Comparative study evaluating the efficiency of cooled and uncooled single-treatment MWA in thyroid nodules after a 3-month follow up

Microwave ablation of benign thyroid nodules: 3-year follow-up outcomes

PURPOSE

To evaluate the effectiveness of microwave ablation (MWA) for the treatment of thyroid nodules according to nodule composition.

MATERIALS AND METHODS

This study evaluated 171 patients with 180 benign thyroid nodules (BTNs) that had been treated with ultrasound-guided MWA. The volume reduction rate (VRR) of thyroid nodules and factors, which had an influence on the VRR, were assessed. Therapeutic success was defined as a >50% volume reduction at the 12-month follow-up. Multivariate regression analysis was used to identify independent predictors of VRR for BTNs after MWA treatment.

RESULTS

The mean diameter and volume of the nodules were 4.3 ± 1.3 cm and 18.9 ± 2.1 ml, respectively. The VRRs at the 1-, 3-, 6-, 12-, 24-, and 36-month follow-ups were 47.1%, 68.2%, 79.7%, 87.4%, 90.1%, and 93.2%, respectively. Of the 180 BTNs, there were 87 solid, 74 predominantly solid, and 19 predominantly cystic nodules. Solid nodules showed significantly lower VRRs compared with the predominantly solid and predominantly cystic nodules at the 1-, 3-, and 6-month follow-ups. For the multivariate regression analysis, the cyst component was an active prognostic factor for the VRR at the 1-, 3-, and 6-month follow-ups; the cyst component was not significantly associated with the VRR at the 12-, 24-, and 36-month follow-ups.

CONCLUSION

Our study suggested that ultrasound-guided MWA is an effective and safe procedure for the treatment of BTNs. Solid nodules indicate a lower VRR and less efficient than predominant solid nodules and predominant cystic nodules after MWA.

Thermal ablation for benign, non-functioning thyroid nodules: A clinical review focused on outcomes, technical remarks, and comparisons with surgery

Thermal ablation (TA) is a therapeutic option for benign, non-functioning thyroid nodules causing symptoms of compression and/or aesthetic concerns. TA was initially introduced as a treatment for patients who refused or were ineligible for surgery. In more recent years, the increase in the positive experiences of TA have paved the way for the idea that TA could be suggested as a first-line treatment. The present review was conceived to summarize the evidence achieved in this field, and to offer a clinical perspective on TA, with particular reference to the comparison between TA and surgery. We searched literature that was focused on two types of TA, laser (LA) and radiofrequency (RFA). The searched literature included short- mid-term prospective and retrospective studies, randomized trials, and meta-analyses that demonstrated a satisfactory volume reduction ratio (VRR), and benefits in cosmetic and symptoms scores. An important drawback of the use of TA, is the regrowth of a certain number of nodules, which necessitate further TA procedures or surgery. Long-term randomized controlled trials to evaluate the cost/effectiveness of TA vs surgery are not currently available. The selection of the nodule, the optimization of interventional techniques, and ultimately, a well-timed second treatment, are all factors that should be considered in a proactive strategy to prevent TA failure.

2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

Standard therapeutic approaches for benign thyroid lesions that warrant intervention are surgery for cold and either surgery or radioiodine for autonomously functioning thyroid nodules (AFTN). Image-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for selected clinical conditions. Due to mounting scientific evidence and widening availability, ETA considered it appropriate to develop guidelines for the use of TA in adult patients. TA procedures are well tolerated, but a dedicated training of the operators is required and information on possible complications needs to be shared with the patients. The following factors should be considered when weighing between observation, surgery, and TA for benign thyroid nodules. In solid non-hyperfunctioning nodules, TA induces a decrease in thyroid nodule volume, paralleled by improvement in symptoms. Nodule re-growth is possible over time and may necessitate repeat treatment, or surgery, in a dialogue with the patient. In AFTN, radioactive iodine is the first-line treatment, but TA may be considered in young patients with small AFTN due to higher probability of restoring normal thyroid function and avoidance of irradiation. In cystic nodules, ethanol ablation (EA) is the most effective and least expensive treatment. TA may be considered for cystic lesions that relapse after EA or have a significant residual solid component following drainage and EA. TA should be restricted to benign lesions that cause symptoms or cosmetic concern. Presently, laser and radiofrequency ablation are the most thoroughly assessed techniques, with similar satisfactory clinical results. Microwaves and high-intensity focused ultrasound therapy options remain to be fully evaluated.

Efficacy and safety of cooled and uncooled microwave ablation for the treatment of benign thyroid nodules: a systematic review and meta-analysis

PURPOSE

To evaluate the effectiveness and safety of microwave ablation (MWA), including cooled MWA (cMWA) and uncooled MWA (uMWA), for the treatment of benign thyroid nodules (BTNs).

METHODS

The databases of MEDLINE, EMBASE and Cochrane library were searched up to 3 Jun, 2018. In this meta-analysis, data of volume reduction rates (VRRs) at the 3-, 6- and 12-month follow-up, and complications are obtained to evaluate the effectiveness and safety of cMWA and uMWA for the treatment of BTNs.

RESULTS

Nine studies involving 1461 patients with 1845 BTNs were included. The pooled VRR at the 3-month follow-up after MWA therapy reached 54.3% (95% CI: 45.3-63.3%, I2 = 97.6%), 73.5% (95% CI: 66.7-80.3%, I2 = 94.9%) at the 6-month follow-up, and 88.6% (95% CI: 84.9-92.4%, I2 = 92.7%) at the 12-month follow-up. The pooled proportions of overall, major and minor complications were 52.4% (95% CI: 29.8-74.9%; I2 = 99.5%), 4.8% (95% CI: 2.7-7.0%; I2 = 55.9%) and 48.3% (95% CI: 31.2-65.4%; I2 = 99.7%). Both cMWA and uMWA achieved similar pooled VRR at the 3-month follow-up (58.4 vs 45.3%, P = 0.07) and pooled proportion of major complications (4.9 vs 5.0%, P = 0.49), while uMWA had higher pooled proportions of overall and minor complications than cMWA (97.8 vs 29.7%, P < 0.01; 97.8 vs 21.0%, P < 0.01), with more patients suffering pain and skin burn after uMWA (100 vs 5.5%, P < 0.01; 47.2 vs 0.2%, P < 0.01).

CONCLUSION

MWA is an effective treatment modality for BTNs. When considering the patient's comfort, cMWA would be a more preferable procedure with less complications.

Horner syndrome as a complication after thyroid microwave ablation: Case report and brief literature review

RATIONALE

Horner's syndrome (HS) can present as a complication of thyroid surgery, particularly after thyroid microwave ablation (MWA). HS presents clinically with eyelid ptosis, miosis, enophthalmos, anhidrosis, and vascular dilatation, all of which result from a damaged oculosympathetic chain. We aimed to try to avoid such devastating symptoms in future cases by exploring reasons for the destruction of the cervical sympathetic trunk.

PATIENT CONCERNS

HS has previously been reported in the literature as a complication of thyroid surgery. Here, we report the case of a 44-year-old female patient who presented with miosis and eyelid ptosis following thyroid MWA.

DIAGNOSES

This patient was subsequently diagnosed with HS.

INTERVENTIONS

Mecobalamin was administered immediately.

OUTCOMES

After 5 months of follow up, the patient's miosis and ptosis was incompletely relieved.

LESSONS

Although HS is a rare complication of thyroid MWA, surgeons must be aware of the anatomic relationship of the cervical sympathetic trunk and thyroid gland with adjacent structures. Moreover, we hope this case presentation enables surgeons to take measures to minimize the possibility of oculosympathetic damage. Long-term follow up and comprehensive assessments are important for the patient's prognosis.

Thermal ablation of thyroid nodules: are radiofrequency ablation, microwave ablation and high intensity focused ultrasound equally safe and effective methods?

OBJECTIVES

This study compares volume reduction of benign thyroid nodules three months after Radiofrequency Ablation (RFA), Microwave Ablation (MWA) or High Intensity Focused Ultrasound (HIFU) to evaluate which of these methods is the most effective and safe alternative to thyroidectomy or radioiodine therapy.

MATERIAL AND METHODS

Ninety-four patients (39 male, 55 female) with a total of 118 benign, symptomatic thyroid nodules were divided into three subgroups. HIFU was applied to 14 patients with small nodules. The other 80 patients were divided up into two groups of 40 patients each for RFA and MWA in the assumption that both methods are comparable effective. The pre-ablative and post-ablative volume was measured by ultrasound.

RESULTS

RFA showed a significant volume reduction of nodules of 50 % (p<0.05), MWA of 44 % (p<0.05) and HIFU of 48 % (p<0.05) three months after ablation. None of the examined ablation techniques caused serious or permanent complications.

CONCLUSION

RFA, MWA and HIFU showed comparable results considering volume reduction. All methods are safe and effective treatments of benign thyroid nodules.

KEY POINTS

• Thermal Ablation can be used to treat benign thyroid nodules • Thermal Ablation can be an alternative to thyroidectomy or radioiodine therapy • Radiofrequency Ablation, Microwave Ablation, High Intensity Focused Ultrasound are safe and effective.

Minimally invasive local ablative therapies in combination with radioiodine therapy in benign thyroid disease: preparation, feasibility and efficiency - preliminary results

PURPOSE

Initial studies of combinations of radioiodine therapy (RIT) and local ablative procedures for the treatment of thyroid nodules have shown promising results. The goal of this study was to evaluate the effectiveness of RIT combined with radiofrequency ablation (RFA) in patients with goitres and to determine which ablative procedure is the most suitable for a combined therapy.

METHODS

Thirty patients with goitres were divided into two subgroups. A test group of 15 patients received combined therapy (RIT + RFA) and a control group of 15 patients received RIT mono therapy. All patients underwent assessments including ultrasound, laboratory evaluation (T3, T4, TSH, TG, TPOAb, TgAbTRAb) and scintigraphic imaging with Tc-99m-Pertechnetate. The 3-month volume reduction was used to evaluate therapy effectiveness.

RESULTS

Combined therapy (subgroup 1) resulted in a significant (p < 0.05) thyroid volume reduction (22.3 ± 54 ml/32.2 ± 58.2%) with better performance (p > 0.05) than the control group (20.2 ± 32.2 ml/29.6 ± 42.1%). All patients became euthyroid after treatment. No major discomfort or complications occurred. A review of the literature investigating combinations of other local ablative procedures with RIT was performed to determine the most promising combination.

CONCLUSIONS

The present study confirms the positive experiences with the combined therapy of RIT and local ablative procedures shown in the current literature and approves this approach for the treatment of goitres with RFA + RIT. These findings, when confirmed by further studies, should expand the indication of combined therapy as a minimally invasive alternative to surgery.

Ultrasound-Guided Percutaneous Microwave Ablation for Solid Benign Thyroid Nodules: Comparison of MWA versus Control Group

BACKGROUND

The aim of this research is to investigate the feasibility of percutaneous ultrasound-guided microwave ablation (MWA) for benign solid thyroid nodules.

METHODS

Ultrasound-guided percutaneous microwave ablation was performed for 90 benign solid thyroid nodules in 75 patients. The volume changes of the nodules were evaluated before and after microwave ablation, and the cosmetic grading and clinical symptoms were assessed as well.

RESULTS

The volume of all the 90 benign thyroid nodules obviously decreased after microwave ablation at 3-, 6-, 9-, and 12-month follow-ups (p < 0.01), while that of the control group increased at the follow-up of 12 months (p < 0.01). The volume reduction rate (VRR) at 3-, 6-, 9-, and 12-month follow-ups was 55.98%, 69.31%, 76.65%, and 84.67% in the MWA group, respectively. The cosmetic problems and clinical symptoms were also improved in the MWA group. All the patients are well tolerated to the procedure. Hoarseness occurred in 2 cases (2.7%) and Horner syndrome in 1 case (1.3%), and 1 patient (1.3%) developed slight burn on cervical skin.

CONCLUSIONS

Ultrasound-guided percutaneous microwave ablation is a practical method for treating benign solid thyroid nodules, and the complications were acceptable. The trial is registered with clinicaltrials.gov with the registration number NCT03057925.