1
|
Collins RA, McManus C, Kuo EJ, Liou R, Lee JA, Kuo JH. Improvement in thyroid-specific quality of life following radiofrequency ablation of benign thyroid nodules: A USA study. Surgery 2024:S0039-6060(24)00693-7. [PMID: 39384472 DOI: 10.1016/j.surg.2024.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/27/2024] [Accepted: 06/02/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND Radiofrequency ablation is an effective minimally invasive technique for benign thyroid nodules, with European and Asian studies reporting improved quality of life following treatment. We aimed to assess the thyroid-related quality of life of patients with benign thyroid nodules treated with radiofrequency ablation in the United States. METHODS This is a prospective single-institution study of patients treated with radiofrequency ablation over a 4-year period. Nodule characteristics and Thyroid-Related Patient-Reported Outcome (ThyPRO)-39 scores were assessed at baseline, 3 months post-procedure, and last follow-up (range: 3-12 months). Wilcoxon signed-rank test was used to assess differences in scores before and after radiofrequency ablation with standardized effect size analysis. RESULTS A total of 56 patients with 76 nodules were treated. The median volume reduction ratio at 1, 3, 6, and 12 months was 44.9% (interquartile range: 27.3-57.3), 65.2% (53.5-73.1), 69.7% (63.5-81.9), and 79.6% (66.2-88.9), respectively. At 3-month follow-up, significant improvement (P < .05) was observed for goiter symptoms (28.9 vs 10.8), anxiety (30.7 vs 19.3), and appearance (29.9 vs 10.8). At last follow-up, significant improvement (P < .05) was observed for goiter symptoms (28.9 vs 8.9), anxiety (30.7 vs 22.3), appearance (29.9 vs 10.8), and overall quality of life (30.3 vs 11.1). Effect sizes were moderate for appearance (standardized effect size 0.5-0.8) at last follow-up. CONCLUSION In the largest US study to date assessing quality of life following radiofrequency ablation, we observed an expected volume reduction ratio and improvements in thyroid-specific quality of life, particularly in the goiter, anxiety, and appearance domains.
Collapse
Affiliation(s)
- Reagan A Collins
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX. https://twitter.com/ReaganACollins
| | - Catherine McManus
- Section of Endocrine Surgery, Columbia University, New York, NY. https://twitter.com/ktmac862
| | - Eric J Kuo
- Section of Endocrine Surgery, Columbia University, New York, NY. https://twitter.com/EricJKuoMD
| | - Rachel Liou
- Section of Endocrine Surgery, Columbia University, New York, NY
| | - James A Lee
- Section of Endocrine Surgery, Columbia University, New York, NY
| | - Jennifer H Kuo
- Section of Endocrine Surgery, Columbia University, New York, NY.
| |
Collapse
|
2
|
Cao SL, Shi WY, Zhao ZL, Wei Y, Yu N, Wu J, Peng LL, Li Y, Yu MA. Investigating the optimal maximum diameter of benign thyroid nodules for thermal ablation on the basis of complete disappearance rate. Int J Hyperthermia 2024; 41:2408374. [PMID: 39326877 DOI: 10.1080/02656736.2024.2408374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/25/2024] [Accepted: 09/19/2024] [Indexed: 09/28/2024] Open
Abstract
OBJECTIVE Thermal ablation (TA) is a safe and effective treatment for benign thyroid nodules (BTNs). However, there has been no consensus on the optimal maximum diameter (MD) of BTNs for TA. This study aimed to identify the optimal MD of BTNs for TA based on complete disappearance rate after TA. MATERIALS AND METHODS This retrospective study included 639 BTNs treated with TA from June 2014 to January 2022. The complete disappearance rate of BTNs after TA was summarized, related influencing factors were explored, and the optimal MD of BTNs for TA was identified. RESULTS At the final follow-up (median: 40 months, range: 24-95 months), the overall volume reduction rate was 95.4 ± 9.0%, and 50.5% of the BTNs (323/639) completely disappeared. The MD was significantly negatively correlated with complete disappearance (odds ratio 0.89, 95% confidence interval 0.87-0.92; p < 0.001). Calcification, comet-tail artifacts, multilocular cysts, and composition of BTNs, as well as diabetes were negatively correlated with complete disappearance. Restricted cubic spline indicated that an MD of 25.0 mm was the optimal threshold of BTNs for TA, which was confirmed by subgroup logistic regression analysis. Compared with BTNs with MD ≤ 25.0 mm, those with MD > 25.0 mm had a greater complication rate (6.5% vs. 2.4%, p = 0.012). CONCLUSIONS The MD of BTNs was negatively correlated with complete disappearance after TA; an MD > 25.0 mm indicated a reduced likelihood of complete disappearance compared with an MD ≤ 25.0 mm. An MD of 25.0 mm is an appropriate threshold of BTNs for TA on the basis of complete disappearance rate.
Collapse
Affiliation(s)
- Shi-Liang Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Wan-Ying Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Na Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
3
|
Fullerton Z, Butler SS, Noel J. Analysis of trends in radiofrequency ablation in a tertiary care center practice. Head Neck 2024; 46:2145-2151. [PMID: 38769729 DOI: 10.1002/hed.27817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) for thyroid nodules has recently been introduced into the United States healthcare system landscape. Little is known about the process of incorporating this procedure into existing clinical practice. METHODS A retrospective chart review of a single institution was conducted to examine referral patterns and decision-making after the introduction of RFA into an endocrine surgery-focused practice. Patient demographics and thyroid-specific data were recorded. Two reviewers abstracted and coded reasons for the noncompletion of RFA. Two-sample t tests were used to compare groups; linear regression was used to assess trends and practice patterns. RESULTS Chart review identified 451 patients referred for consideration of RFA from January 2020 to December 2022. Only 255 (56.5%) went on to receive the treatment. There was no significant difference in nodule volume between treated and nontreated groups (18.5 vs. 14.9 cm3, p = 0.07). Concern for malignancy on genetic testing, size (too large/too small), recommendation for Ethanol ablation, and multinodular disease without target nodules were the most common reasons for physician deferral. Of patients who declined to proceed, 46% opted to undergo surgical excision. Linear regression showed that referral numbers significantly increased with time; however, the proportion of patients receiving treatment decreased yearly, primarily because of higher rates of physician deferral. CONCLUSIONS This study reflects the complex decision-making in offering minimally invasive thyroid nodule ablation. Despite a greater number of referrals over time, physician criteria became increasingly selective. Optimal candidacy in RFA is an evolving determination requiring patient and physician input to guide ideal practice patterns.
Collapse
Affiliation(s)
- Zoë Fullerton
- Department of Otolaryngology, Stanford University, Stanford, California, USA
| | - Santino S Butler
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Julia Noel
- Department of Otolaryngology, Stanford University, Stanford, California, USA
- Santa Clara Valley Medical Center, Fruitdale, California, USA
| |
Collapse
|
4
|
Dueñas JP, Buitrago-Gómez N, Arias-Botero JH, Randolph G, Russell M, Abdelhamid Ahmed A, Valcavi R, Duque CS, Tufano RP. The Influence of Impedance on the Efficacy of Radiofrequency Ablation for Benign Thyroid Nodules. Laryngoscope 2024. [PMID: 39072790 DOI: 10.1002/lary.31666] [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: 04/09/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Radiofrequency ablation (RFA) uses the heat generated by a high-frequency alternating electric current, and according to Ohm's and Joule's law, the delivered current is inversely proportional to the circuit impedance. The primary objective of this study was to investigate whether tissue impedance during radiofrequency ablation (RFA) for benign thyroid nodules is related to the degree of volume reduction. METHODS This observational study included consecutive patients treated with RFA for benign thyroid nodules from February 2020 to August 2023. Technical effectiveness was defined as a volume reduction percentage (VRP) >75% at 6 months after the treatment. Multivariate logistic regression analyses were performed to identify the potential role of clinical factors and changes in tissue impedance on technique effectiveness. RESULTS Totally 72 patients were included with 73 benign thyroid nodules. Maximal impedance peaks reached <18 times, and mean procedural impedance ≤300 Ω were significantly associated with a volume decrease of >75% at bivariate analysis. These cutoff points were exploratory, as no existing literature suggests these variables are related to the degree of volume reduction. After adjusting for age, volume, and composition, significant associations were found for mean electrical impedance in the multivariate analysis (OR = 4.86 [confidence interval [CI] 1.29-18.26], p = 0.019). The energy adjusted by volume (delivered energy) was not associated with a VRP >75% (p = 0.7746). CONCLUSIONS This study suggests that a mean procedural impedance = 300 Ω is related to the effectiveness of RFA as measured by VRP. Additional prospective and randomized studies are needed to compare electrical parameters with VRP. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
Collapse
Affiliation(s)
- Juan Pablo Dueñas
- Division of Endocrine Surgery, Integral Endocrine Surgery Clinic, Medellin, Colombia
| | | | | | - Gregory Randolph
- Otolaryngology Head and Neck Surgery, Claire and John Bertucci Endowed Chair in Thyroid Surgical Oncology, Harvard Medical School, Chief Thyroid/Parathyroid Endocrine Surgical Division, Dept Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Member Endocrine Surgical Service, Massachusetts General Hospital, President American Academy of Otolaryngology Head and Neck Surgery 2016-17, American Head and Neck Society, Administration Division Chair, International Thyroid Oncology Group (ITOG) President, American College of Surgeons Otolaryngology Governor, Boston, Massachusetts, U.S.A
| | - Marika Russell
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Amr Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Roberto Valcavi
- Division of Endocrinology, The Endocrine & Thyroid Clinic (ETC), Reggio Emilia, Italy
| | | | - Ralph P Tufano
- FPG Thyroid and Parathyroid Center, Sarasota Memorial Health Care System, Sarasota, Florida, U.S.A
| |
Collapse
|
5
|
van Velsen EFS, Geeraedts TEA, Bosman A, Zillikens MC. Thermal Ablation for Treating Tumor-induced Osteomalacia in a Patient With IV Phosphate Dependency. JCEM CASE REPORTS 2023; 1:luad086. [PMID: 37908985 PMCID: PMC10580436 DOI: 10.1210/jcemcr/luad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 11/02/2023]
Abstract
Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome associated with tumors secreting fibroblast growth factor 23 that can be cured with complete surgical resection of the tumor. However, when these tumors are at difficult locations, less invasive modalities such as thermal ablation (TA) might be a good alternative. A 40-year-old woman was seen for a second opinion because of severe hypophosphatemia with complaints of fatigue, myalgia, and muscle weakness for which she needed IV phosphate for 15 to 18 hours per day in addition to oral alfacalcidol and phosphate. Initial laboratory results revealed hypophosphatemia (0.59 mmol/L [1.83 mg/dL]; reference range, 0.90-1.50 mmol/L [8.40-10.2 mg/dL]), increased fibroblast growth factor 23 levels (137 RU/mL; reference range, <125 RU/mL), and a reduced TmP-GFR (0.47 mmol/L; reference range, 0.8-1.4 mmol/L). Gallium-positron emission tomography/computed tomography (CT) showed moderately increased uptake at thoracic vertebra (Th) 8 and mildly increased uptake at Th7, suggestive of TIO. Complete tumor removal would have required resection of at least 1 vertebral body. Therefore, CT-guided TA was performed at Th8. No complications were observed, and in the months after, treatment with IV phosphate could be discontinued, indicating a satisfying result from the procedure. This extreme TIO case demonstrates that CT-guided TA can be an alternative to extensive or risky classical surgery.
Collapse
Affiliation(s)
- Evert F S van Velsen
- Department of Internal Medicine, Erasmus University Medical Center, 3015 CE, Rotterdam, The Netherlands
- Erasmus MC Bone Center, Erasmus University Medical Center, 3015 CE, Rotterdam, The Netherlands
| | - Tychon E A Geeraedts
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, 3015 CE, Rotterdam, The Netherlands
| | - Ariadne Bosman
- Department of Internal Medicine, Erasmus University Medical Center, 3015 CE, Rotterdam, The Netherlands
- Erasmus MC Bone Center, Erasmus University Medical Center, 3015 CE, Rotterdam, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, 3015 CE, Rotterdam, The Netherlands
- Erasmus MC Bone Center, Erasmus University Medical Center, 3015 CE, Rotterdam, The Netherlands
| |
Collapse
|
6
|
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
|
7
|
Goldfarb M, Dinauer C. Differences in the management of thyroid nodules in children and adolescents as compared to adults. Curr Opin Endocrinol Diabetes Obes 2022; 29:466-473. [PMID: 35777975 DOI: 10.1097/med.0000000000000754] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe recent advances in the diagnosis and management of thyroid nodules in both children and adults, highlighting differences between the two groups. RECENT FINDINGS Thyroid nodules are less common in children than adults but the risk of malignancy is higher. Screening recommendations for patients with certain genetic syndromes or specific risk factors for thyroid nodules and cancer continue to evolve ultrasound is the most appropriate imaging modality for evaluating thyroid nodules in all patients, but radiographic risk stratification systems validated in adults have not been extensively studied in children. Criteria for proceeding to fine needle aspiration (FNA) biopsy differ some between children and adults, with nodule size being less of a consideration in young patients. Molecular testing continues to improve the diagnostic capabilities of FNA for all age groups, but options for pediatric thyroid nodules are currently limited. In children, only oncogene panels are validated and their exact utility, along with miRNA classifiers, is an evolving area of study. For adults, data support selection of a specific molecular test based on ultrasound characteristics and pretest probability of malignancy. Multiple series have shown that fusion mutations are more common in pediatric thyroid nodules, while point mutations are seen more often in adult thyroid nodules. Molecular data help guide management recommendations regarding the need for surgery when FNA is indeterminate, but clinical use is still being refined. Radiofrequency ablation is a nonoperative approach that has gained significant traction for the treatment of symptomatic benign nodules in adults, but data are currently extremely limited in children. SUMMARY There are difference in the diagnosis and treatment of thyroid nodules in adults and children, the nuances of which are important for clinical management.
Collapse
Affiliation(s)
- Melanie Goldfarb
- Center for Endocrine Tumors, Saint Johns Cancer Institute at Providence Saint Johns Health Center, Santa Monica
| | - Catherine Dinauer
- Section of Pediatric Endocrinology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|