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Qian Y, Li Z, Fan C, Huang Y. Comparison of ultrasound-guided microwave ablation, laser ablation, and radiofrequency ablation for the treatment of elderly patients with benign thyroid nodules: A meta-analysis. Exp Gerontol 2024; 191:112425. [PMID: 38604254 DOI: 10.1016/j.exger.2024.112425] [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: 02/02/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND A new minimally invasive technique, ultrasound-guided thermal ablation has become one of the treatment methods for benign thyroid nodules. This study aims to evaluate the efficacy and safety of laser ablation (LA), radiofrequency ablation (RFA), and microwave ablation (MWA) in the treatment of elderly patients with benign thyroid nodules. METHODS PubMed, Web of Science, and Cochrane Library were searched for qualified randomized controlled studies (RCTs) issued from establishing databases to March 2022. After screening and evaluating the article quality, the data on nodular volume reduction rate (VRR) and the incidence of complications after thermal ablation were extracted and analyzed by RevMan 5.3 and Stata l4.0. RESULTS The meta-analysis included seven articles with 3055 participants. We found that LA, RFA, and MWA could markedly reduce the volume of benign thyroid nodules. LA was superior to RFA and MWA in reducing the volume of benign thyroid nodules in 6 months of follow-up (all P < 0.05). LA, RFA, and MWA can be safely implemented in patients with benign thyroid nodules. The incidence of significant complications after the RFA group was enhanced compared with that in the MWA (P < 0.05), and the incidence of secondary complications after RFA was slightly higher than that of LA (P < 0.05). CONCLUSION LA, RFA, and MWA can markedly reduce the volume of benign thyroid nodules in elderly patients and can safely treat benign thyroid nodules.
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Affiliation(s)
- Ying Qian
- Department of Ultrasound, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu, China
| | - Zheng Li
- Department of Ultrasound, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu, China
| | - Chunyun Fan
- Department of Ultrasound, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu, China
| | - Yong Huang
- Department of Endocrinology, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu, China.
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Zhang P, Wang L, Li G, Wei T, Zhu J, Lei J, Li Z. Psychological impacts of thermal ablation and conventional thyroidectomy in BTN patients: a prospective observational study. Endocrine 2024:10.1007/s12020-024-03814-3. [PMID: 38598064 DOI: 10.1007/s12020-024-03814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Thermal ablation and conventional thyroidectomy are effective therapeutic methods for treating benign thyroid nodules (BTNs), but the psychological impacts of these methods in BTN patients are largely unknown. MATERIALS AND METHODS This survey study prospectively enrolled patients who were admitted to our hospital between July 2021 and July 2022. The four validated scales were applied to quantify psychological distress and sleep quality at five points (the day admitted to the hospital, the day discharged from the hospital, and 1, 3, and 6 months after treatment). Participants who were diagnosed with BTNs and completed the questionnaires were ultimately enrolled and divided into thermal ablation and conventional thyroidectomy groups. A propensity score matching (PSM) cohort was subsequently developed to evaluate longitudinal and cross-sectional changes in psychological-related indicators. RESULTS Among 548 eligible BTN patients, 460 patients completed all the questionnaires throughout the follow-up (response rate: 83.94%), including 368 (80.00%) patients who underwent thermal ablation and 92 (20.00%) patients who underwent conventional thyroidectomy. After PSM, a total of 342 patients were enrolled (256 patients underwent thermal ablation, and 86 patients underwent conventional thyroidectomy). The psychological-related indicators of patients in the thermal ablation group remained relatively stable during the 6-month follow-up, but patients in the conventional thyroidectomy group may have experienced greater anxiety and sleep quality concerns in the longitudinal assessment. Additionally, in the cross-sectional evaluation, the sleep quality of the thermal ablation group was also better than that of the conventional thyroidectomy group postoperatively. CONCLUSIONS Thermal ablation is superior to conventional thyroidectomy for BTN patients in terms of psychological-related indicators.
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Affiliation(s)
- Pan Zhang
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- The Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Lanlan Wang
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- The Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Genpeng Li
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- The Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Wei
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- The Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Jingqiang Zhu
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- The Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Jianyong Lei
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- The Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Zhihui Li
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
- The Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 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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Jing H, Yan L, Xiao J, Li X, Jiang B, Yang Z, Li Y, Sun B, Zhang M, Luo Y. Radiofrequency ablation for papillary thyroid microcarcinoma with a trachea-adjacent versus trachea-distant location. Int J Hyperthermia 2024; 41:2270671. [PMID: 38214143 DOI: 10.1080/02656736.2023.2270671] [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: 07/07/2023] [Accepted: 10/09/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE To evaluate the outcomes of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) adjacent to the trachea and compare them with those of PTMC distant from the trachea. METHODS Patients who received RFA for solitary low-risk PTMC between June 2014 and July 2020 were reviewed and classified into adjacent and distant groups. To balance between-group confounders, the propensity score matching approach was employed. Volume, volume reduction ratio (VRR), tumor disappearance, complications, and disease progression were assessed and compared between the groups. Furthermore, factors affecting disease progression were evaluated. RESULTS A total of 122 and 470 patients were included in the adjacent and distant groups, respectively. Overall VRR was 99.5% ± 3.1 and cumulative tumor disappearance rate was 99.4% after a mean follow-up time of 40.1 months ± 16.2. Overall disease progression and complications incidence were 3.7% and 1.0%, respectively. No substantial differences were observed between the two groups in the latest volume (0.8 mm3 ± 4.1 vs. 0.9 mm3 ± 4.2, p = .77), VRR (99.7% ± 1.6 vs. 99.5% ± 2.7, p = .75), cumulative tumor disappearance rate (92.6% vs. 94.2%, p = .58), and incidence of disease progression (4.1% vs. 4.5%, p = .70) and complication (1.7% vs. 0.8%, p = .86) after 1:2 matching. Additionally, tracheal adjacency exhibited no association with disease progression in multivariate Cox regression analysis (p = .73). CONCLUSION For eligible patients with PTMC located adjacent to or distant from the trachea, RFA may offer a safe and effective alternative treatment method.
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Affiliation(s)
- Haoyu Jing
- Chinese PLA Medical School, Beijing, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xinyang Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Jiang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhen Yang
- Chinese PLA Medical School, Beijing, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yingying Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bin Sun
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Noel JE, Sinclair CF. Radiofrequency Ablation for Benign Thyroid Nodules. J Clin Endocrinol Metab 2023; 109:e12-e17. [PMID: 37401778 DOI: 10.1210/clinem/dgad357] [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: 11/21/2022] [Indexed: 07/05/2023]
Abstract
CONTEXT Thermal ablative techniques of the thyroid have recently gained clinical traction as a therapeutic alternative that provides symptomatic relief and confers potential advantages over surgery. A truly multidisciplinary technique, thyroid ablation is currently performed by endocrinologists, interventional radiologists, otolaryngologists, and endocrine surgeons. Radiofrequency ablation (RFA), specifically, has seen widespread adoption, particularly in the treatment of benign thyroid nodules. This review summarizes current evidence on the application of RFA in benign thyroid nodules, and provides a start to finish overview of procedural preparation, performance, and outcomes. EVIDENCE ACQUISITION A narrative review of literature focusing on RFA in the treatment of benign nodular disease was performed. Emphasis was placed on consensus statements, best practice guidelines, multi-institutional studies, and systematic reviews to summarize key concepts in candidacy, techniques, expectations, and outcomes. FINDINGS RFA is increasingly recognized as a first-line treatment strategy in the management of symptomatic nonfunctional benign thyroid nodules. It can also be considered in functional thyroid nodules with small volumes or in patients ineligible for surgery. A targeted and efficacious technique, RFA results in gradual volume reduction that preserves the function of the surrounding thyroid parenchyma. Proper procedural technique, proficiency in ultrasound, and experience in ultrasound-guided procedures are instrumental to maintaining low complication rates and achieving successful ablation outcomes. CONCLUSIONS In pursuit of a personalized approach, physicians across disciplines are increasingly incorporating RFA into their treatment algorithms, most commonly for benign nodules. As with any intervention, thoughtful selection and implementation ensure a safe procedure with optimal patient benefit.
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Affiliation(s)
- Julia E Noel
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Catherine F Sinclair
- Department of Otolaryngology-Head & Neck Surgery, Monash University Melbourne, Clayton, VIC 3800, Australia , and Mount Sinai School of Medicine: Icahn School of Medicine at Mount Sinai, New York, NY 10019, USA
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Chiu CH, Luo SD, Chiang PL, Lin AN, Wang CK, Chou CK, Chi SY, Chen MH, Lin WC. Factors Influencing a Favorable Outcome for RFA of Huge Benign Thyroid Nodules: Preliminary Results and Short-Term Evaluation. Int J Endocrinol 2023; 2023:9021903. [PMID: 38131035 PMCID: PMC10735726 DOI: 10.1155/2023/9021903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/18/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Objective This study aimed to investigate potentially favorable factors influencing the therapeutic success of radiofrequency ablation (RFA) of huge benign thyroid nodules (BTNs) (volume >100 ml) and to evaluate the feasibility of RFA as an alternative treatment modality for patients unable or unwilling to undergo surgery. Methods This retrospective study evaluated a total of 868 patients, of which 22 patients had huge BTNs who underwent ultrasound-guided moving shot RFA treatment between May 2017 and January 2022. The huge BTNs were categorized into two groups according to a post-RFA treatment volume reduction ratio (VRR) of >80% and <80% at 6 months. Factors influencing these huge BTNs were reviewed, analyzed, and correlated with treatment effectiveness between the two groups. Results The factors influencing an effective VRR included huge BTNs located on the left side (OR 7.875, p = 0.03), predominant solid/spongiform nodules (OR 7.875, p = 0.03), and higher initial ablation rate (IAR) (p = 0.028). Multivariable logistic regression revealed predominant solid/spongiform nodule and the higher IAR were associated with the advanced VRR. Conclusion RFA was effective at decreasing the volume of huge BTNs with an acceptable complication rate. The BTN characteristics correlated with a better VRR at the 6-month short-term follow-up were predominant solid/spongiform BTNs and those with the first time ablation treatment initial ablation rate. Nevertheless, regarding the higher regrowth rate of these groups of patients who may need to be treated more times, RFA can only be a feasible alternative treatment modality for patients unable or unwilling to undergo operation.
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Affiliation(s)
- Chun-Hua Chiu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Kai Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Radiology, Jen-Ai Hospital, Taichung, Taiwan
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Scerrino G, Richiusa P, Graceffa G, Lori E, Sorrenti S, Paladino NC. Editorial: Recent Advances in Thyroid Surgery. J Clin Med 2022; 11:jcm11237233. [PMID: 36498807 PMCID: PMC9740206 DOI: 10.3390/jcm11237233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Thyroid surgery has been, since its earliest application, one of the most notable fields in medicine, illustrated by the fact that the Nobel Prize in Medicine was won, for the first time, for thyroid surgery by Emil Theodor Kocher (1841-1917) in 1909, for his contributions to thyroid physiology, pathology, and surgery [...].
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Affiliation(s)
- Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy
- Correspondence:
| | - Pierina Richiusa
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, Via Del Vespro 129, 90127 Palermo, Italy
| | - Giuseppa Graceffa
- Unit of General and Oncology Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Eleonora Lori
- Department of Surgery, “Sapienza” University of Rome, Viale Del Policlinico 155, 00161 Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgery, “Sapienza” University of Rome, Viale Del Policlinico 155, 00161 Rome, Italy
| | - Nunzia Cinzia Paladino
- Department of General Endocrine and Metabolic Surgery, Conception Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005 Marseille, France
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