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Russotto F, Fiorentino V, Pizzimenti C, Micali MG, Franchina M, Pepe L, Riganati G, Giordano W, Magliolo E, Ristagno S, Rossi ED, Tuccari G, Martini M, Ieni A, Fadda G. Histologic Evaluation of Thyroid Nodules Treated with Thermal Ablation: An Institutional Experience. Int J Mol Sci 2024; 25:10182. [PMID: 39337667 PMCID: PMC11432105 DOI: 10.3390/ijms251810182] [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: 08/08/2024] [Revised: 09/20/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024] Open
Abstract
Thyroid nodules are a common, benign condition with a higher prevalence in women, individuals with iodine deficiency, and radiation exposure. Treatment options for benign thyroid nodules include pharmaceutical therapy, thyroidectomy, and thermal ablation (TA). TA, including laser ablation (LA), radiofrequency ablation (RFA), and microwave ablation (MWA), is a procedure that uses heat to cause tissue necrosis. It is commonly used for large, firm, benign, non-functioning thyroid nodules that cause severe symptoms or pain when surgery is not recommended or desired. When thyroid nodules do not respond to TA, they undergo surgery to resolve the symptoms and clarify the diagnosis. This study aims to analyze the histological alterations found in surgically excised TA-treated thyroid nodules and to evaluate the morphological criteria of differential diagnosis between benign and malignant nodules, establishing whether the alterations observed on the histological sample are a consequence of TA or indicative of neoplastic disease. For this purpose, the adoption of ancillary methods, such as immunohistochemistry, is fundamental to distinguish the artifacts induced by TA from the typical morphological characteristics of malignant neoplasms.
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Affiliation(s)
- Fernanda Russotto
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.R.); (M.G.M.); (M.F.); (L.P.); (G.R.); (W.G.); (G.T.); (M.M.); (A.I.); (G.F.)
| | - Vincenzo Fiorentino
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.R.); (M.G.M.); (M.F.); (L.P.); (G.R.); (W.G.); (G.T.); (M.M.); (A.I.); (G.F.)
| | | | - Marina Gloria Micali
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.R.); (M.G.M.); (M.F.); (L.P.); (G.R.); (W.G.); (G.T.); (M.M.); (A.I.); (G.F.)
| | - Mariausilia Franchina
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.R.); (M.G.M.); (M.F.); (L.P.); (G.R.); (W.G.); (G.T.); (M.M.); (A.I.); (G.F.)
| | - Ludovica Pepe
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.R.); (M.G.M.); (M.F.); (L.P.); (G.R.); (W.G.); (G.T.); (M.M.); (A.I.); (G.F.)
| | - Giuseppe Riganati
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.R.); (M.G.M.); (M.F.); (L.P.); (G.R.); (W.G.); (G.T.); (M.M.); (A.I.); (G.F.)
| | - Walter Giordano
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.R.); (M.G.M.); (M.F.); (L.P.); (G.R.); (W.G.); (G.T.); (M.M.); (A.I.); (G.F.)
| | - Emilia Magliolo
- Department of Pathology, “San Vincenzo” Hospital, 98039 Taormina, Italy;
| | - Serenella Ristagno
- Department of Oncology, Section of Endocrine Surgery, “San Vincenzo” Hospital, 98039 Taormina, Italy;
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A.Gemelli IRCCS, 00168 Rome, Italy;
| | - Giovanni Tuccari
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.R.); (M.G.M.); (M.F.); (L.P.); (G.R.); (W.G.); (G.T.); (M.M.); (A.I.); (G.F.)
| | - Maurizio Martini
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.R.); (M.G.M.); (M.F.); (L.P.); (G.R.); (W.G.); (G.T.); (M.M.); (A.I.); (G.F.)
| | - Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.R.); (M.G.M.); (M.F.); (L.P.); (G.R.); (W.G.); (G.T.); (M.M.); (A.I.); (G.F.)
| | - Guido Fadda
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.R.); (M.G.M.); (M.F.); (L.P.); (G.R.); (W.G.); (G.T.); (M.M.); (A.I.); (G.F.)
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Berisha-Muharremi V, Tahirbegolli B, Phypers R, Hanna R. Efficacy of Combined Photobiomodulation Therapy with Supplements versus Supplements alone in Restoring Thyroid Gland Homeostasis in Hashimoto Thyroiditis: A Clinical Feasibility Parallel Trial with 6-Months Follow-Up. J Pers Med 2023; 13:1274. [PMID: 37623524 PMCID: PMC10455109 DOI: 10.3390/jpm13081274] [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: 08/03/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Hashimoto thyroiditis (HT) is a thyroid-specific autoimmune disorder, triggering hypothyroidism in a population with an adequate dietary intake. Despite the current conventional treatment focuses on the permanent replacement of levothyroxine (LT4) deficiency, it appears that thyroid autoimmunity remains the cause of persistent symptoms in patients with HT, even when they achieve to be euthyroid from a biochemical standpoint. Photobiomodulation (PBM) showed to be an effective therapy in the management of autoimmune diseases, but with limited evidence. Hence, our study was conducted to appraise the efficacy of PBM therapy with supplements in restoring thyroid gland homeostasis in patients with HT compared with supplements alone. Seventy-four female subjects aged between 20 and 50 years old were recruited and divided equally into two groups: PBM and supplements group (group 1); and supplements alone group (group 2). The PBM dosimetry and treatment protocols were as follows: wavelength, 820 nm; power output, 200 mW; continuous emission mode; irradiating time, 20 s per point; fluence, 32 J/cm2 per point; treatment frequency, twice a week (excluding weekends); and treatment duration, three consecutive weeks. Whereas, the supplements protocol for both groups was the same, as follows: subjects with a serum level of vitamin D3 <40 ng/dL, who received replacement according to their serum levels, and all the subjects had a daily intake of 100 µg of oral selenium. The biochemical (FT3, FT4, antiTPO and antiTG) and anthropometric measurements were evaluated. Our findings showed significant improvement in group 1 parameters (PBM+ supplements) compared with group 2 (supplements only) in terms of weight loss and reduction in the following parameters: BMI, hip and waist circumference, waist/hip ratio, TSH, antiTPO, antiTG and treatment dose of LT4 (p < 0.05). Our results, for the first time, demonstrated an efficacy of PBM delivered at a lower fluence with supplements in restoring thyroid function, anthropometric parameters and lifestyle factors in patients with HT. Hence, extensive studies with a longer follow-up period are warranted.
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Affiliation(s)
- Venera Berisha-Muharremi
- Faculty of Medicine, University of Prishtina, Bulevardi i Dëshmorëve nn, 10000 Prishtina, Kosovo;
- Poliklinika Endomedica, Muharrem Fejza Str. Nr. 84, 10000 Prishtina, Kosovo
| | - Bernard Tahirbegolli
- Department of Management of Health Institution and Services, Heimerer College, 10000 Prishtina, Kosovo;
- National Sports Medicine Centre, Lagjia e Spitalit nn, 10000 Prishtina, Kosovo
| | - Ruth Phypers
- Laser Medicine Centre, 10 Harley Street, London W1G 9PF, UK;
| | - Reem Hanna
- Department of Oral Surgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV, 16132 Genoa, Italy
- Department of Restorative Dental Sciences, UCL-Eastman Dental Institute, Faculty of Medical Sciences, Rockefeller, University College London, London WC1E 6DE, UK
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Hossein-Khannazer N, Kazem Arki M, Keramatinia L, Rezaei-Tavirani M. Low-Level Laser Therapy in the Treatment of Autoimmune Thyroiditis. J Lasers Med Sci 2022; 13:e34. [PMID: 36743139 PMCID: PMC9841386 DOI: 10.34172/jlms.2022.34] [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: 01/11/2022] [Accepted: 07/18/2022] [Indexed: 01/27/2023]
Abstract
Introduction: Autoimmune thyroiditis (AIT) is an autoimmune disorder that is characterized by thyroid gland dysfunction. Low-level laser therapy (LLLT), as a safe and non-invasive intervention, has gained much attention in many clinical applications including pain relief, regenerative medicine, and autoimmune. Methods: In this review, we discuss the effect of LLLT on cellular responses and its application in the treatment of AIT. Such keywords as "low-level laser therapy", "photobiomodulation" and "autoimmune thyroiditis" were used to find studies related to laser therapy in AIT in Google Scholar, PubMed and Medline databases. Results: LLLT reduced thyroid gland inflammation and inhibited immune cell trafficking. LLLT modulated inflammatory responses and improved thyroid gland regeneration. Conclusion: Investigations indicated that besides current treatment strategies, LLLT could be a promising therapeutic approach for the treatment of AIT.
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Affiliation(s)
- Nikoo Hossein-Khannazer
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mandana Kazem Arki
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - liasghar Keramatinia
- Department of Social Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Rezaei-Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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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Maletta F, Garberoglio S, Bisceglia A, Ragni A, Retta F, Gallo M, Garberoglio R, Papotti M. Radiofrequency Thermal Ablation for a Small Papillary Thyroid Carcinoma in a Patient Unfit for Surgery: A Case Report. Front Endocrinol (Lausanne) 2021; 12:566362. [PMID: 33854477 PMCID: PMC8040516 DOI: 10.3389/fendo.2021.566362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/11/2021] [Indexed: 11/30/2022] Open
Abstract
Ultrasound-guided radiofrequency thermal ablation has been proposed as an effective and safe procedure for treating patients who have low-risk papillary thyroid microcarcinomas and/or are unfit for surgery. We present the case of a 72-year old male patient with a small thyroid nodule diagnosed as papillary carcinoma after fine needle aspiration. Since the patient had other serious comorbidities, priority was given to other therapies and the malignant thyroid nodule was submitted to active surveillance. After detecting at a follow-up examination a slight dimensional increase of the nodule, the possibility of a radiofrequency thermal ablation was proposed to our patient, who accepted. The procedure was safely and effectively carried out. Follow-up examinations with ultrasonography (or contrast enhanced ultrasound), conducted after 1, 3, 6, and 12 months, demonstrated a progressive reduction of size and loss of vascularization in the treated area. The fine needle aspiration was repeated after 6 months: the sample revealed a very poor cellularity composed of inflammatory cells and thick colloid; no residual neoplastic cells were observed. Our experience confirmed what already demonstrated by previous reports: radiofrequency ablation can effectively eliminate small papillary carcinomas, with a very low complication rate. It may be an alternative strategy for the treatment of low-risk, indolent papillary thyroid microcarcinomas, thus avoiding the potential side-effects of surgery in patients at risk for relevant comorbidities.
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Affiliation(s)
- Francesca Maletta
- Pathology Unit, Department of Laboratory Medicine, Città della Salute e della Scienza Hospital, Turin, Italy
- *Correspondence: Francesca Maletta,
| | - Sara Garberoglio
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Alessandro Bisceglia
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Alberto Ragni
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Francesca Retta
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
- Endocrinology and Metabolic Diseases Unit, AO S.S. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Roberto Garberoglio
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, University of Turin, Turin, Italy
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Cho SJ, Baek JH, Chung SR, Choi YJ, Lee JH. Long-Term Results of Thermal Ablation of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis. Endocrinol Metab (Seoul) 2020; 35:339-350. [PMID: 32615718 PMCID: PMC7386110 DOI: 10.3803/enm.2020.35.2.339] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/14/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Ultrasound-guided thermal ablations have become one of the main options for treating benign thyroid nodules. To determine efficacy of thermal ablation of benign thyroid nodules, we performed a meta-analysis of studies with long-term follow-up of more than 3 years. METHODS Databases were searched for studies published up to August 25, 2019, reporting patients with benign thyroid nodules treated with thermal ablation and with follow-up data of more than 3 years. Data extraction and quality assessment were performed according to PRISMA guidelines. The analysis yielded serial volume reduction rates (VRRs) of ablated nodules for up to 3 years or more, and adverse effect of ablation during follow-up. Radiofrequency ablation (RFA) and laser ablation (LA) were compared in a subgroup analysis. RESULTS The pooled VRRs for ablated nodules showed rapid volume reduction before 12 months, a plateau from 12 to 36 months, and more volume reduction appearing after 36 months, demonstrating long-term maintenance of treatment efficacy. Thermal ablation had an acceptable complication rate of 3.8%. Moreover, patients undergoing nodule ablation showed no unexpected delayed complications during the follow-up period. In the subgroup analysis, RFA was shown to be superior to LA in terms of the pooled VRR and the number of patients who underwent delayed surgery. CONCLUSION Thermal ablations are safe and effective methods for treating benign thyroid nodules, as shown by a long follow-up analysis of more than 3 years. In addition, RFA showed superior VRRs compared with LA for the treatment of benign thyroid nodules, with less regrowth and less delayed surgery.
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Affiliation(s)
- Se Jin Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
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Choi Y, Jung SL. Efficacy and Safety of Thermal Ablation Techniques for the Treatment of Primary Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis. Thyroid 2020; 30:720-731. [PMID: 31801432 DOI: 10.1089/thy.2019.0707] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [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: The increased incidence of primary papillary thyroid microcarcinoma (PTMC) has led to increased research in the field of nonsurgical therapeutic options for those who refuse surgery or are at high risk for surgery. The study aimed at comprehensively evaluating the efficacy and safety of thermal ablation techniques for the treatment of PTMC via a systematic review and meta-analysis. Methods: The Pubmed MEDLINE and EMBASE databases were searched for studies reporting the efficacy and safety of thermal ablations (radiofrequency-, laser-, and microwave-ablations [RFA, LA, and MWA]) until August 10, 2019. A review of 105 potential papers identified 11 eligible papers, including 715 patients. The pooled proportions of complete disappearance and recurrence, and the pooled estimates of mean volume reduction and its rate of the treated PTMC were assessed by using random-effects modeling. The pooled proportions of overall and major complications were calculated. Subgroup analysis was performed according to the treatment modality. Between-study heterogeneity was explored by using χ2 statistic for pooled estimates and inconsistency index I2. Quality of the studies was evaluated by using the Risk of Bias Assessment Tool for Nonrandomized Studies. Results: The pooled proportions of complete disappearance and recurrence of PTMC were 57.6% [95% confidence interval (CI): 35.4-79.8] and 0.4% [95% CI: 0-1.1], respectively. The pooled estimates of mean volume reduction and its rate were 73.5 mm3 [52.4-94.6 mm3] and 98.1% [95% CI: 96.7-99.5], respectively. The pooled proportions of overall and major complications were 3.2% [95% CI: 1.1-5.2] and 0.7% [95% CI: 0-1.5], respectively. Significant between-study heterogeneity was observed for complete disappearance (p < 0.001, I2: 99%), mean volume reduction (p < 0.001, I2: 93%), and its rate (p < 0.001, I2: 86%). Subgroup analysis revealed heterogeneity of the complete disappearance proportion among the treatment modality (I2 range: 95-100%). RFA showed the highest mean volume reduction rate (99.3%), followed by MWA (95.3%) and LA (88.6%) (p < 0.001). Conclusions: All thermal ablation techniques were effective and safe for the treatment of PTMC. However, each treatment modality had significant heterogeneity with respect to complete disappearance of PTMC. Compared with RFA and MWA, LA was less effective in reducing the volume of PTMC.
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Affiliation(s)
- Yangsean Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So-Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Ha SM, Shin JY, Baek JH, Song DE, Chung SR, Choi YJ, Lee JH. Does Radiofrequency Ablation Induce Neoplastic Changes in Benign Thyroid Nodules: A Preliminary Study. Endocrinol Metab (Seoul) 2019; 34:169-178. [PMID: 31099203 PMCID: PMC6599903 DOI: 10.3803/enm.2019.34.2.169] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/15/2019] [Accepted: 04/03/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To evaluate the clinical feasibility of radiofrequency ablation (RFA) of benign thyroid nodules along with cytomorphological alteration, and any malignant transformation through biopsy. METHODS The data were retrospectively collected between April 2008 and June 2013 and core needle biopsy (CNB) was performed on 16 benign thyroid nodules previously treated using RFA. The parameters of the patients were compared, between the time of enrollment and the last follow-up examination, using linear mixed model statistical analysis. RESULTS No atypical cells or neoplastic transformation were detected in the undertreated peripheral portion of treated benign nodules on the CNB specimen. RFA altered neither the thyroid capsule nor the thyroid tissue adjacent to the treated area. On histopathological examinations, we observed 81.2% acellular hyalinization, which was the most common finding. After a mean follow-up period of over 5 years, the mean volume of thyroid nodule had decreased to 6.4±4.2 mL, with a reduction rate of 81.3%±5.8% (P<0.0001). CONCLUSION RFA is a technically feasible treatment method for benign thyroid nodules, with no carcinogenic effect or tissue damage of the normal thyroid tissue adjacent to the RFA-treated zone.
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Affiliation(s)
- Su Min Ha
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicinee, Seoul, Korea
| | - Jun Young Shin
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sae Rom Chung
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sim JS, Baek JH. Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth. Endocrinol Metab (Seoul) 2019; 34:117-123. [PMID: 31257739 PMCID: PMC6599899 DOI: 10.3803/enm.2019.34.2.117] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 11/11/2022] Open
Abstract
Thermal ablation (TA) procedures, such as radiofrequency ablation and laser ablation, are used for the treatment of benign thyroid nodules. Short-term studies (<2 years) have demonstrated that TA is an effective and safe procedure to improve cosmetic or symptomatic problems. However, studies including a longer follow-up period show that treated thyroid nodules can increase in size after 2 to 3 years. Several studies suggest that this results from regrowth at the undertreated nodule margins. Here, we review current data on regrowth after TA and describe factors related to it and possible approaches to prevent it.
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Affiliation(s)
- Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Role of second high-intensity focused ultrasound (HIFU) treatment for unsatisfactory benign thyroid nodules after first treatment. Eur Radiol 2018; 29:1469-1478. [PMID: 30088067 DOI: 10.1007/s00330-018-5671-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/03/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We aimed to assess the efficacy and safety of second high-intensity focused ultrasound (HIFU) ablation treatment in benign thyroid nodules that had failed to shrink by > 50% 6 months after the first treatment. METHODS Twenty-eight patients who did not achieve 50% volume reduction at 6 months after the first HIFU treatment underwent a second HIFU treatment. Nodule volume was measured on ultrasound at baseline, 3 months and 6 months. Extent of nodule shrinkage (by volume reduction ratio) (VRR) = [Baseline volume - volume at 6 months]/[Baseline volume] * 100. Treatment success was defined as VRR > 50%. Obstructive symptom score (by 0-10 visual analogue scale, VAS) was evaluated for 6 months after treatment. RESULTS No complications occurred after the second treatment. The mean 6-month VRR was 21.78 ± 16.87% with a median (range) of 16.16 (1.63-54.07)%. At 6 months, only two (7.1%) patients achieved treatment success, while nine (32.1%) patients had VRR < 10%. However, relative to baseline (3.96 ± 1.04), the mean VAS significantly improved at 3 and 6 months (2.96 ± 1.43, p<0.001 and 2.58 ± 1.39, p<0.001, respectively). There was a significant correlation between VRR and improvement in VAS score at 6 months (ρ=0.438, p=0.025). Greater nodule volume before the second treatment (OR=1.169, 95% CI=1.004-1.361, p=0.045) was a significant factor for greater VRR after the second treatment. CONCLUSIONS Although subjective obstructive symptoms continued to improve after the second treatment, the actual extent of nodule shrinkage was small. Larger-volume nodules tended to shrink more significantly than smaller-volume nodules in the second treatment. KEY POINTS • Second treatment resulted in small shrinkage in unsatisfactory nodules after first treatment. • Obstructive symptoms tended to continue to improve after second treatment. • Larger-size nodules tended to respond better in the second treatment.
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11
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Nixon IJ, Angelos P, Shaha AR, Rinaldo A, Williams MD, Ferlito A. Image-guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications. Head Neck 2018; 40:2103-2115. [PMID: 29684251 DOI: 10.1002/hed.25181] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/03/2018] [Accepted: 02/20/2018] [Indexed: 01/03/2023] Open
Abstract
Image-guided ablation of thyroid disease is increasingly being commonly reported. Techniques including ethanol injection and thermal ablation using radio-frequency, laser, and microwave devices have been described. Minimally invasive approaches to the management of benign cystic, solid, and functional thyroid nodules as well as both primary and recurrent thyroid malignancy have been reported. The purpose of this article is to review the current evidence relating to image-guided ablation of thyroid disease with a focus on clinical outcomes and complication rates for patients treated with this minimally invasive approach.
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Affiliation(s)
- Iain J Nixon
- Ear, Nose, and Throat Department, NHS Lothian, Edinburgh, UK
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Ethics, The University of Chicago Medicine, Chicago, Illinois
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Michelle D Williams
- Department of Pathology, Division of Pathology/Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alfio Ferlito
- Coordinator of The International Head and Neck Scientific Group
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12
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Höfling DB, Chavantes MC, Buchpiguel CA, Cerri GG, Marui S, Carneiro PC, Chammas MC. Safety and Efficacy of Low-Level Laser Therapy in Autoimmune Thyroiditis: Long-Term Follow-Up Study. Int J Endocrinol 2018; 2018:8387530. [PMID: 30532779 PMCID: PMC6247385 DOI: 10.1155/2018/8387530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 06/24/2018] [Accepted: 07/24/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION A randomized clinical trial (RCT) was performed to evaluate the efficacy of low-level laser therapy (LLLT) for hypothyroidism induced by chronic autoimmune thyroiditis (CAT). OBJECTIVE The objective was to assess the safety and actions of LLLT 6 years after completion of the RCT. MATERIALS AND METHODS Forty-three participants were invited to participate in this study 6 years after completion of the RCT. Twenty-five were subjected to LLLT (group L), and 18 were subjected to placebo (group P). Primary outcome measure: frequency of thyroid nodules, which were subjected to fine-needle aspiration biopsy. Secondary outcome measures: dose of levothyroxine required to treat hypothyroidism, thyroid peroxidase antibodies (anti-TPO), and anti-thyroglobulin antibodies (anti-Tg). RESULTS In group L, a nodule was observed in three patients, who all had a Bethesda II classification. In group P, a nodule was also observed in three patients, with two classified as Bethesda II and one as Bethesda III. The levothyroxine dose required by group L was significantly lower than that required by group P (P = 0.002). The anti-TPO and anti-Tg levels did not differ between the groups. CONCLUSION LLLT, by the methods described, has been shown to be safe for the treatment of hypothyroidism resulting from CAT. This trial is registered with ClinicalTrials.gov Identifier: NCT02240563.
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Affiliation(s)
- Danilo Bianchini Höfling
- Ultrasound Unit, Department of Radiology, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, SP, Brazil
| | | | - Carlos Alberto Buchpiguel
- Radiology Institute (InRad); Department of Radiology, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, SP, Brazil
| | - Giovanni Guido Cerri
- Radiology Institute (InRad); Department of Radiology, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, SP, Brazil
| | - Suemi Marui
- Thyroid Unit, Department of Endocrinology and Metabolism, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, Brazil
| | - Paulo Campos Carneiro
- Department of Pathology, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, Brazil
| | - Maria Cristina Chammas
- Ultrasound Unit, Department of Radiology, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, SP, Brazil
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13
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Longo M, Cassoli IP, Fugazzola L, Vannucchi G, Lanzoni M, Castaldi S. Feasibility study for the introduction of a new treatment method for benign thyroid nodules in a teaching and research hospital. J Eval Clin Pract 2014; 20:617-21. [PMID: 24840502 DOI: 10.1111/jep.12177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 12/22/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Numerous scientific publications have confirmed that percutaneous laser thermal ablation (LTA) represents a possible therapeutic option in selected patients with benign thyroid nodules. A study was carried out to evaluate the feasibility of adopting the LTA technique to treat benign thyroid nodules in a teaching and research hospital in northern Italy. METHODS A cost analysis from a company's perspective determined the impact of adoption of the new technique on the overall Hospital budget, considering currently available equipment, infrastructure and personnel, equipment costs and treatment tariffs. RESULTS The cost analysis shows that, strictly from an economic point of view, any provision of the LTA technique will result as a loss on the Hospital's balance sheet. However, it does not estimate the extent of the impact on the overall budget because it did not evaluate the savings that such a technique would make with respect to alternative therapeutic treatments. Therefore, the Hospital policy management decided to extend the current agreement with a private authorized health care structure that already carries out LTA. Also, although difficult to express in economic terms, this new technique would undoubtedly raise the profile and enhance the reputation of the Hospital. CONCLUSIONS Using the new technique in these patients could cut costs for the entire regional health care system, widen the experience of the Hospital's endocrinology team and offer the potential for the procedure also to be provided by operators on a freelance basis within the Hospital.
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Affiliation(s)
- Marcella Longo
- Health Management Board, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Valcavi R, Piana S, Bortolan GS, Lai R, Barbieri V, Negro R. Ultrasound-guided percutaneous laser ablation of papillary thyroid microcarcinoma: a feasibility study on three cases with pathological and immunohistochemical evaluation. Thyroid 2013; 23:1578-82. [PMID: 23978269 DOI: 10.1089/thy.2013.0279] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Ultrasound-guided thermal laser ablation (LA) is a nonsurgical technique that has been proposed, but not fully assessed, for papillary thyroid microcarcinoma (PTMC) treatment. The objectives of this study were to evaluate the clinical feasibility of LA on PTMC as a primary treatment and to prove histologically the absence of residual viable tumor after LA procedure. METHODS Three patients with a Thy 6 diagnosis at fine-needle aspiration cytology with a single PTMC smaller than 10 mm volunteered after full explanation of the protocol. At ultrasound examination, patients had no extrathyroid extension and no evidence of lymph node metastasis. Patients underwent percutaneous ultrasound-assisted LA of the PTMC in the operating room under general anesthesia. One 300 μm plane-cut optic fiber was inserted through the sheath of 21G Chiba needle, exposing 5 mm of the nude fiber in direct contact with tumor tissue, and connected with a laser source operating at 1.064 μm with 3 W output power. Total energy delivery was 1800 J. The surgeon directly started a standard total thyroidectomy. During surgical inspection, no remarkable laser sign was observed in the muscles, the perithyroidal tissues, or the recurrent laryngeal nerves. RESULTS Conventional histology showed destructured and carbonized tissue. Lack of vitality was demonstrated by complete loss of TTF1 and antimitochondria antibody expression in the whole ablated area and in the rim of normal tissue surrounding the tumor. BRAF V600E mutation was detected in cases 1 and 2. Furthermore, in cases 2 and 3, incidental papillary microfoci were found. A lymph node micrometastasis (200 μm) was observed in case 2. CONCLUSIONS This study demonstrates that percutaneous LA is technically feasible for complete PTMC destruction. Now, LA may be useful in selected patients with PTMC, either when the surgeon or a patient refuses surgery, or when the patient is at high risk for an operation. LA may become a primary choice of treatment for PTMC only if future new knowledge would permit preoperative recognition of multifocality and lymph node metastasis.
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Affiliation(s)
- Roberto Valcavi
- 1 Endocrinology Unit, Arcispedale Santa Maria Nuova and Clinical Cancer Research Institute (IRCCS) , Reggio Emilia, Italy
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Andrioli M, Carzaniga C, Persani L. Standardized Ultrasound Report for Thyroid Nodules: The Endocrinologist's Viewpoint. Eur Thyroid J 2013; 2:37-48. [PMID: 24783037 PMCID: PMC3821499 DOI: 10.1159/000347144] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/14/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ultrasonography (US) plays a crucial role in the diagnostic management of thyroid nodules, but its widespread use in clinical practice might generate heterogeneity in ultrasound reports. OBJECTIVES The aims of the study were to propose (a) a standardized lexicon for description of thyroid nodules in order to reduce US reports of interobserver variability and (b) a US classification system of suspicion for thyroid nodules in order to promote a uniform management of thyroid nodules. METHODS RELEVANT PUBLISHED ARTICLES WERE IDENTIFIED BY SEARCHING MEDLINE AT PUBMED COMBINING THE FOLLOWING SEARCH TERMS: ultrasonography, thyroid, nodule, malignancy, carcinoma, and classification system. Results were supplemented with our data and experience. RESULTS A STANDARDIZED US REPORT SHOULD ALWAYS DOCUMENT POSITION, EXTRACAPSULAR RELATIONSHIPS, NUMBER, AND THE FOLLOWING CHARACTERISTICS OF EACH THYROID LESION: shape, internal content, echogenicity, echotexture, presence of calcifications, margins, vascularity, and size. Combining the previous US features, each thyroid nodule can be tentatively classified as: malignant, suspicious for malignancy, borderline, probably benign, and benign. CONCLUSIONS We propose a standardized US report and a tentative US classification system that may become helpful for endocrinologists dealing with thyroid nodules in their clinical practice. The proposed classification does not allow to bypass the required cytological confirmation, but may become useful in identifying the lesions with a lower risk of neoplasm.
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Affiliation(s)
- Massimiliano Andrioli
- Division of Endocrine and Metabolic Diseases, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
- *Massimiliano Andrioli, MD, PhD or Luca Persani, MD, PhD, Ospedale San Luca, IRCCS, Istituto Auxologico Italiano, P. le Brescia 20, IT-20149 Milan (Italy), E-Mail or
| | - Chiara Carzaniga
- Division of Endocrine and Metabolic Diseases, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Luca Persani
- Division of Endocrine and Metabolic Diseases, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
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