1
|
Lim H, Cho SJ, Baek JH. Comparative efficacy and safety of radiofrequency ablation and microwave ablation in benign thyroid nodule treatment: a systematic review and meta-analysis. Eur Radiol 2024:10.1007/s00330-024-10881-7. [PMID: 39046500 DOI: 10.1007/s00330-024-10881-7] [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: 03/07/2024] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Ultrasound-guided thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), has become one of the main options for treating benign thyroid nodules (BTNs). To assess the efficacy of thermal ablation of BTNs, we performed a systematic review and meta-analysis of relevant studies. MATERIALS AND METHODS A comprehensive search of MEDLINE, EMBASE, and COCHRANE databases was performed up to September 25, 2023, to identify studies directly comparing RFA and MWA for pathologically proven BTNs and reporting clinical outcomes and complications. Data extraction and quality assessment were independently performed by two radiologists according to PRISMA guidelines. The analysis yielded the serial volume reduction ratios (VRRs) of ablated nodules for up to 12 months, symptom and cosmetic scores, and complications. RESULTS This analysis included nine studies with 1305 BTNs treated by RFA and 1276 by MWA. VRRs at 1 month, 3 months, and 6 months were similar between RFA and MWA, but RFA showed a significantly higher VRR (83.3%) than MWA (76.9%) at 12 months (p = 0.02). Complication rates showed no significant difference between the two methods. Symptom and cosmetic scores significantly decreased after ablation, without a significant difference between the methods. Subgroup analysis indicated a significantly higher VRR at 12 months for RFA than for MWA for less experienced investigators (≤ 10 years), but no significant difference for more experienced investigators (> 10 years). CONCLUSION RFA and MWA are both effective and safe methods for treating BTNs. RFA showed a higher VRR at 12 months and seems more suitable for less experienced investigators. CLINICAL RELEVANCE STATEMENT RFA and MWA are both effective and safe treatments for BTNs, with RFA showing a higher VRR at 12 months. Both methods offer minimally invasive and reliable treatment for thyroid nodules. KEY POINTS The most effective thermal ablation technique for BTNs remains undetermined. RFA showed a higher VRR at 12 months than MWA. Both techniques are effective for treating thyroid nodules; RFA offers greater benefits, particularly for less experienced investigators.
Collapse
Affiliation(s)
- Hunjong Lim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, 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.
| |
Collapse
|
2
|
Xu Q, Xu XH, Liu ZZ, Zhu JB, Ding HH, Jin CC, Yan ZH. Efficacy and safety of ultrasound-guided percutaneous radiofrequency ablation for synovial hyperplasia. Int J Hyperthermia 2024; 41:2328113. [PMID: 38964750 DOI: 10.1080/02656736.2024.2328113] [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: 09/12/2023] [Accepted: 03/03/2024] [Indexed: 07/06/2024] Open
Abstract
PURPOSE This study aimed to investigate the efficacy and safety of ultrasound-guided percutaneous radiofrequency ablation (RFA) for the treatment of synovial hyperplasia in the knee joints of antigen-induced arthritis (AIA) model rabbits. METHODS Forty Japanese large-eared white rabbits were divided into AIA and control groups. After successful induction of the AIA model, the knee joints were randomly assigned to RFA and non-RFA groups. The RFA group underwent ultrasound-guided RFA to treat synovial hyperplasia in the knee joint. Dynamic observation of various detection indices was conducted to evaluate the safety and effectiveness of the RFA procedure. RESULTS Successful synovial ablation was achieved in the RFA group, with no intraoperative or perioperative mortality. Postoperative the circumference of the knee joint reached a peak before decreasing in the third week after surgery. The incidence and diameter of postoperative skin ulcers were not significantly different compared to the non-RFA group (p > .05). Anatomical examination revealed an intact intermuscular fascia around the ablated area in the RFA group. The ablated synovial tissue initially presented as a white mass, which subsequently liquefied into a milky white viscous fluid. Gross articular cartilage was observed, along with liquefied necrosis of the synovium on pathological histology and infiltration of inflammatory cells in the surrounding soft tissue. CONCLUSION The experimental results demonstrated that ultrasound-guided RFA of the knee in the treatment of synovial hyperplasia in AIA model animals was both effective and safe.
Collapse
Affiliation(s)
- Qi Xu
- Department of Ultrasound, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Xiao-Hui Xu
- Department of Medical and Health Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ze-Zheng Liu
- Department of Ultrasound, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Jian-Bi Zhu
- Department of Ultrasound, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Huan-Huan Ding
- Department of Ultrasound, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Chun-Chun Jin
- Department of Ultrasound, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China
| | - Zhi-Han Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Key Laboratory of Structural and Functional Imaging, Wenzhou, China
| |
Collapse
|
3
|
Xing MH, Shaari AL, Beute JE, Yun J, Chai RL. Thyroid Ethanol and Radiofrequency Ablation: A Call for Patient-Friendly Online Resources. ORL J Otorhinolaryngol Relat Spec 2024; 86:82-88. [PMID: 38310864 DOI: 10.1159/000535657] [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: 06/09/2022] [Accepted: 12/04/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION The multiple treatment options available to patients with thyroid nodules can generate uncertainty and confusion. Radiofrequency ablation (RFA) and ethanol ablation (EA) are two alternative modalities to manage thyroid nodules. As patients more frequently utilize online resources to guide their decision-making, the quality of such resources must be evaluated. The goal of this study was to assess the quality of online patient materials relating to RFA and EA compared to standard thyroidectomy. METHODS The terms "thyroidectomy," "thyroid radiofrequency ablation," and "thyroid ethanol ablation" were searched on Google. Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Patient Education Materials Assessment Tool (PEMAT) understandability and actionability were calculated for each website. Statistical analysis was conducted on SPSS Statistics. Google trends were used to determine search interest for each term (May 2016 - May 2021). RESULTS Of the 77 websites that met our inclusion criteria (30 thyroidectomy sites, 30 RFA sites, and 17 EA sites), the average FRE, FKGL, and SMOG scores of the RFA websites were significantly worse than those of the thyroidectomy websites (p < 0.05). The FKGL and SMOG scores of the EA websites were significantly worse than those of the thyroidectomy websites (p < 0.05). The average understandability and actionability scores for thyroidectomy websites were significantly higher than those of RFA and EA websites (p < 0.05). CONCLUSION Ablation websites have lower search interest, readability, validity, understandability, and actionability scores in comparison to traditional thyroidectomy websites. Our findings emphasize the need to consider readability and PEMAT scores when developing online educational resources for ablative alternatives to thyroidectomy to allow for greater patient accessibility.
Collapse
Affiliation(s)
- Monica H Xing
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Ariana L Shaari
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - John E Beute
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Jun Yun
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
4
|
Xu X, Peng Y, Han G. Five-year follow-up results of thermal ablation for benign thyroid nodules: Systematic review and meta-analysis. Am J Otolaryngol 2024; 45:104025. [PMID: 37639985 DOI: 10.1016/j.amjoto.2023.104025] [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: 06/08/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES Confidence in long-term treatment results of thermal ablation for benign thyroid nodules (BTNs) is required in comparison with surgery. The objective of this meta-analysis is to report 5-year follow-up results of thermal ablation for BTNs. METHODS Ovid PUBMED, COCHRANE, and EMBASE databases were searched through Feb 30, 2023, for studies reporting outcomes in patients with BTNs treated with thermal ablation and followed up for about 5 years. Pooled volume reduction rates (VRRs) at 6, 12, 24, 36, 48, and 60 months after thermal ablation were assessed. Data were extracted and methodological quality was assessed independently by two radiologists according to the PRISMA guidelines. RESULTS Five studies, involving 939 patients, met the inclusion criteria through database searches. 137 patients experienced local nodules recurrence during a mean pooled 59.25-month follow-up. Seventeen of them proved to be non-benign. Fifty of all patients with nodules regrowth had a secondary surgery, while 35 had a secondary thermal ablation. The pooled mean major complication rate was 7.70 %, with no patient experiencing life-threatening or delayed complications. CONCLUSIONS Thermal ablation is an excellent local nodules control method in patients with BTNs, and results in a clinically significant and long-lasting volume reduction of BTNs. The risk of regrowth and needing retreatment was lower after thermal ablation.
Collapse
Affiliation(s)
- Xidong Xu
- Department of Thyroid Surgery, the Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Ying Peng
- The Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Guoxin Han
- Department of Thyroid Surgery, the Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China.
| |
Collapse
|
5
|
Li N, Huber TC. Radiofrequency Ablation for Benign Thyroid Nodules: Radiology In Training. Radiology 2023; 306:54-63. [PMID: 36066365 DOI: 10.1148/radiol.220116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two patients, one with benign nonfunctioning nodules and one with functioning thyroid nodules, both of whom underwent radiofrequency ablation, are presented. Preprocedural evaluation, procedural considerations, and follow-up care of thyroid radiofrequency ablation, as well as published evidence on the topic, are discussed.
Collapse
Affiliation(s)
- Ningcheng Li
- From the Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239
| | - Timothy C Huber
- From the Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239
| |
Collapse
|
6
|
Lim JY, Kuo JH. Thyroid Nodule Radiofrequency Ablation: Complications and Clinical Follow Up. Tech Vasc Interv Radiol 2022; 25:100824. [DOI: 10.1016/j.tvir.2022.100824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
7
|
Hussain I, Zulfiqar F, Li X, Ahmad S, Aljammal J. Safety and Efficacy of Radiofrequency Ablation of Thyroid Nodules-Expanding Treatment Options in the United States. J Endocr Soc 2021; 5:bvab110. [PMID: 34258495 PMCID: PMC8271212 DOI: 10.1210/jendso/bvab110] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Radiofrequency ablation (RFA) has only recently gained popularity in the United States for treatment of thyroid nodules (TNs), with a limited number of patients having undergone the procedure in this country. OBJECTIVE To evaluate the safety and efficacy of RFA of TNs performed in an outpatient setting in the United States. METHODS This is a retrospective, single-center study of 53 patients who underwent RFA of 58 TNs between November 2018 and January 2021. The reduction in volume of nodule, cosmetic and symptomatic improvement, effect on thyroid function, and complications following RFA were assessed. RESULTS Eleven out of 53 patients were excluded from the analysis. A total of 47 benign TNs (23 nonfunctioning thyroid nodules [NFTNs] and 24 autonomously functioning thyroid nodules [AFTNs]), were assessed after RFA. The median reduction in volume was 70.8% after a median follow-up period of 109 days, with symptomatic and cosmetic improvement (P < 0.0001). Compared with larger nodules, smaller nodules had greater volume reduction (P = 0.0266). RFA improved thyrotropin (TSH) in AFTNs (P value = 0.0015) and did not affect TSH in NFTNs (P value = 0.23). There were no major complications; however, 1 patient had self-limited local bleeding and another had transient voice change that recovered in 6 months. CONCLUSION RFA is a safe and efficacious treatment for symptomatic NFTNs and AFTNs in our population and is especially effective for smaller nodules. RFA should be considered an alternative for TNs in patients who cannot or do not want to undergo surgery.
Collapse
Affiliation(s)
- Iram Hussain
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-8537, USA
| | | | - Xilong Li
- Division of Biostatistics, Department of Population and Data Science, University of Texas Southwestern Medical Center, Dallas, TX 75390-8537, USA
| | | | | |
Collapse
|
8
|
Choi Y, Jung SL, Jang J, Shin NY, Ahn KJ, Kim BS. CT-based quantitative evaluation of the efficacy after radiofrequency ablation in patients with benign thyroid nodules. Int J Hyperthermia 2021; 37:742-748. [PMID: 33480816 DOI: 10.1080/02656736.2020.1779358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness of CT for quantitative assessment of the neck structures after RFA in patients with benign thyroid nodules. MATERIALS AND METHODS This single-center, retrospective cohort study included 38 patients with benign thyroid nodules who had received RFA and had available pre- and post-treatment CT images. Changes in the tracheal anteroposterior (AP)/transverse diameter ratio, cross-sectional tracheal area, midline deviation of the trachea, and anterior neck angle after RFA were quantitatively measured using CT. Volume reduction rates (VRRs) for the thyroid gland and nodules were measured using CT and US, respectively, and the intraclass correlation coefficient (ICC) was calculated. The paired Wilcoxon signed-rank test was used to compare pre- and post-treatment CT-based measurements, and univariate linear regression analysis was performed to determine the association of VRR with the mean delivered radiofrequency energy, number of RFA sessions, and initial thyroid volume. RESULTS After RFA, the tracheal AP/transverse diameter ratio and midline deviation were significantly decreased while the tracheal area and anterior neck angle were significantly increased (all, p < 0.001). The thyroid volume reduction was also significant (VRR, 42.1% ± 21.1%, p < 0.001), with moderate consistency between the CT-based thyroid VRR and US-based nodule VRR (ICC = 0.68, 95% confidence interval = 0.38-0.83, p < 0.001). The mean delivered radiofrequency energy (p = 0.565), number of RFA sessions (p = 0.209), and initial thyroid volume (p = 0.363) showed no significant association with VRR. CONCLUSION CT-based quantitative assessments may be useful for evaluating improvements in the neck structures after RFA for benign thyroid nodules.
Collapse
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
| | - Jinhee Jang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Na-Young Shin
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kook-Jin Ahn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
9
|
Muhammad H, Santhanam P, Russell JO. Radiofrequency ablation and thyroid nodules: updated systematic review. Endocrine 2021; 72:619-632. [PMID: 33449296 DOI: 10.1007/s12020-020-02598-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE In the thyroid gland, radiofrequency ablation (RFA) is being applied to both benign nodules and cancers internationally, while interest is also growing in the West. Benign thyroid nodules (BTNs) may be candidates for intervention when symptoms develop. For differentiated thyroid cancers (DTC), surgery is currently the first-line treatment. However, for candidates with high surgical risk or those who refuse to undergo repeated surgery, newer techniques such as RFA are an option. Surgery is associated with complications including hypothyroidism, voice change, hypocalcemia, and a scar. RFA has been used in Asian and European institutions as an alternative to surgery, but is relatively new in North America. Although RFA is not associated with significant complications, few randomized control trials have assessed its efficacy. The studies to date suggest a low rate of severe complications and a small need for thyroid hormone replacement following RFA. Further large-scale studies focusing on a Western population are needed. The aim of this review is to evaluate the evidence with respect to the current studies and data about the safety and efficacy of radiofrequency ablation for the management of BTNs and DTC. METHODS We systematically searched the PubMed/MEDLINE, EMBASE, Clinical Queries, and Web of Science databases, for articles published up to April 30th, 2020. RESULTS Total of 75 studies that met the inclusion criteria were included in the review. Thirty-five studies focused on RFA use for solid nodules, 12 studies on predominantly cystic nodules, 10 for autonomously functioning thyroid nodules, and 18 studied were published on differentiated thyroid cancer. CONCLUSIONS RFA seems to be an effective and safe alternative to surgery in high-risk surgical patients with thyroid cancers and for selected BTNs. Additional trials with longer follow-up in North American patients are needed to validate its full role in the armamentarium of thyroid ologists.
Collapse
Affiliation(s)
- Haris Muhammad
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, 21204, USA
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| |
Collapse
|
10
|
Bernardi S, Palermo A, Grasso RF, Fabris B, Stacul F, Cesareo R. Current Status and Challenges of US-Guided Radiofrequency Ablation of Thyroid Nodules in the Long Term: A Systematic Review. Cancers (Basel) 2021; 13:2746. [PMID: 34205994 PMCID: PMC8199252 DOI: 10.3390/cancers13112746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/22/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND US-guided minimally-invasive techniques, such as radiofrequency ablation (RFA) have emerged as an alternative treatment for benign and malignant thyroid nodules. This systematic review aims to provide an overview on the long-term outcomes of US-guided RFA in patients with benign and malignant thyroid nodules. METHODS We systematically searched PubMed/MEDLINE, EMBASE, and Scopus to identify articles reporting the outcomes of thyroid RFA after a follow-up of at least 3 years. RESULTS A total of 20 studies met the inclusion criteria and were included in the review. In patients with benign thyroid nodules, RFA significantly reduced nodule volume and this was generally maintained for the following 5 years. However, a small but not negligible proportion of nodules regrew and some of them required further treatments over time. In patients with malignant nodules, RFA has been used not only to treat differentiated thyroid cancer (DTC) neck recurrences, but also to treat papillary thyroid microcarcinoma (PTMC). In most patients with PTMC, RFA led to complete disappearance of the tumor. When it was compared to surgery, RFA was not inferior in terms of oncologic efficacy but it had a lower complication rate. However, RFA did not allow for final pathology, disease staging and accurate risk stratification. CONCLUSIONS US-guided RFA significantly reduces benign thyroid nodules and destroys most PTMC, and this is generally maintained for at least 5 years after the initial treatment. Further studies addressing the risk of regrowths in patients with benign thyroid nodules, as well as the risk of recurrence in patients with PTMC are needed.
Collapse
Affiliation(s)
- Stella Bernardi
- Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy;
- U.C.O. Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, 34149 Trieste, Italy
| | - Andrea Palermo
- Unità di Endocrinologia e Diabete, Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
| | - Rosario Francesco Grasso
- U.O.S. Radiologia Interventistica, Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
| | - Bruno Fabris
- Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy;
- U.C.O. Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, 34149 Trieste, Italy
| | - Fulvio Stacul
- S.C. Radiologia, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Maggiore Hospital, 34125 Trieste, Italy;
| | - Roberto Cesareo
- U.O.S. Malattie Metaboliche, Ospedale Santa Maria Goretti, 04100 Latina, Italy;
| |
Collapse
|
11
|
Monpeyssen H, Alamri A, Ben Hamou A. Long-Term Results of Ultrasound-Guided Radiofrequency Ablation of Benign Thyroid Nodules: State of the Art and Future Perspectives-A Systematic Review. Front Endocrinol (Lausanne) 2021; 12:622996. [PMID: 34122328 PMCID: PMC8187951 DOI: 10.3389/fendo.2021.622996] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background Nearly 20 years after the first feasibility study, minimally invasive ultrasound (US)-guided therapeutic techniques are now considered as a safe and effective alternative to surgery for symptomatic benign thyroid nodules. Radiofrequency ablation (RFA) is one of the most widely used treatment in specialized thyroid centers but, due to the relatively recent introduction into clinical practice, there are limited long-term follow-up studies. Aim of our work was to review the outcomes of RFA on solid nonfunctioning and on autonomous thyroid nodules (AFTN) on a long-time period for assessing the results in term of efficacy, complications, and costs and to compare them to the current indications of RFA. Methods A systematic review was performed using EMBASE and Medline library data between 2008 and 2021. Seventeen studies evaluated RFA for the treatment of benign solid (nonfunctioning or autonomous) thyroid nodules, with an at least 18 months of follow-up. Data extraction and quality assessment were performed by two endocrinologist according to PRISMA guidelines. Anthropometric data, safety and efficacy parameters were collected. Results The majority of the studies was retrospective study and reported 933 nodules, mostly solid. Baseline volume ranged between 6.1 ± 9.6 and 36.3 ± 59.8 ml. Local analgesia was used and the time duration of the treatment was between 5 ± 2 and 22.1 ± 10.9 min. The volume reduction rate at 12 months ranged from 67% to 75% for the nodule treated with a single procedure and reached to 93.6 ± 9.7% for nodules treated with repeat ablations. The regrowth rate at 12 months ranged from 0% to 34%. Conclusion All the studies under examination consistently validated the long-term clinical efficacy and the substantial safety of RFA for the treatment of benign thyroid nodules. Thermal ablation, however, is an operator-dependent technique and should be performed in centers with specific expertise. The selection of the patients should be rigorous because the nodule size and the structural and functional characteristics influence the appropriateness and the outcomes of the treatment. Future perspectives as the treatment of micro-papillary thyroid cancer or cervical recurrence need further investigations.
Collapse
Affiliation(s)
- Hervé Monpeyssen
- American Hospital of Paris, Thyroid Unit, Neuilly-sur-Seine, France
| | - Ahmad Alamri
- Department of Endocrinology, Diabetology and Nutrition, Paris Saint-Joseph Hospital, Paris, France
| | - Adrien Ben Hamou
- American Hospital of Paris, Thyroid Unit, Neuilly-sur-Seine, France
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
12
|
Sim JS, Baek JH. Unresolved Clinical Issues in Thermal Ablation of Benign Thyroid Nodules: Regrowth at Long-Term Follow-Up. Korean J Radiol 2021; 22:1436-1440. [PMID: 34047509 PMCID: PMC8316783 DOI: 10.3348/kjr.2021.0093] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| |
Collapse
|
13
|
Sharma RK, Kuo JH. Complications of RFA for Thyroid Nodules: Prevention and Management. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
14
|
Muhammad H, Santhanam P, Russell JO, Kuo JH. RFA and benign thyroid nodules: Review of the current literature. Laryngoscope Investig Otolaryngol 2021; 6:155-165. [PMID: 33614945 PMCID: PMC7883624 DOI: 10.1002/lio2.517] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022] Open
Abstract
Benign thyroid nodules (BTNs) are commonly found in the general population. They are usually asymptomatic and their incidence has increased as a result of wide-spread use of ultrasound. Benign nodules are typically monitored clinically until they increase in size, resulting in compressive symptoms warranting surgery. However, although surgery is generally well-tolerated and of low-risk, it is associated with a small risk for several complications including hypothyroidism, nerve injury, hematoma, injury to other structures and wound infection. Recently, newer image-guided ablation techniques including radiofrequency ablation (RFA) have been introduced. RFA has a similar safety profile when compared to surgery and has shown promising results in challenging surgical candidates. Though several studies have been published in Asian and European countries on the efficacy of RFA, limited data is available on the North American population. The aim of the study is to review the current literature establishing the clinical outcomes and safety of RFA for benign nodules. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Haris Muhammad
- Department of Internal MedicineGreater Baltimore Medical CenterTowsonMarylandUSA
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes, & Metabolism, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jonathon O. Russell
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jennifer H. Kuo
- Department of Surgery, Section of Endocrine SurgeryColumbia University Medical CenterNew YorkNew YorkUSA
| |
Collapse
|
15
|
Nguyen VB, Nguyen TX, Nguyen VVH, Nguyen HT, Nguyen DT, Le CV. Efficacy and Safety of Single-Session Radiofrequency Ablation in Treating Benign Thyroid Nodules: A Short-Term Prospective Cohort Study. Int J Endocrinol 2021; 2021:7556393. [PMID: 34552630 PMCID: PMC8452432 DOI: 10.1155/2021/7556393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/15/2021] [Accepted: 09/02/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The aims of this study are to evaluate the safety and efficacy of RFA in the treatment of benign thyroid nodule(s) and to find independent factors related to the volume reduction rate of the nodule(s). MATERIALS AND METHODS This short-term prospective study from a single medical center was conducted on 93 benign thyroid nodules in 93 patients treated with RFA. Two basic techniques were used: the trans-isthmic approach and moving-shot technique. Clinical and ultrasonography examinations were performed at 1- and 3-month follow-up after the treatment session. Primary outcomes included volume reduction ratio (VRR) at 1-month and 3-month follow-ups; secondary outcomes were therapeutic success rate and complications. Multiple linear regression analysis was used to determine independent factors associated with VRR. RESULTS A final sample of 78 patients with 78 nodules, given participant rate 83.8% (including 60 solid nodules, 16 predominantly cystic nodules, and 2 thyroid cysts), was followed up for 3 months. The mean volume reduction ratio was 41.47% and 64.72% after 1-month and 3-month follow-ups, respectively. The therapeutic success rate was 30.8% at 1-month and 84.6% at 3-month follow-ups. Symptom score and cosmetic score improved significantly. There was no change in thyroid function tests. Two minor complications (transient voice change) were found. The multiple linear regression analysis showed that the internal component of the nodules significantly related to the VRR during the 3-month follow-up (β = 23.00; 95%CI (7.59-38.45)). CONCLUSION RFA was demonstrated as a safe and effective option for benign thyroid nodules treatment. It can be used as an alternative treatment with encouraging results.
Collapse
Affiliation(s)
- Van Bang Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Thi Xuan Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Van Vy Hau Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Hai Thuy Nguyen
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Dinh Toan Nguyen
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Chi Van Le
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| |
Collapse
|
16
|
Sim JS, Baek JH. Long-Term Outcomes of Thermal Ablation for Benign Thyroid Nodules: The Issue of Regrowth. Int J Endocrinol 2021; 2021:9922509. [PMID: 34335748 PMCID: PMC8321738 DOI: 10.1155/2021/9922509] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/20/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Thermal ablation (TA) for benign thyroid nodules (BTNs) is widely accepted as an effective and safe alternative to surgery. However, studies on the long-term outcomes of TA have reported problems with nodule regrowth and symptom recurrence, which have raised the need for adequate control of regrowth. Therefore, a more complete TA with a longer-lasting treatment effect may be required. In this study, we review and discuss long-term outcomes and regrowth of BTNs following TA and evaluate factors affecting the long-term outcomes. We also discuss the management of regrowth based on long-term outcomes.
Collapse
Affiliation(s)
- Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam 13590, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| |
Collapse
|
17
|
Bo XW, Lu F, Xu HX, Sun LP, Zhang K. Thermal Ablation of Benign Thyroid Nodules and Papillary Thyroid Microcarcinoma. Front Oncol 2020; 10:580431. [PMID: 33194708 PMCID: PMC7658440 DOI: 10.3389/fonc.2020.580431] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
Due to the increasing rates of physical examination and application of advanced ultrasound machines, incidences of benign thyroid nodules (BTNs) and papillary thyroid microcarcinoma (PTMC) were dramatically up-regulated in recent years. Thermal ablation (TA) has been widely used and regarded as a safe and effective method to eliminate or reduce BTNs and recurrent low-risk PTMC. However, conclusions using TA to treat primary PTMC are controversial. Recently, several long-term and prospective studies on TA treatment of BTNs and primary PTMC have been reported. Here, we review current literatures and progress on TA treatment of BTNs and PTMC and underline the way to get the best treatment outcomes, providing a comprehensive insight into the research progresses in this field.
Collapse
Affiliation(s)
- Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Feng Lu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Kun Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Appaduray SP, Too CW. Iatrogenic thyroid pseudoaneurysm following thyroid nodule radiofrequency ablation. BMJ Case Rep 2020; 13:13/5/e234784. [PMID: 32381528 DOI: 10.1136/bcr-2020-234784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 54-year-old Chinese woman presented for radiofrequency ablation (RFA) of benign thyroid nodules. A few hours after the procedure, the patient developed neck swelling and tenderness. Doppler ultrasound (US) images of the neck revealed haematoma with a vascular hypoechoic mass at the RFA site, suspicious for pseudoaneurysm. These findings were confirmed on subsequent on-table fluoroscopy following direct US-guided needle puncture and injection of contrast, demonstrating opacification of the mass and extravasation. Successful occlusion of the pseudoaneurysm was performed using US-guided thrombin injection. The patient made a good recovery with follow-up US 1 month later showing no recurrence of haematoma or pseudoaneurysm.
Collapse
Affiliation(s)
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| |
Collapse
|