eleftherios Spartalis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Sotirios P Karagiannis
- 4th Department of Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Nikolaos Plakopitis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Maria Anna Theodori
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Dimosthenis Chrysikos
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, Aghia Sophia Hospital, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Georgios Boutzios
- Endocrine Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens , Athens, Greece
| | - Michael Spartalis
- Laboratory of Experimental Surgery and Surgical Research "N.S Christeas", National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Theodore Troupis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Nikolaos Nikiteas
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
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Haiyan S, Lin W, Shuhua H, Wang W. High-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone analogs (GnRHa) and levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis: a case series with long-term follow up. Int J Hyperthermia 2020; 36:1179-1185. [PMID: 31793356 DOI: 10.1080/02656736.2019.1679892] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: This research was conducted to assess the long-term outcomes of a combination treatment of High-intensity focused ultrasound (HIFU) ablation, gonadotropin-releasing hormone analogs (GnRHa) and Levonorgestrel-releasing intrauterine system (LNG-IUS) for women with adenomyosis (AD).Methods: One hundred and forty-two patients with AD were enrolled and treated with HIFU conservative treatment in combination with adjuvant therapy of GnRHa and LNG-IUS. All the cases were followed up to 5 years after treatment. The volumes of uteri, AD lesions, and menstrual blood, and dysmenorrhea scores were measured. Also, the incidences of recurrence and complications were recorded.Results: Both the uterine and lesion volumes significantly decreased after treatment. The uterine volume gradually reduced after treatment, reaching the lowest level of 122.07 ± 44.12 cm3 at 12 months after treatment, with an average reduction rate of 45%, and then increased slightly, maintaining a reduction rate of about 35% compared with the baseline level. Similar decreases in AD lesion volumes, dysmenorrhea scores, and menstrual flow were also demonstrated. Hemoglobin levels increased. Moreover, the long-term recurrence rates were low, with 5.68% and 7.91% in dysmenorrhea and menorrhagia, respectively. No serious complications or adverse events were reported.Conclusions: HIFU ablation, in combination with GnRHa and LNG-LUS, might be a safe and effective alternative in the treatment for women with adenomyosis.
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Affiliation(s)
- Sun Haiyan
- Department of Gynecology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Wang Lin
- Department of Gynecology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Huang Shuhua
- Department of Gynecology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Wei Wang
- Department of Gynecology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Prakash PS, Oh HB, Tan WB, Parameswaran R, Ngiam KY. The Efficacy and Safety of High-Intensity Focused Ultrasound (HIFU) Therapy for Benign Thyroid Nodules-A Single Center Experience from Singapore. World J Surg 2019; 43:1957-1963. [PMID: 30863871 DOI: 10.1007/s00268-019-04976-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is a recent noninvasive technique of treating thyroid nodules. Our study aims to investigate the efficacy and safety of HIFU in treating benign thyroid nodules. METHODS This is a retrospective analysis of consecutive patients who underwent HIFU of benign thyroid nodules at our institution from July 2017-2018. All procedures were performed by a single surgeon. Patients were evaluated immediately post-procedure, and at subsequent intervals of 1 week, 1 month, 3 months, and 6 months. The primary endpoint was thyroid nodule volume reduction at 6 months posttreatment. Secondary endpoints were post-procedure local complications. RESULTS Ten patients with 13 thyroid nodules were included. The median follow-up period was 426 days (range 238-573). Mean maximum diameter reduced from 2.6 cm (±0.8) pretreatment to 1.4 cm (±0.7, P < 0.05) 6 months posttreatment. Mean nodule volume reduced from 5.2 cm3 (±4.2) pretreatment to 1.5 cm3 (±1.3, P = 0.01) 6 months posttreatment. Mean volume reduction ratio (VRR) at 6 months posttreatment was 63.2% (±22.5, P < 0.05), with volume reduction of ≥50% in 10 of 13 (76.9%) nodules. Two nodules (15.4%) showed size increases from 4 months posttreatment. No patients experienced local skin burns or hematomas. Mean pain scores were 1.5 (±1.2) immediate post-procedure, 0.8 (±1.5) at 1 week, and 0.6 (±1.2) at 1 month post-procedure, respectively, with no reports of pain beyond 1 month. Only two (20.0%) patients had early, temporary posttreatment voice hoarseness. CONCLUSION Our study shows HIFU ablation to be efficacious and safe-with significant thyroid nodule volume reductions, and no significant or prolonged local complications.
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Affiliation(s)
- Prajwala S Prakash
- Division of Thyroid and Endocrine Surgery, University Surgical Cluster, National University Health System (NUHS), NUHS Tower Block Level 8, Singapore, 119228, Singapore
| | - Han Boon Oh
- Division of Thyroid and Endocrine Surgery, University Surgical Cluster, National University Health System (NUHS), NUHS Tower Block Level 8, Singapore, 119228, Singapore
| | - Wee Boon Tan
- Division of Thyroid and Endocrine Surgery, University Surgical Cluster, National University Health System (NUHS), NUHS Tower Block Level 8, Singapore, 119228, Singapore
| | - Rajeev Parameswaran
- Division of Thyroid and Endocrine Surgery, University Surgical Cluster, National University Health System (NUHS), NUHS Tower Block Level 8, Singapore, 119228, Singapore
| | - Kee Yuan Ngiam
- Division of Thyroid and Endocrine Surgery, University Surgical Cluster, National University Health System (NUHS), NUHS Tower Block Level 8, Singapore, 119228, Singapore.
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11
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Lang BHH, Woo YC, Chiu KWH. Two-year outcomes of single-session high-intensity focused ultrasound (HIFU) treatment in persistent or relapsed Graves' disease. Eur Radiol 2019; 29:6690-6698. [PMID: 31209622 DOI: 10.1007/s00330-019-06303-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/03/2019] [Accepted: 06/04/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the longer-term disease relapse of ultrasound (US)-guided high-intensity focused ultrasound (HIFU) ablation as a treatment for persistent/relapsed Graves' disease (GD). METHODS After ethics approval, consecutive patients with persistent or relapsed GD who underwent bilateral US-guided HIFU ablation from 2016 to 2017 were retrospectively analyzed. Altogether, 75 patients received HIFU ablation of the central portion of the right and left thyroid lobes with areas near the trachea-esophageal groove and common carotid artery un-ablated. They were followed for 24 months or longer. Baseline thyrotropin (TSH), free T4, anti-thyroid autoantibodies, and TSH receptor (TSHR) antibody were checked. Primary outcome was the 24-month relapse rate. Relapse referred to hyperthyroidism (free T4 (FT4) > 23 pmol/L) afterwards. Variables associated with relapse were analyzed by binary logistic regression. RESULTS The cohort comprised mostly females (84.0%) with a mean age of 42.05 ± 10.74 years. The 24-month relapse rate was 41.3% with 31 patients suffering a relapse. No patient suffered from hypothyroidism. Three patients (4.0%) suffered from temporary vocal cord palsy but these injuries recovered spontaneously after 2 months. In univariate analysis, higher daily dose of carbimazole (OR = 1.125, 95% CI = 1.023-1.237, p = 0.015) and higher baseline TSHR level (OR = 1.085, 95% CI = 1.022-1.152, p = 0.007) were significant factors for disease relapse. In the multivariate analysis, higher baseline TSHR level was a significant independent factor for disease relapse within 24 months (OR = 1.079, 95% CI = 1.014-1.148, p = 0.016). CONCLUSIONS US-guided HIFU of the thyroid gland was a safe and relatively efficacious treatment in the longer term for patients with persistent or relapsed GD. KEY POINTS • US-guided HIFU ablation is relatively efficacious in the longer term. • US-guided HIFU ablation of the thyroid is safe. • Higher TSHR level may lead to higher disease relapse after treatment.
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Affiliation(s)
- Brian Hung-Hin Lang
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong SAR, China.
| | - Yu-Cho Woo
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
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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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Two sequential applications of high-intensity focused ultrasound (HIFU) ablation for large benign thyroid nodules. Eur Radiol 2019; 29:3626-3634. [DOI: 10.1007/s00330-019-06021-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/19/2018] [Accepted: 01/18/2019] [Indexed: 12/16/2022]
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Lang BHH, Woo YC, Chiu KWH. Two-year efficacy of single-session high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Eur Radiol 2018; 29:93-101. [PMID: 29922925 DOI: 10.1007/s00330-018-5579-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Assessing the efficacy of single high-intensity focused ultrasound (HIFU) ablation in benign thyroid nodules beyond 12 months. METHODS One hundred and eight patients underwent single HIFU treatment. Extent of nodule shrinkage [by volume reduction ratio (VRR)] and obstructive symptom score [by 0-10 visual analogue scale (VAS)] were evaluated for 24 months after treatment. VRR (%) was calculated based on the formula: [baseline volume - volume at visit] / [baseline volume] × 100. Binary logistic regression was performed to evaluate factors associated with 24-month treatment success (VRR ≥ 50%). RESULTS After treatment, the mean (± SD) VRR at 3, 6, 12 ,18 and 24 months were 51.32 ± 20.71%, 62.99 ± 22.05%, 68.66 ± 18.48%, 69.76 ± 17.88% and 70.41 ± 17.39%, respectively, while the median (IQR) VAS at baseline, 6, 12 and 24 months was gradually lowered from 4.0 (2.0), 2.0 (1.0), 2.0 (1.0) to 1.0 (2.0), respectively. Sixty-three (58.3%) nodules had a further volume reduction (i.e. > 4.5%) from 12 to 24 months, while 22 (20.4%) nodules had a volume increase of > 4.5% from 12 to 24 months. Small pre-ablation nodule volume was a significant determinant for treatment success at 24 months (OR=1.045, 95% CI=1.021-1.092, p = 0.038). CONCLUSIONS A majority of nodules had further volume reduction beyond 12 months after single HIFU ablation, but since one-fifth of nodules had a notable volume increase beyond 12 months, a longer period of surveillance would be necessary. Small pre-ablation nodule volume was a significant factor determining 24-month treatment success. KEY POINTS • Small but significant nodule shrinkage continues beyond 12 months after single treatment. • Obstructive symptom continues to improve beyond 12 months after single treatment • Smaller-sized nodules have a greater chance of treatment success at 24 months.
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Affiliation(s)
- Brian H H Lang
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China. .,Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, SAR, China.
| | - Yu-Cho Woo
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China
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