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Wang YH, Chiang PL, Lin AN, Wang CK, Lee CY, Chou CK, Chang YH, Chi SY, Luo SD, Lin WC. Long-term outcomes of radiofrequency ablation for intrathoracic goiter up to 5 years: evaluated by computed tomography/magnetic resonance imaging and ultrasound. Int J Hyperthermia 2024; 41:2378865. [PMID: 39004424 DOI: 10.1080/02656736.2024.2378865] [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: 04/09/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVES This study evaluated the long-term efficacy and safety of radiofrequency ablation (RFA) for intrathoracic goiter (ITG) over a follow-up period exceeding six months. METHODS From 2017 to 2022, 22 patients (6 males, 16 females) with 24 ITGs treated with RFA at a single medical center were evaluated. All patients underwent ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI) before RFA. Follow-up CT/MRI was performed six months after the initial RFA and then every 6-12 months. The primary outcomes measured were the degree of extension, goiter volume, volume reduction rate (VRR), tracheal deviation, and tracheal lumen. Additionally, we assessed the outcomes of single-session RFA (n = 16) vs. multiple sessions (n = 8) on goiters and explored the correlation between ITG volume measurements obtained using ultrasonography and CT/MRI. RESULTS The median follow-up period was 12 months (interquartile range: 6-36.8 months). At the last follow-up, the nodule volume measured by CT/MRI had significantly decreased (76.2 vs. 24.6 mL; p < 0.05), with a VRR of 64.6%. Patients who underwent multiple RFA sessions showed a significantly higher VRR than the single-session patients (63.8 vs. 80.1%, p < 0.05). The intraclass correlation between goiter volumes measured using US and CT/MRI was moderate. CONCLUSION This study affirms the long-term efficacy and safety of RFA for ITG, providing an alternative treatment for nonsurgical candidates. Multiple RFA sessions may be beneficial for achieving better volume reduction. Sole reliance on ultrasonography is inadequate; therefore, integrating CT/MRI is essential for accurate pre-RFA and follow-up assessments.
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Affiliation(s)
- Yu-Hsin Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Ying Lee
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Kai Chou
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Radiology, Jen-Ai Hospital, Dali Branch, Taichung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Yuan W, Di L, Yu X, Li J. Comparison of efficacy and safety of different minimally invasive therapies for thyroid nodules: A network meta-analysis. Endocrine 2024:10.1007/s12020-024-03782-8. [PMID: 38517639 DOI: 10.1007/s12020-024-03782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE This study aimed to compare efficacy and safety of minimally invasive therapies such as radiofrequency ablation (RFA), microwave ablation (MWA), ethanol ablation (EA), and laser ablation (LA) for thyroid nodules through network meta-analysis (NMA). METHODS This study searched PubMed, Web of Science, Embase, and The Cochrane Library databases to collect randomized controlled trials (RCTs) or cohort studies comparing efficacy and safety of different minimally invasive therapies for thyroid nodules. Newcastle-Ottawa Scale (NOS) was implemented to assess quality of included cohort studies, and Cochrane risk of bias assessment tool was utilized to evaluate quality of included RCTs. Eligible studies contained at least one of the following clinical outcome measures: volume reduction rate (VRR), symptom score, cosmetic score, nodule regrowth rate, and complication rate. STATA software was utilized for NMA. RESULTS Sixteen eligible studies (4 RCTs, 11 retrospective cohort studies, 1 prospective cohort study) involved 4094 patients. NMA results revealed that RFA group had the highest VRR at 1 months and 12 months. There were no significant differences in symptom scores and cosmetic scores among all treatment methods, with the lowest symptom scores and cosmetic scores in RFA group. LA group had a significantly higher nodule regrowth rate than RFA and MWA groups, with the lowest in RFA group. There were no significant differences in complication rate among all treatment methods. CONCLUSION RFA had the highest VRR for thyroid nodules, and it excelled in symptom scores, cosmetic scores, and nodule regrowth rates.
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Affiliation(s)
- Wei Yuan
- Department of Oncology, General Hospital of Yangquan Coal Industry Group, Yangquan, Shanxi Province, China.
- Department of Oncology and Interventional Radiology, Yang Quan Hospital of Shanxi Medical University, Yangquan, Shanxi Province, China.
| | - Liju Di
- Department of Oncology, General Hospital of Yangquan Coal Industry Group, Yangquan, Shanxi Province, China
- Department of Oncology and Interventional Radiology, Yang Quan Hospital of Shanxi Medical University, Yangquan, Shanxi Province, China
| | - Xiaoxin Yu
- Department of ultrasonography, General Hospital of Yang Quan Coal Industry Group, Yangquan, Shanxi Province, China
| | - Jian Li
- Department of endocrinology, General Hospital of Yang Quan Coal Industry Group, Yangquan, Shanxi Province, China
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Bernardi S, Rosolen V, Barbone F, Borgato S, Deandrea M, De Feo P, Fugazzola L, Gambelunghe G, Negro R, Oleandri S, Papi G, Papini E, Retta F, Rossetto R, Sansone D, Serra G, Sconfienza LM, Solbiati L, Spiezia S, Stacul F, Mauri G. Clinical Outcomes of Thermal Ablation Re-Treatment of Benign Thyroid Nodules: A Multicenter Study from the Italian Minimally Invasive Treatments of the Thyroid Group. Thyroid 2024; 34:360-370. [PMID: 38149599 DOI: 10.1089/thy.2023.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Background: Thermal ablation (TA) is an established therapeutic option alternative to surgery in patients with solid benign thyroid nodules causing local symptoms. However, a variable part of thyroid nodules remain viable after these nonsurgical treatments, and as many as 15% of nodules treated with TA may require a second treatment over time. This study aimed to evaluate the outcomes of TA re-treatment on symptomatic benign thyroid nodules where the volume decreased by <50% after the first procedure ( = technique inefficacy). Methods: We performed a multicenter retrospective cohort study including patients who underwent re-treatment with TA for benign thyroid nodules, whose volume decreased by <50% after initial treatment. The primary aim was to evaluate volume and volume reduction ratio (VRR) over time and compare the 6- and 12-month VRR after first versus second treatment. The secondary aim was to identify protective or risk factors for technique inefficacy, regrowth, and further treatments, expressed as adjusted hazard ratios (HRs) and confidence interval [CI], after adjustment for sex, age, nodule volume, structure and function, nodule regrowth or symptom relapse, technique used and if the same technique was used for the first and second TA and time between them. Results: We included 135 patients. Re-treatment led to VRR of 50% and 52.2% after 6 and 12 months. VRR after re-treatment was greater than after first treatment in small and medium size nodules (<30 mL), while there were no differences for large nodules (>30 mL). After re-treatment technique inefficacy rate was 51.9%, regrowth rate was 12.6%, and further treatment rate was 15.6%. Radiofrequency ablation (RFA) was protective toward technique inefficacy (HR = 0.40 [CI 0.24-0.65]) and need of further treatments (HR = 0.30 [CI 0.12-0.76]). Large nodule volume (>30 mL) was associated with increased risk of re-treatment (HR = 4.52 [CI 1.38-14.82]). Conclusions: This is the first study evaluating the outcomes of re-treatment on symptomatic benign thyroid nodules with a VRR <50% after the initial TA treatment. Best results were seen in small and medium nodules (<30 mL) and after RFA. Prospective confirmatory studies are needed.
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Affiliation(s)
- Stella Bernardi
- Dipartimento di Scienze Mediche, Università degli Studi di Trieste, Trieste, Italy
- UO Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Valentina Rosolen
- Direzione centrale salute, politiche sociali e disabilità, Regione Friuli Venezia Giulia, Trieste, Italy
| | - Fabio Barbone
- Dipartimento di Scienze Mediche, Università degli Studi di Trieste, Trieste, Italy
| | - Stefano Borgato
- Divisione Endocrinologia e Metabolismo, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Maurilio Deandrea
- SC Endocrinologia Diabetologia e Malattie del Metabolismo, Ospedale Mauriziano Umberto I, Torino, Italy
| | | | - Laura Fugazzola
- Divisione Endocrinologia e Metabolismo, IRCCS Istituto Auxologico Italiano, Milano, Italy
- Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
| | | | - Roberto Negro
- UO Endocrinologia, Ospedale Vito Fazzi, Lecce, Italy
| | - Salvatore Oleandri
- SC Endocrinologia e Malattie Metaboliche, Azienda Sanitaria Locale Città di Torino, Torino, Italy
| | | | - Enrico Papini
- Dipartimento di Endocrinologia e Metabolismo, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Francesca Retta
- SC Endocrinologia Diabetologia e Malattie del Metabolismo, Ospedale Mauriziano Umberto I, Torino, Italy
| | - Ruth Rossetto
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Azienda ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniela Sansone
- SC Endocrinologia e Malattie Metaboliche, Azienda Sanitaria Locale Città di Torino, Torino, Italy
| | - Giuseppe Serra
- Dipartimento di Medicina, Università degli Studi di Udine, Udine, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Luigi Solbiati
- Dipartimento di Scienze Biomediche, Università Humanitas, Milano, Italy
| | - Stefano Spiezia
- UO Chirurgia Endocrina e Ecoguidata, Ospedale del Mare, ASL Napoli1, Napoli, Italy
| | - Fulvio Stacul
- UO Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Giovanni Mauri
- Divisione di Radiologia Interventistica, IRCCS Istituto Europeo di Oncologia (IEO), Milano, Italy
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Akgun E, Romero-Velez G, Berber E. Assessing the efficacy of thyroid nodule radiofrequency ablation using patient-reported outcome measures. Surgery 2024; 175:654-660. [PMID: 37741775 DOI: 10.1016/j.surg.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/27/2023] [Accepted: 07/08/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Radiofrequency ablation has recently emerged as an alternative treatment for thyroid nodules. Most studies are centered on volume reduction, whereas a few have assessed symptom improvement mainly with nonstandardized metrics. As experience in the United States is growing, we aim to assess the efficacy of radiofrequency ablation in treating benign thyroid nodules using the validated Patient-Reported Outcomes Measurement for Parathyroid and Thyroid Disease. METHODS This is a prospective study of a newly established radiofrequency ablation program at a single tertiary referral center in 2022. Patients who underwent radiofrequency ablation were evaluated using the Patient-Reported Outcomes Measurement for Parathyroid and Thyroid Disease, a validated metric ranging from 0 to 100 at baseline, 2 weeks, 3 months, and 6 months. In addition, a thyroid ultrasound was done at those intervals to assess size and volume reduction. Procedure complications were evaluated as well. RESULTS A total of 25 patients underwent radiofrequency ablation during the study period for a total of 32 nodules treated; 84% were female with a mean age of 51 years. The baseline mean nodule volume and largest dimension were 13 ± 11 mL and 3.4 ± 1 cm, respectively. A significant change in the Patient-Reported Outcomes Measurement for Parathyroid and Thyroid Disease compressive score was seen at 3 months (38.9 ± 26.4 to 21.0 ± 21.4; P = .004) and 6 months (32.7 ± 19.9 to 17.5 ± 21.0; P = .02) but not at 2 weeks (41.0 ± 22.7 to 36.1 ± 21.9; P = .28). Significant volume and size reductions were seen at all 3-time points. Two complications occurred. CONCLUSION Our initial results of the thyroid radiofrequency ablation program find that it effectively alleviates symptoms by reducing nodule size in patients with symptomatic benign thyroid nodules.
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Affiliation(s)
- Ege Akgun
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Gustavo Romero-Velez
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Eren Berber
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH.
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Shin JH, Seo M, Lee MK, Jung SL. Comparison of the Therapeutic Efficacy and Technical Outcomes between Conventional Fixed Electrodes and Adjustable Electrodes in the Radiofrequency Ablation of Benign Thyroid Nodules. Korean J Radiol 2024; 25:199-209. [PMID: 38288899 PMCID: PMC10831303 DOI: 10.3348/kjr.2023.0577] [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: 06/21/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE This study aimed to compare therapeutic efficacy and technical outcomes between adjustable electrode (AE) and conventional fixed electrode (FE) for radiofrequency ablation (RFA) of benign thyroid nodules. MATERIALS AND METHODS Between 2013 and 2021, RFA was performed on histologically proven benign thyroid nodules. For the AE method, AE length ≥ 1 cm with higher power and < 1 cm with lower power were utilized for ablating feeding vessels and nodules, especially those near anatomical structures, respectively. The therapeutic efficacy (volume reduction rate [VRR], complication rate, and regrowth rate) and technical outcomes (total energy delivery, ablated volume/energy, RFA time, and ablated volume/time) of FE and AE were compared. Continuous parameters were compared using a two-sample t-test or Mann-Whitney U test, and categorical parameters were compared using a chi-squared test or Fisher's exact test. RESULTS A total of 182 nodules (FE: 92 vs. AE: 90) in 173 patients (mean age ± standard deviation, 47.0 ± 14.7 years; female, 90.8% [157/173]; median follow-up, 726 days [interquartile range, 441-1075 days]) were analyzed. The therapeutic efficacy was comparable, whereas technical outcomes were more favorable for AE. Both electrodes demonstrated comparable overall median VRR (FE: 92.4% vs. AE: 84.9%, P = 0.240) without immediate major complications. Overall regrowth rates were comparable between the two groups (FE: 2.2% [2/90] vs. AE: 1.1% [1/90], P > 0.99). AE demonstrated a shorter median RFA time (FE: 811 vs. AE: 627 seconds, P = 0.009). Both delivered comparable median energy (FE: 42.8 vs. AE: 29.2 kJ, P = 0.069), but AE demonstrated higher median ablated volume/energy and median ablated volume/time (FE: 0.2 vs. AE: 0.3 cc/kJ, P < 0.001; and FE: 0.7 vs. AE: 1.0 cc/min, P < 0.001, respectively). CONCLUSION Therapeutic efficacy between FE and AE was comparable. AE demonstrated better technical outcomes than FE in terms of RFA time, ablated volume/energy, and ablated volume/time.
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Affiliation(s)
- Jae Ho Shin
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Minkook Seo
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Kyoung Lee
- Department of Radiology, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Russell JO, Frazier KM. Radiofrequency Ablation for Benign Nodules and for Cancer, Too? Otolaryngol Clin North Am 2024; 57:83-97. [PMID: 37845130 DOI: 10.1016/j.otc.2023.09.004] [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] [Indexed: 10/18/2023]
Abstract
Radiofrequency ablation (RFA) is a minimally invasive procedure performed under ultrasound guidance that offers the ability to significantly reduce the size of benign thyroid nodules. Although application for benign nodules has only emerged during the past 5 to 10 years in North America, RFA has an impressive track record of nodule reduction, compressive and cosmetic symptom improvement, and excellent safety profile without the morbidity of open surgery. The role of RFA in autonomous functioning nodules, thyroid cancer, and indeterminate nodules is controversial and remains an area of investigation.
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Affiliation(s)
- Jonathon O Russell
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA.
| | - Kaitlyn M Frazier
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA
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Aliberti C, Impellizzeri H, Inama M, Moretto G, Vitali A, Balduzzi A, Toaiari M, Francia G, Casaril A. Microwave ablation for large benign thyroid nodules: a proposal for a new approach: "the fluid-motion technique". Updates Surg 2024; 76:239-244. [PMID: 37899391 DOI: 10.1007/s13304-023-01663-9] [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: 02/24/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Most thyroid nodules are benign, and treatment is primarily indicated for patients with symptoms or cosmetic concerns related to nodular volume. Recently, there has been growing interest in nonsurgical and minimally invasive techniques for the treatment of symptomatic benign thyroid nodules, including microwave ablation (MWA). AIMS This study aims to evaluate the effectiveness, efficacy, and safety of ultrasound-guided uncooled MWA in the treatment of benign symptomatic thyroid nodules, using a new ablation technique called the "fluid-motion technique." MATERIALS AND METHODS From April 2021 to February 2023, a total of 150 patients with benign thyroid nodules were treated using MWA at the Endocrine Surgery Unit of Pederzoli Hospital, Peschiera del Garda (Italy), with 102 of them being followed-up for at least 6 months. RESULTS Before treatment, the mean major diameter was 38.4 ± 10.0 mm, and the mean volume was 13.6 ± 10.5 mL. At 1 month, the mean volume was 6.8 ± 6.2 mL, and at 3 months, it was 4.6 ± 4.1 mL. The mean Volume Reduction Rate (VRR) at 3 months was 61.1 ± 22.0%. Of the nodules, 17 (17%), 65 (66%), and 20 (19%) had volumes ≤ 10, 10.1-20, and ≥ 20.1 mL, respectively. For these nodules, the mean VRR at 3 and 6 months was 55.3 ± 16%, 63.4 ± 24.8%, 72 ± 26.9% and 68.0 ± 11.2%, 73.5 ± 18.3%, and 81.6 ± 15.8%, respectively. CONCLUSION Our study shows that ultrasound-guided MWA is an effective and safe minimally invasive treatment for benign thyroid nodules. The goal is to achieve a VRR that can reduce symptoms and improve cosmetic appearance.
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Affiliation(s)
- C Aliberti
- Interventional Radiology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - H Impellizzeri
- EndocrineSurgery Unit, Pederzoli Hospital, Peschiera del Garda, Italy.
| | - M Inama
- Minimal Invasive Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - G Moretto
- Minimal Invasive Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - A Vitali
- Minimal Invasive Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - A Balduzzi
- Minimal Invasive Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - M Toaiari
- Endocrinology Service, Pederzoli Hospital, Peschiera del Garda, Italy
| | - G Francia
- Endocrinology Service, Pederzoli Hospital, Peschiera del Garda, Italy
| | - A Casaril
- EndocrineSurgery Unit, Pederzoli Hospital, Peschiera del Garda, Italy
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Noel JE, Sinclair CF. Radiofrequency Ablation for Benign Thyroid Nodules. J Clin Endocrinol Metab 2023; 109:e12-e17. [PMID: 37401778 DOI: 10.1210/clinem/dgad357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Indexed: 07/05/2023]
Abstract
CONTEXT Thermal ablative techniques of the thyroid have recently gained clinical traction as a therapeutic alternative that provides symptomatic relief and confers potential advantages over surgery. A truly multidisciplinary technique, thyroid ablation is currently performed by endocrinologists, interventional radiologists, otolaryngologists, and endocrine surgeons. Radiofrequency ablation (RFA), specifically, has seen widespread adoption, particularly in the treatment of benign thyroid nodules. This review summarizes current evidence on the application of RFA in benign thyroid nodules, and provides a start to finish overview of procedural preparation, performance, and outcomes. EVIDENCE ACQUISITION A narrative review of literature focusing on RFA in the treatment of benign nodular disease was performed. Emphasis was placed on consensus statements, best practice guidelines, multi-institutional studies, and systematic reviews to summarize key concepts in candidacy, techniques, expectations, and outcomes. FINDINGS RFA is increasingly recognized as a first-line treatment strategy in the management of symptomatic nonfunctional benign thyroid nodules. It can also be considered in functional thyroid nodules with small volumes or in patients ineligible for surgery. A targeted and efficacious technique, RFA results in gradual volume reduction that preserves the function of the surrounding thyroid parenchyma. Proper procedural technique, proficiency in ultrasound, and experience in ultrasound-guided procedures are instrumental to maintaining low complication rates and achieving successful ablation outcomes. CONCLUSIONS In pursuit of a personalized approach, physicians across disciplines are increasingly incorporating RFA into their treatment algorithms, most commonly for benign nodules. As with any intervention, thoughtful selection and implementation ensure a safe procedure with optimal patient benefit.
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Affiliation(s)
- Julia E Noel
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Catherine F Sinclair
- Department of Otolaryngology-Head & Neck Surgery, Monash University Melbourne, Clayton, VIC 3800, Australia , and Mount Sinai School of Medicine: Icahn School of Medicine at Mount Sinai, New York, NY 10019, USA
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Chiu CH, Luo SD, Chiang PL, Lin AN, Wang CK, Chou CK, Chi SY, Chen MH, Lin WC. Factors Influencing a Favorable Outcome for RFA of Huge Benign Thyroid Nodules: Preliminary Results and Short-Term Evaluation. Int J Endocrinol 2023; 2023:9021903. [PMID: 38131035 PMCID: PMC10735726 DOI: 10.1155/2023/9021903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/18/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Objective This study aimed to investigate potentially favorable factors influencing the therapeutic success of radiofrequency ablation (RFA) of huge benign thyroid nodules (BTNs) (volume >100 ml) and to evaluate the feasibility of RFA as an alternative treatment modality for patients unable or unwilling to undergo surgery. Methods This retrospective study evaluated a total of 868 patients, of which 22 patients had huge BTNs who underwent ultrasound-guided moving shot RFA treatment between May 2017 and January 2022. The huge BTNs were categorized into two groups according to a post-RFA treatment volume reduction ratio (VRR) of >80% and <80% at 6 months. Factors influencing these huge BTNs were reviewed, analyzed, and correlated with treatment effectiveness between the two groups. Results The factors influencing an effective VRR included huge BTNs located on the left side (OR 7.875, p = 0.03), predominant solid/spongiform nodules (OR 7.875, p = 0.03), and higher initial ablation rate (IAR) (p = 0.028). Multivariable logistic regression revealed predominant solid/spongiform nodule and the higher IAR were associated with the advanced VRR. Conclusion RFA was effective at decreasing the volume of huge BTNs with an acceptable complication rate. The BTN characteristics correlated with a better VRR at the 6-month short-term follow-up were predominant solid/spongiform BTNs and those with the first time ablation treatment initial ablation rate. Nevertheless, regarding the higher regrowth rate of these groups of patients who may need to be treated more times, RFA can only be a feasible alternative treatment modality for patients unable or unwilling to undergo operation.
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Affiliation(s)
- Chun-Hua Chiu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Kai Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Radiology, Jen-Ai Hospital, Taichung, Taiwan
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10
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Richter JP, Richter CP, Gröner D. [Ultrasound-guided ablation techniques for thyroid lesions]. Laryngorhinootologie 2023; 102:916-927. [PMID: 37734389 DOI: 10.1055/a-2144-4132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Ultrasound-guided ablation techniques have been increasingly introduced into routine treatment of thyroid lesions as a complement to existing surgical therapies and radioiodine treatment. In cystic or predominantly cystic lesions instillation therapy (ethanol/polidocanol ablation) has yielded good results. Novel thermal ablation techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA) and high intensity focused ultrasound (HIFU), induce irreversible cellular effects by locally applying temperatures ≥ 60 °C to the targeted thyroid region. Lesions causing local symptoms or focal hyperfunctionality can thus be selectively treated under continuous sonographic monitoring. While a considerable body of evidence supports the efficacy and safety of various local ablative techniques, future challenges lie in initiating comparative prospective trials and in standardizing clinical practice, training and continuous quality assessment on a regional and superregional level. In the future, it shall be indicated to include local ablative techniques - so far not known to all patients in Germany - into the informed decision-making process as a suitable alternative or supplement to existing therapies.
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Affiliation(s)
- Johannes-Paul Richter
- Klinik für Nuklearmedizin, Universitätsklinikum Magdeburg, Otto-von-Guericke-Universität, Magdeburg
| | - Carl-Philip Richter
- Chirurgische Klinik am Rathenauplatz, Schilddrüsenzentrum Baden-Württemberg, Heilbronn
| | - Daniel Gröner
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt am Main, Frankfurt am Main
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11
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Chai M, Yu J, Liang P. Trajectory analysis of microwave ablation treatment effect on the quality of life and emotional distress in patients with papillary thyroid cancer. Endocrine 2023; 82:602-612. [PMID: 37480495 DOI: 10.1007/s12020-023-03451-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/06/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Trajectory changes of quality of life (QOL) and psychological status in patients with T1N0M0 papillary thyroid cancer (PTC) after microwave ablation (MWA) treatment. METHODS Patients with T1N0M0 PTC who underwent MWA from March to August 2021 were included in this study. Patients completed the European Organisation for Research and Treatment of Cancer questionnaire (QLQ-C30), Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QOL) and Hospital Anxiety and Depression Scale (HADS) at baseline, 3 months, 6 months, 9 months and 12 months after MWA. RESULTS 181 patients were enrolled in this study. All patients met a minimum of 12 months of follow-up. The QOL at baseline and 12 months after MWA were 14.95 ± 1.78 and 14.19 ± 1.73 (P < 0.01), respectively. Patients' anxiety was 3.33 ± 1.81 and 1.49 ± 2.14 (P < 0.01), respectively. Patients' depression was 2.14 ± 2.10 and 1.40 ± 2.22 (P < 0.01), respectively. In the trajectory analysis, 73%, 19% and 8% of patients achieved significant improvement, slight improvement and stable in QOL, respectively, with older, female, lower education and lower monthly income as the risk factors of QOL. 63%, 31% and 6% of patients achieved significant improvement, slight improvement and stable in anxiety, respectively, with younger, female, lower education, lower monthly income, unmarried or divorced and higher T3, T4 levels as the risk factors of anxiety. 72%, 21% and 7% of patients achieved significant improvement, slight improvement and stable in depression, respectively, with younger, lower monthly income and unmarried or divorced as the risk factors of depression. CONCLUSIONS MWA can effectively improve the QOL and emotional distress of patients with T1N0M0 PTC.
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Affiliation(s)
- Mengwei Chai
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, China
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, China.
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
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12
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Filippou A, Evripidou N, Damianou C. Robotic system for magnetic resonance imaging-guided focused ultrasound treatment of thyroid nodules. Int J Med Robot 2023; 19:e2525. [PMID: 37149886 DOI: 10.1002/rcs.2525] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Herein, a robotic system offering Magnetic Resonance-guided Focused Ultrasound (MRgFUS) therapy of thyroid nodules was developed. METHODS The robotic system offers linear motion in 2 PC-controlled axes that navigate a 3 MHz single-element focused transducer. The system, through a C-arm structure attaches to the table of Magnetic Resonance Imaging (MRI) scanners and couples to the neck of patients lying in the supine position. The MRI compatibility of the developed system was assessed inside a 3 T scanner. Benchtop and MRI feasibility studies evaluating the heating performance of the system were executed on excised pork tissue and on homogeneous and thyroid model agar-based phantoms. RESULTS The MRI compatibility of the system was successfully established. Grid sonications executed using robotic motion inflicted discrete and overlapping lesions on the excised tissue, while magnetic resonance (MR) thermometry successfully monitored thermal heating in agar-based phantoms. CONCLUSIONS The developed system was found to be efficient with ex-vivo evaluation. The system can perform clinical MRgFUS therapy of thyroid nodules and other shallow targets after further in-vivo evaluation.
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Affiliation(s)
- Antria Filippou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus
| | - Nikolas Evripidou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus
| | - Christakis Damianou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus
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13
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Cerit MN, Yücel C, Cerit ET, Yalçın MM, Şendur HN, Oktar SÖ. Comparison of the Efficiency of Radiofrequency and Microwave Ablation Methods in the Treatment of Benign Thyroid Nodules. Acad Radiol 2023; 30:2172-2180. [PMID: 37357048 DOI: 10.1016/j.acra.2023.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/27/2023]
Abstract
RATIONALE AND OBJECTIVES To compare the efficacy of two thermal ablation techniques (radiofrequency vs microwave ablation) in the treatment of benign thyroid nodules. MATERIALS AND METHODS A total of 80 patients with 80 nodules underwent thermal ablation of thyroid nodules with either radiofrequency ablation (RFA) (23 females and 14 males; mean age 41 ± 9years) or microwave ablation (MWA) (28 females and 15 males; mean age 45 ± 11years). Ultrasound assessments were made at the 1st, 3rd, 6th, and 12th months after the ablation procedure. RESULTS The mean initial volume of the nodules (RFA: 15.6 mL [min 2.5-max 74]; MWA: 40 mL [min 2-max 205]) was statistically significantly different (P < .001). The following were the volume reduction rates of nodules at 1, 3, 6, and 12months, respectively: after RFA: 46.8 ± 13.5%, 62.9 ± 13.6%, 71.6 ± 11.9%, and 77.9 ± 10.3%. After MWA: 38.7 ± 12.5%, 54 ± 15.3%, 59.6 ± 12.5%, and 65 ± 11.3%. For all months, volume reduction rates in the RFA group were significantly higher than those in the MWA group (P < .05). One patient treated by RFA reported an abscess formation and another patient treated by RFA had a self-limiting hematoma, who recovered without any further treatment. Also, in the MWA group, one patient had abscess formation and another patient had transient recurrent nerve paralysis, who recovered with appropriate treatment. CONCLUSION Both methods are effective in treating benign thyroid nodules; however, RFA provides a better volume reduction.
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Affiliation(s)
- Mahi N Cerit
- Department of Radiology, Gazi University Faculty of Medicine, Beşevler, 06500 Ankara, Turkey (M.N.C., C.Y., H.N.S., S.Ö.O.).
| | - Cem Yücel
- Department of Radiology, Gazi University Faculty of Medicine, Beşevler, 06500 Ankara, Turkey (M.N.C., C.Y., H.N.S., S.Ö.O.); Private Radiology Clinic, Gazi University Faculty of Medicine, Ankara, Turkey (C.Y.)
| | - Ethem T Cerit
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey (E.T.C., M.M.Y.)
| | - Mehmet M Yalçın
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey (E.T.C., M.M.Y.)
| | - Halit N Şendur
- Department of Radiology, Gazi University Faculty of Medicine, Beşevler, 06500 Ankara, Turkey (M.N.C., C.Y., H.N.S., S.Ö.O.)
| | - Suna Ö Oktar
- Department of Radiology, Gazi University Faculty of Medicine, Beşevler, 06500 Ankara, Turkey (M.N.C., C.Y., H.N.S., S.Ö.O.)
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14
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Kandil E, Issa PP, Randolph GW. Can Thyroid Nodules be Managed with Radiofrequency Ablation? Adv Surg 2023; 57:87-101. [PMID: 37536864 DOI: 10.1016/j.yasu.2023.05.004] [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] [Indexed: 08/05/2023]
Abstract
Radiofrequency ablation (RFA) is an established and growing minimally-invasive technique with an impressive safety profile used to manage thyroid nodules. Beyond shorter operative and recovery times, the main advantages of RFA include the lack of an incisional scar as well as maximizing the potential for maintenance of normal thyroid function. RFA can significantly reduce nodular volume, achieving rates of 60% to 95% in a breadth of thyroid disease, including benign nodules, primary carcinomas, and recurrent malignancies. Thorough patient counselling is imperative for RFA candidates, including a discussant of complications, nodule regrowth, and the potential for a subsequent ablation session.
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Affiliation(s)
- Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Peter P Issa
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
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15
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Ahn HS, Jung SL, Baek JH, Sung JY, Kim JH. [Training of Radiofrequency Ablation for Thyroid Nodules in Korea: Current and Future Perspective]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1009-1016. [PMID: 37869107 PMCID: PMC10585075 DOI: 10.3348/jksr.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/01/2023] [Accepted: 09/16/2023] [Indexed: 10/24/2023]
Abstract
Radiofrequency ablation (RFA) is a minimally invasive treatment modality used as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. In Korea, RFA for thyroid nodules was first performed in 2002, and a large population study was published in 2008. The Task Force Committee of the Korean Society of Thyroid Radiology (KSThR) developed its first recommendations for RFA in 2009, which were revised in 2012 and 2018. The KSThR guideline was the first guideline for RFA of thyroid nodules worldwide and has become a guideline for physicians to perform thyroid RFA in Korea and other countries around the world. These guidelines have contributed significantly to the establishment and widespread use of RFA worldwide. In addition, since 2015, the KSThR has conducted intensive hands-on courses depending on the level of the participants. In this article, the authors introduce the history of eduction for RFA conducted by the KSThR and describe the learning curve of RFA and current training programs in Korea, along with future directions for training programs.
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16
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Kim MK, Shin JH, Hahn SY, Kim H. Delayed Cancer Diagnosis in Thyroid Nodules Initially Treated as Benign With Radiofrequency Ablation: Ultrasound Characteristics and Predictors for Cancer. Korean J Radiol 2023; 24:903-911. [PMID: 37634644 PMCID: PMC10462893 DOI: 10.3348/kjr.2023.0386] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE Regrowth after radiofrequency ablation (RFA) of symptomatic large thyroid nodules, initially treated as benign, sometimes turns out to be malignancies. This study aimed to assess the ultrasound (US) characteristics of thyroid nodules initially treated as benign with RFA and later diagnosed as cancers, predictive factors for cancers masquerading as benign, and methods to avoid RFA in these cancers. MATERIALS AND METHODS We reviewed the medical records of 134 consecutive patients with 148 nodules who underwent RFA between February 2008 and November 2016 for the debulking of symptomatic thyroid nodules diagnosed as benign using US-guided biopsy. We investigated the pre-RFA characteristics of the thyroid nodules, changes at follow-up after RFA, and the final surgical pathology. RESULTS Nodule regrowth after RFA was observed in 36 (24.3%) of the 148 benign nodules. Twenty-two of the 36 nodules were surgically removed, and malignancies were confirmed in seven (19.4% of 36). Of the 22 nodules removed surgically, pre-RFA median volume (range) was significantly larger for malignant nodules than for benign nodules: 22.4 (13.9-84.5) vs. 13.4 (7.3-16.8) mL (P = 0.04). There was no significant difference in the regrowth interval between benign and malignant nodules (P = 0.49). The median volume reduction rate (range) at 12 months was significantly lower for malignant nodules than for benign nodules (51.4% [0-57.8] vs. 83.8% [47.9-89.6]) (P = 0.01). The pre-RFA benignity of all seven malignant nodules was confirmed using two US-guided fine-needle aspirations (FNAs), except for one nodule, which was confirmed using US-guided core-needle biopsy (CNB). Regrown malignant nodules were diagnosed as suspicious follicular neoplasms by CNB. Histological examination of the malignant nodules revealed follicular thyroid carcinomas, except for one follicular variant, a papillary thyroid carcinoma. CONCLUSION Symptomatic large benign thyroid nodules showing regrowth or suboptimal reduction after RFA may have malignant potential. The confirmation of these nodules is better with CNB than with FNA.
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Affiliation(s)
- Myoung Kyoung Kim
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Haejung Kim
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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17
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Li Y, Li W, Jiang B, Zhao J, Zhang Y, Luo Y. Analysis and prediction of regrowth in benign thyroid nodules undergoing radiofrequency ablation: a retrospective study with a 5-year follow-up. Eur Radiol 2023; 33:5615-5624. [PMID: 36951983 DOI: 10.1007/s00330-023-09481-8] [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: 08/27/2022] [Revised: 11/23/2022] [Accepted: 02/05/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To evaluate the 5-year follow-up results of radiofrequency ablation (RFA) for benign thyroid nodules (BTNs), and construct pre- and postablation nomogram models to predict regrowth in BTNs undergoing RFA. METHODS According to the occurrence of regrowth, BTNs were divided into two subgroups, the regrowth group and the nonregrowth group, and the variables were compared between these two subgroups. Then, univariate and multivariate Cox regression analyzes were utilized to filter the independent prognostic factors of regrowth, which then were introduced into the pre- and postablation prognostic nomograms, respectively. The discrimination powers and prediction performances of the nomograms were appraised by receiver operating characteristic (ROC) curves and calibration charts. RESULTS The 5-year mean volume reduction rate was 88.80%, with a complication rate of 0.35% (7/200). Within 5 years of follow-up, the regrowth rate was 19% (38/200). Pre- and postablation prognostic nomograms were established to predict the probability of nonregrowth at 1, 3, and 5 years after RFA. The preablation nomogram included initial volume, perinodular vascularity, and high enhancement ring. The postablation nomogram incorporated total volume, perinodular vascularity, and energy applied per volume. The area under the ROC curves and concordance index values of these models were all above 0.7, indicating that the prognostic nomograms achieved satisfactory discrimination powers and prediction performances. CONCLUSION RFA for BTNs has long-term efficacy and safety under the influence of key techniques. The pre- and postablation nomograms constructed in the present study might facilitate clinical decision-making before RFA and for the follow-up management after RFA. KEY POINTS • Perinodular vascularity, rather than intranodular vascularity was an independent predictor of regrowth, both before and after the RFA procedure. • A high enhancement ring on preablation contrast-enhanced ultrasound was an independent predictor of regrowth. • Pre- and postablation nomograms might facilitate clinical decision-making before RFA and follow-up management after RFA.
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Affiliation(s)
- Yi Li
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Wen Li
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bo Jiang
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jiahang Zhao
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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18
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Papini E, Hegedüs L. Minimally Invasive Ablative Treatments for Benign Thyroid Nodules: Current Evidence and Future Directions. Thyroid 2023; 33:890-893. [PMID: 37265153 DOI: 10.1089/thy.2023.0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Enrico Papini
- Department of Endocrinology, Regina Apostolorum Hospital, Albano, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University, Odense, Denmark
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19
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Motaghed Z, Chegeni H, Mosadeghkhah A, Azimi Aval M, Gerami R, Ebrahiminik H. Effect of ultrasound parameters of benign thyroid nodules on radiofrequency ablation efficacy. BMC Med Imaging 2023; 23:85. [PMID: 37337132 DOI: 10.1186/s12880-023-01044-z] [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: 12/29/2022] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND AND AIM Ultrasound-guided radiofrequency ablation (RFA) is a minimally invasive therapy for thyroid nodules (TNs). Understanding the determinants of RFA efficacy can improve treatment and prognosis. This study aims to investigate the relationship between ultrasound parameters of benign TNs and the efficacy of RFA. METHODS A pretest-posttest interventional study was conducted in 2021 on 250 randomly sampled patients with benign TNs, receiving RFA. For this purpose, the volume reduction (VR) and the VR ratio (VRR) of the nodules were measured at the 1-, 3-, 6-, and 12-month follow-up periods after the RFA completion. The technical success rate (TSR) of this procedure was then categorized into four states, including low (VRR < 25%), moderate (VRR = 25-49%), high (VRR = 50-74%), and very high (VRR ≥ 75). Ordered logistic regression (OLR) was further utilized to investigate the effect of the ultrasound parameters of TNs on the TSR. The analyses were notably performed using Stata 14.2. RESULTS The VRR at the 1-, 3-, 6-, and 12-month follow-up periods were 38.7%, 53.6%, 59.3%, and 59.9%, respectively. The mean VR was also statistically significant at all follow-ups (p < 0.001). At the 1-, 3-, and 6-month follow-up periods, the VR of over 50% was observed in 28.2%, 52.1%, and 65.2% of the nodules, respectively. The odds ratios (ORs) of the RFA success were found to be 4.3 times higher for the nodules in the left lobe compared to the right lobe (OR: 4.31, p = 0.002), 6.3 times greater for isoechoic nodules compared to hyperechoic nodules (OR: 6.39, p < 0.001), 6.2 times higher for hyper-vascular nodules compared to hypo-vascular nodules (OR: 6.25, p = 0.005), and 2.3 times greater for mixed nodules compared to solid ones (OR: 2.37, p = 0.049). CONCLUSION The ultrasound parameters of TNs had a statistically significant effect on the efficacy of RFA. Small-sized, isoechoic, and hyper-vascular nodules, as well as those with mixed tissue, were observed to respond better to RFA, leading to a better prognosis in terms of VR after treatment.
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Affiliation(s)
- Zahra Motaghed
- Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | | | - Ali Mosadeghkhah
- Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Azimi Aval
- Department of Interventional Radiology and Radiation Sciences Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Reza Gerami
- Department of Radiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Hojat Ebrahiminik
- Department of Interventional Radiology and Radiation Sciences Research Center, AJA University of Medical Sciences, Tehran, Iran.
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20
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Chen P, Feng C, Huang L, Chen H, Feng Y, Chang S. Exploring the research landscape of the past, present, and future of thyroid nodules. Front Med (Lausanne) 2023; 9:831346. [PMID: 36714145 PMCID: PMC9877524 DOI: 10.3389/fmed.2022.831346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction The purpose of this study was to assess the landscape of thyroid nodules research during the last 22 years using machine learning and text analysis. Methods In November 2021, we obtained from PubMed all works indexed under the Medical Subject Headings (MeSH) subject line "thyroid nodules." The entire set of search results was retrieved in XML format, and metadata such as title, abstract, keywords, MeSH words, and year of publication were extracted for bibliometric evaluation from the original XML files. To increase the specificity of the investigation, the Latent Dirichlet allocation (LDA) topic modeling method was applied. Results Our study included 5,770 research papers. By using frequency analysis of MeSH terms, research on thyroid nodules was divided into two categories: clinical and basic. The proportion of clinical research is nearing 89% and is dominated by the differential diagnosis of thyroid nodules. In contrast, the proportion of MeSH terms relating to basic research was just 11%, with DNA mutation analysis being the most common topic. Following this, LDA analysis revealed the thyroid nodule study had three clusters: Imaging Studies, Biopsy and Diagnosis, and Epidemiology and Screening of Thyroid Cancer. The result suggests that current thyroid nodule research appears to have focused on ultrasonography and histological diagnosis, which are tightly correlated. Molecular biomarker research has increased, therefore enhancing the diagnostic precision of thyroid nodules. However, inflammation, anxiety, and mental health disorders related to thyroid nodules have received little attention. Conclusion Basic research on thyroid nodules has unmet research requirements. Future research could focus on developing strategies to more efficiently identify malignant nodules, exploring the mechanism of thyroid nodule development, and enhancing the quality of life of thyroid patients.
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Affiliation(s)
- Pei Chen
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Chenzhe Feng
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Leyi Huang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Haolin Chen
- Department of Mathematics, University of California, Davis, Davis, CA, United States
| | - Yeqian Feng
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China,*Correspondence: Yeqian Feng,
| | - Shi Chang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan, China,Clinical Research Center for Thyroid Disease in Hunan Province, Changsha, Hunan, China,Hunan Provincial Engineering Research Center for Thyroid and Related Diseases Treatment Technology, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China,Shi Chang,
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21
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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.
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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
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22
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Intraoperative Radiofrequency Ablation for Contralateral Benign Nodules in Unilateral Thyroid Cancer Patients to Relieve Anxiety. J Surg Res 2022; 276:347-353. [DOI: 10.1016/j.jss.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/11/2022] [Accepted: 03/16/2022] [Indexed: 11/18/2022]
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23
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Kim HJ, Baek JH, Cho W, Sim JS. Long-term follow-up of the radiofrequency ablation of benign thyroid nodules: the value of additional treatment. Ultrasonography 2022; 41:661-669. [PMID: 36039675 PMCID: PMC9532194 DOI: 10.14366/usg.21231] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/03/2022] [Indexed: 11/03/2022] Open
Abstract
PURPOSE This study aimed to evaluate the efficacy of additional radiofrequency ablation (RFA) treatment for benign thyroid nodules. METHODS Electronic medical records at a single institution from September 2008 to August 2016 were searched, and consecutive patients treated with RFA due to benign thyroid nodules with cosmetic or symptomatic problems were enrolled. All patients were followed up for at least 30 months. The nodules were divided into three groups: group 1 included nodules that met the criteria for additional treatment and underwent additional treatment, group 2 included nodules that met the criteria but did not undergo additional treatment, and group 3 included nodules that did not meet the criteria. The ablation results were compared among the three groups in terms of the initial ablation ratio (IAR) and volume reduction ratio (VRR). RESULTS Ninety nodules from 88 patients were included in the study. At the last follow-up, group 1 showed a significantly smaller nodule volume and larger VRR (2.5 mL and 84.6%, respectively) than group 2 (8.1 mL and 39.8%, respectively, P<0.001), but did not present a significant difference from group 3 (0.9 mL, P=0.347, and 92.8%, P=0.238). The IAR was significantly higher in group 3 (94.5%) than in the other two groups (group 1, 81.1%; group 2, 82.8%; P<0.001). CONCLUSION Multiple treatment sessions achieve greater VRR. Therefore, additional treatment could be considered for patients who meet the corresponding criteria.
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Affiliation(s)
- Hyun Jin Kim
- Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woojin Cho
- Department of Otolaryngology-Head and Neck Surgery, Withsim Clinic, Seongnam, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
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24
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Orlandi D, Viglino U, Dedone G, Leale G, Caruso P, Mauri G, Turtulici G. US-CT fusion-guided percutaneous radiofrequency ablation of large substernal benign thyroid nodules. Int J Hyperthermia 2022; 39:847-854. [PMID: 35757935 DOI: 10.1080/02656736.2022.2091167] [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: 10/17/2022] Open
Abstract
The aim of the present study was to assess feasibility, safety and outcome of ultrasound (US) guided percutaneous radiofrequency (RF) ablation of large substernal benign thyroid nodules assisted by US-computed tomography (CT) fusion imaging and real-time virtual needle tracking (VT) system. Thirty patients (18 females, mean age 56 y, range 32-76 y) with 35 benign nonfunctioning thyroid nodules (mean volume ± SD 26.8 ± 7.6 mL; range 20-38mL) were selected for CT-US fusion guided RF ablation. Nodules' volume was evaluated before treatment and during 12-months follow-up. Complications' rate was also evaluated. US-CT fusion imaging with VT system was feasible in all cases (feasibility 100%) and it was always possible to complete the procedure as planned (technical success 100%). Minor complications occurred in 2/30 cases (6.6%). No major complications occurred. 50% volume reduction (technique efficacy) was achieved in 93% cases, with a significant mean volume reduction at 12 months follow-up (68.7 ± 10.8%), (p < .001). The VT system could be useful in thyroid nodules ablation procedures assistance being able to track the RF electrode tip even when this is obscured by the bubbles produced by the ablative process. The combination of fusion imaging with VT assisted RF ablation represents a safe, non-surgical treatment option for patients with large substernal benign thyroid nodules.
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Affiliation(s)
- Davide Orlandi
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Umberto Viglino
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Genova, Italy
| | - Giorgia Dedone
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Giacomo Leale
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Pietro Caruso
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
| | - Giovanni Mauri
- Dipartimento di Oncologia ed Emato-oncologia, Università degli studi di Milano, Milano, Italy.,Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Giovanni Turtulici
- Dipartimento di Radiologia e Ecografia Interventistica, Ospedale Evangelico Internazionale, Genova, Italy
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25
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Yuan Q, Zheng L, Hou J, Zhou R, Xu G, Li C, Wu G. Total thyroidectomy versus hemithyroidectomy with intraoperative radiofrequency ablation for unilateral thyroid cancer with contralateral nodules: A propensity score matching study. J Otolaryngol Head Neck Surg 2022; 51:26. [PMID: 35690848 PMCID: PMC9188696 DOI: 10.1186/s40463-022-00578-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background For unilateral papillary thyroid carcinoma (PTC) patients with contralateral benign nodules, optimal treatment decisions are made according to patient preference and the disease’s pathological features. This study was performed to evaluate the efficacy and complications of hemithyroidectomy with intraoperative radiofrequency ablation (RFA) compared with total thyroidectomy. Methods Patients with unilateral PTC and cytologically benign contralateral nodules were enrolled from 2014 to 2018. Total thyroidectomy or hemithyroidectomy with intraoperative RFA of the contralateral nodule was offered to patients who had anxiety regarding their disease. The operation-related parameters, transient or permanent nerve injury, hypocalcemia and disease recurrence, were recorded and compared between the two groups. Results After propensity score matching, 191 patients who underwent total thyroidectomy and 224 contralateral nodules in 191 patients underwent hemithyroidectomy with intraoperative RFA (HTRFA) were included. The volume reduction ratios of the contralateral nodules were 67.7% at 12 months and 95.8% at 24 months. The total thyroidectomy group reported significantly higher hypocalcemia than HTRFA within one year (7.8% vs. 2.6%, p = 0.022). Supplemental levothyroxine was not required in 28.3% (54/191) of the patients one year after HTRFA. With a median follow-up of 4.1 years, three recurrences (1.6%) were observed in the HTRFA, and no recurrence occurred in the total thyroidectomy group (p = 0.246). Conclusions Hemithyroidectomy for unilateral PTC and intraoperative RFA for contralateral nodules were acceptable and effective treatment approaches and did not increase the risk of complications. Graphical Abstract ![]()
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Affiliation(s)
- Qianqian Yuan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Lewei Zheng
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Jinxuan Hou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Rui Zhou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Gaoran Xu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Chengxin Li
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China.
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26
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Baldwin CK, Natter MB, Patel KN, Hodak SP. Minimally Invasive Techniques for the Management of Thyroid Nodules. Endocrinol Metab Clin North Am 2022; 51:323-349. [PMID: 35662444 DOI: 10.1016/j.ecl.2022.01.001] [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] [Indexed: 12/07/2022]
Abstract
Image-guided interventional techniques have emerged as promising treatments for thyroid disease. Percutaneous ethanol ablation, radiofrequency ablation, laser ablation, high intensity focused ultrasound, and microwave ablation have shown efficacy in treating benign thyroid disease. There is increasing evidence that these techniques may effectively treat papillary thyroid microcarcinomas, recurrent and metastatic disease, follicular neoplasms, and parathyroid lesions. They are performed in an outpatient setting, well-tolerated, with negligible risk for thyroid hormone supplementation, making them a popular alternative to surgical resection. In this comprehensive review, we discuss the devices, techniques, advantages, and disadvantages of each intervention, and summarize the published outcomes.
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Affiliation(s)
- Chelsey K Baldwin
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA.
| | - Michael B Natter
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA
| | - Kepal N Patel
- Otolaryngology and Biochemistry, Division of Endocrine Surgery, Department of Surgery, Division of Endocrine Surgery, New York University School of Medicine, 530 1st Avenue, Floor 12, NY 10016, USA
| | - Steven P Hodak
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA
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27
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Li L, Qiu X. Safety and Efficacy of Ultrasound-Guided Radiofrequency Ablation for Benign Nonfunctional Thyroid Nodules in Children: A Retrospective Study of 62 Patients with Over Four Years of Follow-Up. Thyroid 2022; 32:525-535. [PMID: 34915754 DOI: 10.1089/thy.2021.0454] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Image-guided radiofrequency ablation (RFA) for benign nonfunctional thyroid nodules in adults has been shown to be effective and safe, but few trials address the use of RFA in children. Therefore, this study was designed to assess the efficacy and safety of RFA application to benign nonfunctional thyroid nodules in children. Methods: A retrospective study of RFA for 70 benign nonfunctional thyroid nodules in 62 children with four-year follow-up was conducted. Volume reduction ratio (VRR), technique efficacy, regrowth rate, symptom score, and cosmetic score were calculated to evaluate the efficacy. Complications and side effects were recorded. Logistic regression analysis was performed to identify risk factors, and subgroup analyses were performed. Results: Patients were followed up for at least four years (59.1 ± 10.5 months, range 48-85 months). After RFA treatment, the VRR and technique efficacy rates were highest at the first year* (77.5% and 91.4%, respectively) but decreased by four years (55.1% and 81.4%, respectively). The symptom score decreased from 4.0 ± 2.1* to 0.8 ± 1.6 (Z = -6.82, p < 0.001), and the cosmetic score decreased from 3.3 ± 0.7 to 1.3 ± 0.9 (Z = -7.0, p < 0.001).* The nodule regrowth rate was 22.9%, of which 56.3% of cases represented loss of efficacy. In the cases of loss of efficacy, 66.7% had greater volume than their initial presentation. Patients who received a second RFA treatment due to loss of efficacy lost efficacy again. Bilateral nodules, low vascularity, and low cystic components were independent risk factors correlating with technique efficacy. Bilateral nodules correlated with low VRR, low efficacy rate, and high regrowth rate. Nodules with a higher proportion of cystic components had higher VRR. The overall complication rate was 4.8%. Conclusions: RFA was effective in reducing the volume of benign nonfunctional thyroid nodules in children, providing significant symptomatic relief with a good safety profile during short- and long-term follow-up. RFA is a good minimally invasive treatment modality for selected pediatric patients, and it may not be appropriate for the treatment of bilateral thyroid nodules in children.
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Affiliation(s)
- Liwen Li
- Department of Thyroid surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, PR China
| | - Xinguang Qiu
- Department of Thyroid surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, PR China
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28
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Li Y, He H, Li W, Zhao J, Ge N, Zhang Y, Luo Y. Efficacy and safety of radiofrequency ablation for calcified benign thyroid nodules: results of over 5 years' follow-up. BMC Med Imaging 2022; 22:75. [PMID: 35459125 PMCID: PMC9027040 DOI: 10.1186/s12880-022-00795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of radiofrequency ablation (RFA) for treating calcified benign thyroid nodules (CBTNs). Methods Fifty-two patients with 52 CBTNs who underwent RFA in our hospital were included in this retrospective study. According to the size of calcifications, CBTNs were divided into two groups: the punctate echogenic foci (PEF) group and macrocalcification group. Moreover, the macrocalcification group was further subdivided into two groups, the strong group and the weak group, based on their morphologic characteristics. After the RFA procedure, routine ultrasound (US) and clinical evaluation were performed at 1, 3, 6 and 12 months postoperatively and every 12 months thereafter. Results The mean follow-up time was 68.98 ± 7.68 months (60–87 months), and the 5-year mean volume reduction rate (VRR) after RFA was 92.95%, with a complication rate of 0.6% (3/52). The mean initial volume of the macrocalcification group was significantly larger than that of the PEF group (9.94 ± 24.60 ml vs. 0.23 ± 0.22 ml, respectively; P = 0.011). Thus, their VRRs were not comparable between the two groups. However, baseline characteristics did not show statistically significant differences between the strong and weak macrocalcification subgroups. The VRRs of the strong subgroup were significantly lower than those of the weak subgroup at the 3-year, 4-year, and 5-year follow-ups. Conclusion RFA was effective and safe for treating CBTNs. Strong macrocalcification was related to the VRR of CBTNs after the RFA procedure.
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Affiliation(s)
- Yi Li
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China.,Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Hongying He
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wen Li
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China.,Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jiahang Zhao
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China.,Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Naiqiao Ge
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China.,Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Yukun Luo
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
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29
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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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30
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Lai L, Liu Z, Zhang J, Ni X, Liu J, Luo T, Dong Y, Zhou J. Effect of Hashimoto's thyroiditis on the extent of the ablation zone in early stages of ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma: a large cohort study of 772 patients. Int J Hyperthermia 2022; 39:397-404. [PMID: 35209788 DOI: 10.1080/02656736.2022.2041736] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the effect of Hashimoto's thyroiditis (HT) on the extent of ablation zone in ultrasound (US)-guided radiofrequency ablation (RFA) for early stages of papillary thyroid microcarcinoma (PTMC). METHOD We selected 772 patients with 797 PTMCs who underwent with RFA from August 2017 to August 2020. They were subdivided into two groups as follows: (i) 216 patients (224 PTMCs) with HT in the 'HT + PTMC' group and (ii) 556 patients (573 PTMCs) with healthy thyroid in the 'PTMC' group. We assessed the extent (maximum diameter and volume) of the ablation zone by contrast-enhanced ultrasound (CEUS) immediately, one day, and 1 week following RFA. RESULTS The ablation zone of the 'HT + PTMC' group was smaller than that of the 'PTMC' group at 1 week of RFA (maximum diameter: 14.6 ± 3.1 mm vs. 15.2 ± 3.2 mm and volume: 0.932 ± 0.498 mL vs. 1.028 ± 0.540 mL, respectively, p < .05). However, there were no differences before, immediately, and one day post-RFA (p > .05). Life-threatening complications did not develop in any of the patients. CONCLUSION RFA-treated PTMCs were smaller in size in patients with HT than in those with a healthy thyroid at 1 week of RFA. However, the exact mechanism underlying this phenomenon and its clinical significance warrant further investigation.
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Affiliation(s)
- Limei Lai
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhenhua Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingwen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaofeng Ni
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Juan Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting Luo
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yijie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianqiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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31
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Ho T, Tai DK, Chick W, Chiang BJ, Kwok PCH. Initial Experience of Ultrasound Guided Radiofrequency Ablation of Benign Symptomatic Thyroid Nodules: Safety and
Short‐Term
Efficacy. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tsit‐lai Ho
- Department of Surgery Queen Elizabeth Hospital
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32
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Radiofrequency ablation for benign symptomatic thyroid nodules in the Netherlands: successful introduction of a minimally-invasive treatment option improving quality of life. J Vasc Interv Radiol 2022; 33:530-537.e1. [PMID: 35121096 DOI: 10.1016/j.jvir.2022.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/16/2021] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The aim is to report the results of radiofrequency ablation (RFA) in patients with symptomatic benign thyroid nodules (SBTN) within our regional Thyroid Network and to evaluate their health-related and thyroid-related quality of life (QoL). MATERIALS AND METHODS Eligibility criteria for RFA were nodule size between 2.0 cm and 5.0 cm; solid component >20%; benign cytology on two separate cytological assessments and unequivocal symptoms related to mechanical compression. The primary end point of this study was volume reduction at 1 year post ablation. Secondary outcomes were health-related and thyroid related QoL measured by the SF-36 and ThyPRO-39 questionnaire as well as complication rates. RESULTS A total of 72 SBTN in 67 patients were included. The median age was 50.0 [IQR: 41.0 - 56.0] years and 91.0% were women. Median volume reduction at 6 weeks, 6 months, 1 year, 2 years, and 3 years were 51.0%, 63.9%, 65.2%, 81.3% and 90.3% respectively. Patients showed significant improvement on the SF-36 physical component scale and the ThyPRO-39 overall QoL-impact scale. An absolute improvement was seen within the ThyPRO-39 goiter and cosmetic complaints. The overall complication rate was 9.0%, of which 4.5% were considered major. CONCLUSION RFA is an effective treatment option for SBTN with significant volume reduction and improvement in health-related and thyroid-related QoL.
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Bom WJ, Joosten FBM, van Borren MMGJ, Bom EP, van Eekeren RRJP, de Boer H. Radiofrequency ablation for symptomatic, non-functioning, thyroid nodules: a single-center learning curve. Endocr Connect 2022; 11:EC-21-0304.R2. [PMID: 34887358 PMCID: PMC8859967 DOI: 10.1530/ec-21-0304] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Radiofrequency ablation (RFA) is increasingly considered the prime option for treating symptomatic, benign, non-functioning thyroid nodules (NFTN). However, little is known about the degree of operator experience required to achieve optimal results. This study describes the RFA learning curve of a single-center team. METHODS A retrospective cohort study of the first 103 patients receiving RFA treatment for a single, symptomatic, and benign NFTN, with a follow-up of at least 1 year. The primary outcome measure was technique efficacy, defined as the percentage of patients with a 6-month nodal volume reduction ratio (VRR) >50% after single-session RFA. Optimal treatment efficacy was defined as a 6-month VRR >50% achieved in at least 75% of patients. Secondary outcomes were complications of RFA and indications of secondary interventions. RESULTS Median nodal volume at baseline was 12.0 mL (range 2.0-58.0 mL). A 6-month VRR >50% was achieved in 45% of the first 20 patients, 75% of the next 20, and 79% of the following 63 patients. Complications included minor bleeding (N = 4), transient hyperthyroidism (N = 4), and transient loss of voice (N = 1). Poor volume reduction or nodular regrowth led to diagnostic lobectomy in 11 patients and a second RFA in 5. Lobectomy revealed a follicular carcinoma (T2N0M0) in 2 patients. In 1 patient, nodule regrowth was caused by an intranodular solitary B-cell lymphoma. CONCLUSION About 40 procedures are required to achieve a 6-month VRR >50% in the majority of patients. Appropriate follow-up with re-evaluation is recommended for all patients with a VRR <50% and in those with regrowth to exclude underlying malignancy.
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Affiliation(s)
- W J Bom
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - F B M Joosten
- Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands
- Correspondence should be addressed to F B M Joosten or H de Boer: or
| | - M M G J van Borren
- Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, the Netherlands
| | - E P Bom
- Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - H de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
- Correspondence should be addressed to F B M Joosten or H de Boer: or
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Multicenter Study of Benign Thyroid Nodules with Radiofrequency Ablation: Results of 762 Cases over 4 Years in Taiwan. J Pers Med 2022; 12:jpm12010063. [PMID: 35055378 PMCID: PMC8782025 DOI: 10.3390/jpm12010063] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness and safety of radiofrequency ablation (RFA) treatment for benign thyroid nodules (BTNs) in five medical centers in Taiwan. METHODS From April 2016 to July 2020, 762 patients underwent ultrasound guided RFA treatment of 826 benign thyroid nodules at five medical centers in Taiwan. The RFA procedure was performed by radiologists, otolaryngologists, or surgeons. Patients were grouped into three subgroups according to the initial volume of BTNs. The volume reduction ratio (VRR) of each nodule, and complications were analyzed at 1, 3, and 6 months after RFA treatment and the three groups compared. RESULTS The large nodular group showed greater VRR compared to the other two groups at first 1-month follow-up. At 6-months follow-up, there was no significant difference of VRR among the three groups. Goiters with difference in size can attain a successful VRR (>50%) although different specialists demonstrated variable VRR after 6-months follow-up. A total of 40 (4.8%) complications were reported. All patients recovered spontaneously without surgery intervention. CONCLUSIONS The reliability and safety of RFA for benign thyroid nodules had been established. RFA has gradually become an alternative to surgery in the treatment of benign thyroid nodules in Taiwan.
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Wu T, Zheng B, Tan L, Yin T, Lian Y, Xu S, Ye J, Ren J. A novel parallel overlapping mode for complete ablation of large benign thyroid nodules in a single-session radiofrequency ablation. Front Endocrinol (Lausanne) 2022; 13:915303. [PMID: 35992133 PMCID: PMC9390060 DOI: 10.3389/fendo.2022.915303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/04/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) has been widely applied in patients with benign thyroid nodules (BTNs), and complete ablation in a single-session treatment brings great benefits to patients. While how the ablation should be planned and performed to achieve complete ablation in a single-session treatment in large BTNs remains unknown. PURPOSE To determine a more suitable ablation strategy for sufficient treatment in a single-session treatment. MATERIALS AND METHODS This retrospective study included 108 BTNs receiving RFA treatment. These patients were divided into two groups: group A using one insertion point with a fan-shaped overlapping mode and group B using multiple insertion points with a novel parallel overlapping mode. All the treatments used a hydrodissection approach and moving-shot technique. Contrast-enhanced ultrasonography (CEUS) was used to guide the supplementary ablation. Follow-ups were performed at 1, 3, 6 and 12 months. The rates of supplementary ablation, initial ablation ratio (IAR), the rates of complete ablation (CAR), treatment effects and complications between the two groups were compared. RESULTS The group B had larger treated nodules (10.2ml vs 6.4ml, P<0.001) than group A, while group B had a lower rate of supplementary ablation (21.6% vs 75.4%, P<0.001), especially in the BTNs with craniocaudal diameters ≥30mm (22.0% vs 100%, P<0.001). With the assistance of supplementary ablation, both groups achieved similar IAR (100% vs 100%, P=0.372) and CAR (94.7% vs 94.1%, P=1.000). Two groups showed similar VRRs at 12-month follow-up (77.9% vs 77.5%, P=0.894) and similar rates of complications (3.5% vs 2.0%, P=1.000). CONCLUSIONS Needle placement using the multiple insertion points with a novel parallel overlapping mode would be easier to achieve complete ablation with less supplementary ablation, especially in large nodules.
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Affiliation(s)
- Tao Wu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bowen Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lei Tan
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Tinghui Yin
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yufan Lian
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shicheng Xu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin Ye
- Department of Otolaryngology-Head and Neck Surgery, Third Affiliated Hospital of Sun Yat−Sen University, Guangzhou, China
- *Correspondence: Jin Ye, ; Jie Ren,
| | - Jie Ren
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Jin Ye, ; Jie Ren,
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Zhu Y, Jiao Z, Zhu L, Xie F, Song Q, Yan L, Luo Y, Zhang M. A New Perspective for Predicting the Therapeutic Success of RFA in Solid BTNs: Quantitative Initial RFA Ratio by Contrast-Enhanced Ultrasound. Front Endocrinol (Lausanne) 2022; 13:904459. [PMID: 35774147 PMCID: PMC9237222 DOI: 10.3389/fendo.2022.904459] [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: 03/25/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The short-term therapeutic success of radiofrequency ablation (RFA) in solid benign thyroid nodules is of great concern. The aim of this study was to investigate a new method, initial radiofrequency ablative ratio (IRAR) using contrast-enhanced ultrasound (CEUS), for predicting therapeutic success of RFA in solid benign thyroid nodules (BTNs) immediately and effectively after RFA. METHODS A total of 813 nodules in 776 patients with benign thyroid nodules were treated with RFA from January 2014 to August 2018, among which 120 patients (M:F=41:79) with 120 solid BTNs (small: ≤10ml, n=57; medium: 10-30ml, n=42; large: >30ml, n=21) were enrolled in our study according to the inclusion criteria. The IRAR was defined as the ablative volume ratio immediately after RFA displayed by CEUS. The therapeutic success was evaluated at the 6-month follow-up. The relationship between the IRAR and volume reduction ratio (VRR) at 6-month was analyzed. The marginal regrowth of solid BTNs was also examined by CEUS at the 6 and 12 months of follow-up. RESULTS In medium and large nodules, the IRAR was significantly and positively correlated with VRR (r= 0.69, P < 0.001) at 6 months after RFA. There was a tendency to achieve therapeutic success (50% VRR: 55/63, 87.3%) when the IRAR exceeded 75%, and marginal regrowth was also relatively slow within 12 months after a single session treatment. No significant correlation between IRAR and VRR of small nodules was found. In conclusion, IRAR is significantly and positively correlated with VRR, which may indicate therapeutic success when it exceeds 75%. CONCLUSIONS CEUS can be used to accurately quantify the IRAR, which is positively correlated with the VRR. Moreover, the IRAR may be used as a parameter to predict the short-term therapeutic success of RFA in solid BTNs.
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Affiliation(s)
- Yaqiong Zhu
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Ziyu Jiao
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lianhua Zhu
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Fang Xie
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Qing Song
- Departments of Ultrasound, The Seventh Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Yukun Luo, ; Mingbo Zhang,
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Yukun Luo, ; Mingbo Zhang,
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Squarcia M, Mora M, Aranda G, Carrero E, Martínez D, Jerez R, Valero R, Berenguer J, Halperin I, Hanzu FA. Long-Term Follow-Up of Single-Fiber Multiple Low-Intensity Energy Laser Ablation Technique of Benign Thyroid Nodules. Front Oncol 2021; 11:584265. [PMID: 34950572 PMCID: PMC8691264 DOI: 10.3389/fonc.2021.584265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Aim The short-term and long-term efficacy of different thermal percutaneous ablation techniques remains a topical issue. Our group implemented percutaneous laser ablation (LA), a moving-shot technique to increase efficiency and reduce costs and variability of LA by applying multiple lower-intensity energy illuminations (MLIEI) covering the nodular volume (V) through changes in position of a single laser fiber within the thyroid nodule. The aim of the present study was to evaluate the efficacy of the single-fiber LA-MLIEI during a 5-year follow-up and to identify possible predictors of the final outcome. Methods Prospective study: Thirty outpatients (23 women and seven men) with benign symptomatic thyroid nodules were assigned to single-fiber LA-MLIEI, between 2012 and 2015. A single LA session was performed under real-time ultrasound (US) guidance using a 1,064-nm continuous-wave laser at 3 W. A 400-µm optical fiber was inserted through a 21-gauge needle, and 3–10 illuminations were performed per nodule, administering between 400 and 850 J/illumination. The total administered energy was calculated on the initial V of the nodule and the estimated ablation area. US evaluation was performed after LA-MLIEI at 1 week and 1, 3, 6, and 12 months and after that annually up to 5 years. Clinical symptoms, laboratory thyroid function during follow-up, and acute and chronic complications of treatment were registered. Results On follow-up, 67% (n: 20) were responders to single-fiber LA-MLIEI, while 33% (n: 10) were non-responders. The responder group initiated V reduction (ΔV) at 1 month, with remission of symptoms, and presented a 50% ΔV at 3 months of treatment; the maximum response was achieved at 24 months and remained stable until the end of the study. The non-responder group presented a ΔV of less than 50% at 12 months; though a tendency to >50% ΔV was observed at 24–36 months, there was subsequent regrowth, and 40% of this group required surgery. ΔV was positively correlated with the total administered energy/V (J/V) and inversely with nodule V. No severe adverse effects were observed. Thyroid function remained normal in all patients. Remission of symptoms occurred rapidly after 1 month. Conclusions LA with multiple fractional discharges employing a single fiber in a unique session is a safe and inexpensive technique that allows rapid reduction of thyroid nodules, with a stable response up to 5 years, similarly to what has been reported with the conventional LA. Total nodule volume appears as a predictive factor of the reduction.
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Affiliation(s)
- Mattia Squarcia
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain.,Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mireia Mora
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Gloria Aranda
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Enrique Carrero
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Daniel Martínez
- Department of Pathology and Anatomy, Hospital Clinic, Barcelona, Spain
| | - Ramona Jerez
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Ricard Valero
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Joan Berenguer
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain
| | - Irene Halperin
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Felicia A Hanzu
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Abd El-Galil MS, Ali AH, Botros RM, Abd El-Khaleq YI, Hetta OMA. Efficacy and safety of ultrasound (US)-guided radiofrequency ablation of benign thyroid nodules. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021; 52:57. [DOI: 10.1186/s43055-021-00435-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/03/2021] [Indexed: 09/01/2023] Open
Abstract
Abstract
Background
We evaluated 45 benign thyroid nodules of 40 patients treated with radiofrequency (RF) ablation and followed up for 6 months. The inclusion criteria included unilateral or bilateral thyroid nodules with compression symptoms or cosmetic problems, cytological confirmation of benignity without atypical cells, and patient refusal or unfit for surgery. There was no predilection for the size, number, ultrasound nature of the nodules, (solid, cystic, or complex). RF ablation was performed using Mygen (M-3004) RF generator from RF Medical Co., Ltd, South Korea. The volume of the nodules and clinical problems were evaluated before and after the procedure. Complications and factors related to volume reduction were evaluated. The purpose of the study is to evaluate the efficacy and safety of US-guided radiofrequency (RF) ablation in the treatment of benign thyroid nodules.
Results
The volume reduction ratio (%) of the thyroid nodules was statistically significant. The mean VRR was 58.41 ± 15.27SD at 1 month, 73.26 ± 11.22SD at 3 months, and 82.54 ± 12.49SD at 6 months. P value was < 0.001. The radiofrequency ablation did not affect the normal thyroid function of the 38 patients who were euthyroid at the start of the study. Thyroid function normalized 1 month after ablation of the two autonomously functioning thyroid nodules. The compressive symptoms resolved in 22 patients (55%) and improved in the rest of the 18 patients (45%) with the median decreased from 8 (IQR 6–9), range 4–10 before treatment to 0 (IQR 0–1), range 0–3 after 6 months. Cosmetic problems improved in all 40 patients by P value < 0.001. The procedure had no sustained or life-threatening complications.
Conclusions
RF ablation was effective in reducing the size of the benign thyroid nodules and in controlling nodule-related compressive symptoms as well as cosmetic problems. There were no major complications sustained and no life-threatening complications or sequelae happened. RF ablation can be used as an alternative non-surgical minimally invasive treatment for patients with benign thyroid nodules.
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Lan Y, Li N, Song Q, Zhang MB, Luo YK, Zhang Y. Correlation and agreement between superb micro-vascular imaging and contrast-enhanced ultrasound for assessing radiofrequency ablation treatment of thyroid nodules: a preliminary study. BMC Med Imaging 2021; 21:175. [PMID: 34809604 PMCID: PMC8609811 DOI: 10.1186/s12880-021-00697-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/22/2021] [Indexed: 12/29/2022] Open
Abstract
Background To evaluate the correlation and agreement between superb micro-vascular imaging (SMI) mode and the contrast-enhanced ultrasound (CEUS) mode for the ablative completeness and the volumes of ablation lesions to determine the clinical application value of SMI in follow-up after radiofrequency ablation.
Methods From April 2020 to June 2020, two radiologists used SMI and CEUS mode to measure the volume of the ablation lesion. We use intra-class correlation coefficient (ICC), scatter plots and Bland–Altman plots to evaluate the correlation and agreement of the two techniques. In addition, intra- and inter-observer reliability in volume measurement of ablation lesions with SMI mode was assessed. Results SMI mode and CEUS mode have good agreement in the evaluation of ablative completeness. The ICC was 0.876 and 0.928 of reader A and reader B between SMI mode and CEUS mode in terms of ablation lesions volume measurement. There was a strong correlation between the two modes in both reader A and reader B (rA = 0.808; rB = 0.882). The ICC was 0.836 for the inter-observer reliability of SMI technique. The scatter plot showed a good linear relation (r = 0.715). In the Bland–Altman plot, 4.35% (1/23) of the points was outside the 95% limits of agreement. The ICC was 0.965 for the intra-observer reliability of SMI technique, the scatter plot also showed a strong linear correlation (r = 0.965). In the Bland–Altman plot, 8.70% (2/23) of the points was outside the 95% limits of agreement. Conclusions SMI and CEUS have good agreement and correlation in the ablation volume measurement. SMI technology is expected to be applied as an alternative to CEUS in the clinical follow-up of ablation lesions.
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Affiliation(s)
- Yu Lan
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, 94 Weijin Road, Nankai District, Tianjin, China.,Department of Ultrasound, The People's Hospital of Liaoning Province, Shenyang, China
| | - Nan Li
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China
| | - Qing Song
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China
| | - Ming-Bo Zhang
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China.
| | - Yu-Kun Luo
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China. .,School of Medicine, Nankai University, 94 Weijin Road, Nankai District, Tianjin, China.
| | - Yan Zhang
- Department of Ultrasound, General Hospital of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, China.
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Abstract
Tumor ablation has been widely applied in Asia, accounting for 44.65% of clinical studies worldwide. We reviewed 5853 clinical studies to provide insight on the advance of tumor ablation in Asia chronologically and geographically among different techniques and organs. Since 1998, tumor ablation application has dramatically evolved in Asia. All kinds of ablation techniques, including percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA), cryoablation (CA), high-intensity focused ultrasound (HIFU), and irreversible electroporation (IRE), have been applied, with the first application of PEI and the most popular application of RFA. Twenty-five countries and one district in Asia have applied tumor ablation in various organs, including liver, lung, uterus, thyroid, kidney, pancreas, bone, prostate, breast, adrenal gland, lymph node parathyroid, esophagus, etc. Due to the high incidence of tumors as well as advanced economy and technology, East Asia accounted for 93.87% of studies, led by China (45.00%), Japan (32.72%), South Korea (12.10%), and Taiwan (4.03%). With the enrichment of evidence from large-scale multicenter and randomized control studies, China and South Korea have issued several guidelines on tumor ablation for liver, lung, and thyroid, which provided recommendations for global standardization of tumor ablation techniques. Therefore, Asia has made active contribution to global tumor ablation therapy.KeypointsKey point 1: Asia accounted for 44.65% of clinical studies worldwide on tumor ablation.Key point 2: Twenty-five countries and one district in Asia have used tumor ablation in various organs, and East Asia accounted for 93.87% of studies, led by China (45.00%), Japan (32.72%), South Korea (12.10%), and Taiwan (4.03%).Key point 3: China and South Korea have issued several guidelines on tumor ablation for liver, lung, and thyroid, which provided recommendations for global standardization of tumor ablation techniques.
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Affiliation(s)
- Luo Wang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jinshun Xu
- Department of Ultrasound, Laboratory of Ultrasound Imaging Drug, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Ma Y, Wu T, Yao Z, Zheng B, Tan L, Tong G, Lian Y, Baek JH, Ren J. Continuous, Large-Volume Hydrodissection to Protect Delicate Structures around the Thyroid throughout the Radiofrequency Ablation Procedure. Eur Thyroid J 2021; 10:495-503. [PMID: 34956921 PMCID: PMC8647085 DOI: 10.1159/000519625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/30/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Small-volume hydrodissection liquid dissipates rapidly and confers only short-term protection during radiofrequency ablation (RFA) of benign thyroid nodules. The aim of this study was to establish a safe method for continuous, large-volume hydrodissection. METHODS A long needle was inserted and positioned outside the thyroid capsule; 5% glucose was injected to maintain a 3- to 5-mm continuous safety buffer. From October 2015 to July 2020, 166 patients underwent hydrodissection with different volumes, and ablation efficacy and complications associated with different liquid volumes (≤40 mL vs. >40 mL) were compared at 1-month postprocedure. Moreover, 20 mL liquid (equivalent to 250 mL in the human body) was injected around the thyroid of a rhesus monkey, after which CT scans were used to visualize the liquid's fate and verify its safety. RESULTS The 51 patients with 10-40 mL injections and 116 patients with larger injections (45-450 mL) showed similar complete ablation rates (88.46% vs. 90.44%, p = 0.582), comparable 6-month VRR (82.79% vs. 76.62%, p = 0.079), and complication incidences, although the latter group had larger nodules (9.11 mL vs. 13.79 mL, p = 0.003), more energy delivered (3.44 kcal vs. 6.04 kcal, p < 0.001), and longer operation times (51.37 min vs. 69.2 min, p < 0.001). In the animal experiment, the 20 mL of liquid diffused quickly (within 10 min) from the vicinity of the thyroid to the mediastinum and retropharyngeal space. It was observed in the kidneys at 10 min and disappeared from the neck and chest space by 24 h. CONCLUSIONS Continuous, large-volume hydrodissection can protect the delicate structures around the thyroid throughout the RFA procedure and might be beneficial in large thyroid nodule ablation.
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Affiliation(s)
- Yanping Ma
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
- *Jung Hwan Baek, , Jie Ren,
| | - Tao Wu
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Zhicheng Yao
- General Surgery Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Bowen Zheng
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Lei Tan
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Ge Tong
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Yufan Lian
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
- *Jung Hwan Baek, , Jie Ren,
| | - Jie Ren
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
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Computer-Analyzed Ultrasound Predictors of the Treatment Efficacy of Radiofrequency Ablation for Benign Thyroid Nodules. World J Surg 2021; 46:112-120. [PMID: 34608544 DOI: 10.1007/s00268-021-06340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
AIM Radiofrequency ablation (RFA) is a relatively safe and efficient alternative to surgery for patients with benign thyroid nodules. We investigated predictive factors associated with volume reduction using digital imaging analysis. METHODS In this retrospective study, a prospectively maintained database containing the data of patients who received treatment from April 2019 to March 2020 was analyzed. Computerized analysis for quantitative measurement of echogenicity, heterogeneity, and the proportion of cystic components was performed on ultrasonographic images. The volume reduction rate (VRR) was calculated during follow-up. Treatment efficacy was defined as a volume reduction greater than 50% of baseline volume. RESULTS The median volume of 58 benign thyroid nodules before RFA was 22.7 mL. Of 53 nodules with sufficient follow-up, the median VRR was 46.4%, 61.5%, 63.4%, and 67.4% at 1, 3, 6, and 12 months, respectively. Overall, at one-year follow-up, treatment efficacy was achieved in 39 (74%) nodules. In a multivariate regression analysis, the proportion of cystic components and RFA treatment time were independently associated with treatment efficacy. A subgroup analysis focusing on solid nodules indicated a negative correlation between echogenicity and VRR. CONCLUSIONS The proportion of cystic components in thyroid nodules is the main predictor of RFA treatment efficacy. In solid nodules, higher echogenicity is associated with a lower volume reduction.
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Muhammad H, Tehreem A, Russell JO, Tufano RP. Radiofrequency Ablation and Autonomous Functioning Thyroid Nodules: Review of the Current Literature. Laryngoscope 2021; 132:906-914. [PMID: 34375454 DOI: 10.1002/lary.29811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Autonomously functioning thyroid nodules (AFTNs) have long been treated with either surgery or radioactive iodine (RAI). Being an invasive procedure, even thyroid lobectomy for this condition is associated with complications such as anesthesia side effects, scarring, iatrogenic hypothyroidism, and injury to other structures. Similarly, RAI is associated with hypothyroidism and may require multiple courses. Therefore, minimally invasive techniques such as radiofrequency ablation (RFA) are being advocated as an alternative treatment for AFTNs. To date, only few studies have been published on this topic and are largely on European and Asian populations. The aim of this review is to assess the efficacy and safety of RFA as a potential alternative for treatment of AFTNs compared to conventional surgery and radioiodine. METHODS/STUDY DESIGN Comprehensive PubMed and Embase searches were performed using the following terms such as (autonomously functioning thyroid nodules and radiofrequency ablation), (radiofrequency ablation and hyperthyroidism), and (radiofrequency ablation and toxic thyroid nodule). Both prospective and retrospective studies were included based on the inclusion and exclusion criteria specified in the text. RESULTS Initially, 57 studies were identified and after excluding 47 studies, finally 10 studies were included in the review. CONCLUSION Although surgery remains the first line treatment for AFTN. However, RFA is a safe option compared to RAI or surgery, especially in patients who are high-risk surgical candidates or have absolute contraindications to RAI. Currently, trials with follow-up greater than or equal to 5 years are warranted. It will aid in formulating a standardized surveillance protocol and also generalize RFA's use for AFTN. Laryngoscope, 2021.
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Affiliation(s)
- Haris Muhammad
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, Maryland, U.S.A
| | - Aniqa Tehreem
- Department of Internal Medicine, Sinai Hospital, Baltimore, Maryland, U.S.A
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Wang N, Zheng B, Wu T, Tan L, Lian Y, Ma Y, Guo R, Xu S, Zeng L, Xu W, Ren J. Thyroid dysfunction following radiofrequency ablation for benign thyroid nodules: more likely to occur within one-week and in high-risk population. Int J Hyperthermia 2021; 38:1060-1068. [PMID: 34265235 DOI: 10.1080/02656736.2021.1950849] [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: 10/20/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) has been recommended as the treatment for benign thyroid nodules (BTNs) by some guidelines. However, detailed follow-up instructions for thyroid function about the timing and affected populations after RFA are lacked due to insufficient researches. This 12-month prospective study aimed to evaluate the incidence and risk factors of thyroid dysfunction at different time points after RFA, especially within 1 week that previous studies didn't concern. METHODS Seventy-five euthyroid patients who underwent RFA for symptomatic BTNs were enrolled (ChiCTR-INR-16007884). The incidence of thyroid dysfunction within 1 week, at 1, 6, and 12 months after RFA was evaluated. The risk factors for different types of thyroid dysfunction in the different terms were further analyzed. RESULTS Within 1 week after RFA, the incidence of thyroid dysfunction was as high as 36.00% unexpectedly, and only overt thyrotoxicosis and subclinical thyrotoxicosis occurred, which were significantly associated with the low-normal baseline thyrotropin (TSH) level (p = 0.001) and high ablation volume ratio (p = 0.008). From 1 to 12 months (the long term), the incidence dropped significantly and remained low (8.00-12.00%); and thyroid dysfunction presented as overt thyrotoxicosis, subclinical thyrotoxicosis, and subclinical hypothyroidism. The long-term thyrotoxicosis group had more cases with diabetes and lower baseline TSH levels. The long-term subclinical hypothyroidism group had more cases with positive thyroid peroxidase antibodies, higher baseline TSH levels, and higher ablation volume ratios. CONCLUSIONS After the RFA of BTNs, thyroid dysfunction was more likely to occur within 1 week and in populations with risk factors.
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Affiliation(s)
- Nana Wang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Bowen Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Tao Wu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Lei Tan
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Yufan Lian
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Yanping Ma
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Rui Guo
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Shicheng Xu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
| | - Longyi Zeng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, Guangdong, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, Guangdong, China
| | - Jie Ren
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research Guangzhou, Guangdong, China
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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.
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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
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Implications of radiofrequency ablation in patients undergoing thyroid surgery for benign disease in the United States. Surgery 2021; 171:160-164. [PMID: 34304890 DOI: 10.1016/j.surg.2021.04.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Radiofrequency ablation is an alternative strategy for the management of benign thyroid conditions. We analyzed the proportion of patients who underwent thyroid surgery for benign conditions who would be potentially eligible for radiofrequency ablation. METHODS We identified patients who underwent thyroid surgery from 2015 to 2019 at the study institution for Bethesda II cytopathology or toxic adenoma. Patients were considered potentially eligible for radiofrequency ablation if they had a dominant nodule >2 cm with or without compression symptoms, a dominant nodule <2 cm with compression symptoms, or a toxic adenoma. RESULTS Of 411 patients in total, 284 (69.1%) would be eligible to consider thyroid radiofrequency ablation. In the radiofrequency ablation-eligible group, 20 (7.0%) experienced voice change after surgery, and 2 (0.7%) were dissatisfied or concerned about their scar. In the radiofrequency ablation-eligible group, 70 patients (24.6%) had malignancy diagnosed by final pathology, and 23 patients (8.1%) had cancers that were equal to or larger than 1 cm in size. CONCLUSION Many patients who undergo surgery for benign thyroid disease could be considered for radiofrequency ablation as an alternative treatment modality. Given the rate of occult malignancy, optimal evaluation of nondominant nodules before radiofrequency ablation and long-term thyroid surveillance for patients who undergo radiofrequency ablation should be further studied.
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Yan L, Deng C, Song Q, Li N, Ren L, He H, Li W, Zhang M, Luo Y. Radiofrequency ablation versus reoperation for benign thyroid nodules that developed after previous thyroid surgery. Int J Hyperthermia 2021; 38:176-182. [PMID: 33573406 DOI: 10.1080/02656736.2021.1873429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To compare the clinical outcomes of radiofrequency ablation (RFA) versus reoperation for benign thyroid nodules that developed after previous thyroid surgery. METHODS A total of 53 patients with 53 benign nodules developed after previous thyroid surgery were evaluated in this retrospective study. Eighteen patients were treated by RFA (RFA group) and 35 patients underwent reoperation (reoperation group). The efficacy, safety, thyroid function, blood loss, hospitalization, total treatment time, and cost were compared between the two groups. RESULTS In the RFA group, the mean volume decreased significantly from 12.78 ± 17.57 ml to 0.94 ± 1.01 ml (p = 0.043) with a volume reduction rate of 85.27 ± 14.35% and significant improvement in symptom and cosmetic scores (all p = 0.001). Therapeutic efficacy was achieved with a single session in all thyroid nodules. The total treatment time (6.12 ± 3.17 min vs. 110.26 ± 44.41 min, p < 0.001), blood loss (0 ml vs. 82.58 ± 105.55 ml, p < 0.001) and hospitalization(0 days vs. 9.66 ± 4.28 days, p < 0.001) were significantly lower in the RFA group than those in reoperation group, but the costs of treatment were similar(2262.12 ± 221.54 USD vs. 2638.04 ± 1062.90 USD, p = 0.081). The incidence of complications was significantly higher in the reoperation group than in the RFA group(31.43 vs. 0%, p < 0.001). Furthermorre, 65.17% of patients developed hypothyroidism after reoperation, whereas the thyroid function of the patients in the RFA group was unaffected. CONCLUSION For patients with benign thyroid nodules developed after previous thyroid surgery, RFA can be considered as a safe and effective alternative to reoperation with advantages of maintenance of intact thyroid function and low incidence of complications.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Cuiai Deng
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.,Department of Ultrasound, Xinhui People's Hospital of Jiangmen City, Jiangmen, China
| | - Qing Song
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nan Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ling Ren
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - HongYing He
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wen Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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Kuo JH, McManus C, Lee JA. Analyzing the adoption of radiofrequency ablation of thyroid nodules using the diffusion of innovations theory: understanding where we are in the United States? Ultrasonography 2021; 41:25-33. [PMID: 34551469 PMCID: PMC8696140 DOI: 10.14366/usg.21117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/01/2021] [Indexed: 11/09/2022] Open
Abstract
Thyroid nodules are very common and found in up to 68% of the general U.S. population on ultrasound. Although thyroidectomy has long been the mainstay of treatment for malignant and symptomatic benign thyroid nodules, various interventional ablative techniques have emerged in the last couple of decades as alternative non-surgical treatment options. Globally, the most widely adopted technique has been ultrasound-guided radiofrequency ablation (RFA). RFA of thyroid nodules was first performed in 2002, and there has been an expanding body of evidence since 2006 showing that RFA and other interventional ablative techniques are effective treatments for benign solid thyroid nodules, toxic adenomas, and thyroid cysts. More recently, evidence has emerged that these techniques may be effective treatment for low-risk thyroid cancer and recurrent disease. Despite these findings, the United States has been slow to adopt these techniques, with only a single publication on RFA more than a decade after the first series was published. EM Rogers’ Diffusion of Innovation Theory provides us the appropriate lens to carefully analyze the process of adoption of RFA for thyroid nodules-to understand where we are currently, as well as, the important next steps that must be accomplished in order for RFA and other ablative techniques to be successfully adopted into the management algorithm of thyroid nodules in the United States.
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Affiliation(s)
- Jennifer H Kuo
- Section of Endocrine Surgery, Columbia University, New York, NY, USA
| | - Catherine McManus
- Section of Endocrine Surgery, Columbia University, New York, NY, USA
| | - James A Lee
- Section of Endocrine Surgery, Columbia University, New York, NY, USA
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Fei Y, Qiu Y, Huang D, Xing Z, Li Z, Su A, Zhu J. Effects of energy-based ablation on thyroid function in treating benign thyroid nodules: a systematic review and meta-analysis. Int J Hyperthermia 2021; 37:1090-1102. [PMID: 32981370 DOI: 10.1080/02656736.2020.1806362] [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: 02/08/2023] Open
Abstract
BACKGROUND Whether thyroid function would be affected by ablation remains controversial. This systematic review and meta-analysis aimed to investigate the effects of energy-based ablation on thyroid function in treating benign thyroid nodules. METHODS EMBASE, PubMed, Cochrane Library, and Web of Science databases were searched. The mean difference (MD) or standard MD (SMD) was applied to assess changes in thyroid function, thyroglobulin (Tg), and antibodies after ablation. RevMan version 5.3 was used for data synthesis. RESULTS Forty-two studies involving 6380 patients were eligible. The pooled results revealed significant decrease of 1-day thyroid-stimulating hormone (95% CI, -0.67 to -0.14), significant increase of 1-day, 1-week, and 1-month free thyroxine (95% CI, 1.57 to 5.28; 95% CI, 0.61 to 2.42; 95% CI, -0.76 to -0.15), 1-day and 1-week Tg level (95% CI, 0.40 to 0.81; 95% CI, 0.21 to 1.29), 6-month anti-thyroglobulin antibodies (95% CI, 0.02 to 0.26), 1- and 3-month thyroperoxidase antibody (95% CI, 0.02 to 0.22; 95% CI, 0.17 to 0.43), and 1-day, 1-, and 3-month thyrotrophin receptor antibody (95% CI, 0.10 to 0.43; 95% CI, 0.00 to 0.30; 95% CI, 0.13 to 0.36) after ablation. No statistically significant differences were found in these six indicators in the longer term. The results of subgroup analysis were similar to the pooled results. No significant publication bias was found. CONCLUSIONS Energy-based ablation was more likely to have negative effects on thyroid function and antibodies and led to transient increase in Tg level in the short term. However, most of the patients would not develop any thyroid dysfunction in the long-term follow-up.
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Affiliation(s)
- Yuan Fei
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Yuxuan Qiu
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.,Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhichao Xing
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhe Li
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Anping Su
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Jingqiang Zhu
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
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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.
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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
| | - 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
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