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Fan KY, Loh EW, Tam KW. Efficacy of HIFU for the treatment of benign thyroid nodules: a systematic review and meta-analysis. Eur Radiol 2024; 34:2310-2322. [PMID: 37792080 DOI: 10.1007/s00330-023-10253-7] [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: 11/10/2022] [Revised: 07/17/2023] [Accepted: 08/03/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Thyroid nodules are common and sometimes associated with cosmetic issues. Surgical treatment has several disadvantages, including visible scarring. High-intensity focused ultrasound (HIFU) is a recent noninvasive treatment for thyroid nodules. The present study aims to evaluate the effectiveness and safety of HIFU for the treatment of benign thyroid nodules. METHODS We searched PubMed, Embase, and Cochrane Library for studies evaluating the outcomes of HIFU for patients with benign thyroid nodules. We conducted a meta-analysis by using a random effects model and evaluated the volume reduction ratio, treatment success rate, and incidence of treatment-related complications. RESULTS Thirty-two studies were included in the systematic review. Only 14 studies were used in the meta-analysis because the other 18 involved data collected during overlapping periods. The average volume reduction ratios at 3, 6, and 12 months after treatment were 39.02% (95% CI: 27.57 to 50.47%, I2: 97.9%), 48.55% (95% CI: 35.53 to 61.57%, I2: 98.2%), and 55.02% (95% CI: 41.55 to 68.48%, I2: 99%), respectively. Regarding complications, the incidences of vocal cord paresis and Horner's syndrome after HIFU were 2.1% (95% CI: 0.2 to 4.1%, I2: 14.6%) and 0.7% (95% CI: 0 to 1.9%, I2: 0%), respectively. CONCLUSIONS HIFU is an effective and safe treatment option for patients with benign thyroid nodules. However, the effects of HIFU on nodules of large sizes and with different properties require further investigation. Additional studies, particularly randomized controlled trials involving long-term follow-up, are warranted. CLINICAL RELEVANCE STATEMENT Surgical treatment for thyroid nodules often results in permanent visible scars and is associated with a risk of bleeding, nerve injury, and hypothyroidism. High-intensity focused ultrasound may be an alternative for patients with benign thyroid nodules. KEY POINTS • The success rate of HIFU treatment for thyroid nodules is 75.8% at 6 months. Average volume reduction ratios are 48.55% and 55.02% at 6 and 12 months. • The incidence of complications such as vocal fold paresis, Horner's syndrome, recurrent laryngeal nerve palsy, hypothyroidism, and skin redness is low. • HIFU is both effective and safe as a treatment for benign thyroid nodules.
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Affiliation(s)
- Kang-Yun Fan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - El-Wui Loh
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Imaging, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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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: 4] [Impact Index Per Article: 4.0] [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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3
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Czech N, Hoppe P. [The Echotherapy as non-invasive treatment option for thyroid diseases]. Laryngorhinootologie 2022; 101:562-568. [PMID: 35738270 DOI: 10.1055/a-1076-9540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Focused ultrasound is becoming more and more important when it comes to its application in thyroid diseases due to the development of echotherapy. This article provides insights in the application of echotherapy and the treatment process as well as clinical experiences and future perspectives. Studies have already been able to show significant volume reductions and improvement of symptoms after the treatment of benign and symptomatic thyroid nodules. Moreover, a high tolerability and a low profile in risk and side effects has been demonstrated.
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Affiliation(s)
| | - Peter Hoppe
- Zentrum für Nuklearmedizin und PET/CT, Bremen
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Vorländer C, Fischer A, Korkusuz H. High intensity focused ultrasound in the therapy of benign thyroid nodules-first German bicentric study with long-term follow-up. Endocrine 2022; 77:112-120. [PMID: 35476180 DOI: 10.1007/s12020-022-03058-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/10/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The study evaluated high-intensity-focused ultrasound (HIFU) for benign thyroid nodules in terms of efficiency, complication rate, influence of preablative nodule size, parameters influencing the therapeutic success and hormonal-thyroid-function. METHODS Seventy-two patients with 75 nodules were treated with HIFU at 2 centers from 2014-2019. Median nodule volume was 4.4 ml (range 0.33-53). The therapeutic ultrasound probe (EchoPulse THC900888-H) generated 80-90 °C in the target tissue with 87.6-320.3 J per sonication. Nodal volume was measured at baseline and over 12 months after therapy in a retrospective bicentric-study with long-term follow-up. Hormonal-thyroid function (TSH, T3, T4) was measured before and after ablation. Complications were assessed. RESULTS Significant volume reduction (p < 0.05 Wilcoxon-signed-rank test) of thyroid nodules was 38.98% at 3 months, 37.32% at 6 months, 61.54% at 9 months and 60.66% at 12 months. Volume reduction of nodules <3 ml did not differ significantly from nodules >3 ml (p > 0.05 Mann-Whitney test). At 3 months solid nodules had a significant volume reduction of 52.08%, complex nodules of 32.57%, nodules treated under regional anesthesia of 33.07% and under general anesthesia of 49.47%. Hormonal-thyroid function was not influenced significantly by HIFU therapy (p > 0.05 Wilcoxon-signed-rank test). Complication rate was 3.8%. No long-term complications occurred. CONCLUSION Significant volume reduction of thyroid nodules up to 12 months after HIFU was shown. All complications were reversible. Therapy was more efficient in solid than complex nodules and in nodules treated under general anesthesia than with regional anesthesia. Hormonal-thyroid-function was not affected. TRIAL REGISTRAFTION NUMBER 2020-1728-evBO. Date of registration: 16.06.2020. Agency: Ethik-Kommission bei der Landesäztekammer Hessen.
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Affiliation(s)
- Christian Vorländer
- Bürgerhospital Frankfurt, Nibelungenallee 37, 60318, Frankfurt am Main, Hessen, Germany
| | - Anne Fischer
- DZTA - Deutsches Zentrum für Thermoablation e.V., Nibelungenallee 37-41, 60318, Frankfurt am Main, Hessen, Germany.
| | - Hüdayi Korkusuz
- Afyonkarahisar Sağlık Bilimleri Üniversitesi, Zafer Sağlık Külliyesi, Dörtyol Mahallesi 2078 Sokak No: 3, Afyonkarahisar, Turkey
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Chung SR, Baek JH, Suh CH, Choi YJ, Lee JH. Efficacy and safety of high-intensity focused ultrasound (HIFU) for treating benign thyroid nodules: a systematic review and meta-analysis. Acta Radiol 2020; 61:1636-1643. [PMID: 32202137 DOI: 10.1177/0284185120909339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is an emerging thermal ablation technique that has been successfully applied to various benign thyroid nodules. PURPOSE To evaluate the efficacy and safety of HIFU for the treatment of benign thyroid nodules. MATERIAL AND METHODS The Ovid-MEDLINE and EMBASE databases were searched up to 9 July 2018 for studies describing the use of HIFU to treat benign thyroid nodules. We included studies that have outcomes with sufficient detail to evaluate the volume reduction rate (VRR). The pooled proportions of VRR ≥50% and pooled VRR at one, three, and six months after HIFU were assessed using random-effects modeling. Heterogeneity among studies was determined using Chi-square statistics for pooled estimates and the inconsistency index I2. RESULTS Seven studies were included in the systematic review and four in the meta-analysis. The pooled VRR at one, three, and six months after HIFU were 17.59 (95% confidence interval [CI] 12.56-22.62), 48.93 (95% CI 42.20-55.66), and 60.43 (95% CI 51.88-68.98). The pooled proportions of VRR ≥50% at six months after HIFU were 75% (95% CI 53-89; I2=73.6%). There were no major complications of HIFU. CONCLUSION HIFU may be a safe and effective treatment modality for benign thyroid nodules, especially for small nodules.
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Affiliation(s)
- Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Negro R, Trimboli P. Thermal ablation for benign, non-functioning thyroid nodules: A clinical review focused on outcomes, technical remarks, and comparisons with surgery. Electromagn Biol Med 2020; 39:347-355. [PMID: 32799679 DOI: 10.1080/15368378.2020.1809448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Thermal ablation (TA) is a therapeutic option for benign, non-functioning thyroid nodules causing symptoms of compression and/or aesthetic concerns. TA was initially introduced as a treatment for patients who refused or were ineligible for surgery. In more recent years, the increase in the positive experiences of TA have paved the way for the idea that TA could be suggested as a first-line treatment. The present review was conceived to summarize the evidence achieved in this field, and to offer a clinical perspective on TA, with particular reference to the comparison between TA and surgery. We searched literature that was focused on two types of TA, laser (LA) and radiofrequency (RFA). The searched literature included short- mid-term prospective and retrospective studies, randomized trials, and meta-analyses that demonstrated a satisfactory volume reduction ratio (VRR), and benefits in cosmetic and symptoms scores. An important drawback of the use of TA, is the regrowth of a certain number of nodules, which necessitate further TA procedures or surgery. Long-term randomized controlled trials to evaluate the cost/effectiveness of TA vs surgery are not currently available. The selection of the nodule, the optimization of interventional techniques, and ultimately, a well-timed second treatment, are all factors that should be considered in a proactive strategy to prevent TA failure.
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Affiliation(s)
- Roberto Negro
- Division of Endocrinology, "V. Fazzi" Hospital , Lecce, Italy
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Disease, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale , Bellinzona, Switzerland.,Faculty of Biomedical Science, Università D ella Svizzera Italiana , Lugano, Switzerland
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Spartalis E, Karagiannis SP, Plakopitis N, Theodori MA, Chrysikos D, Paschou SA, Boutzios G, Schizas D, Spartalis M, Troupis T, Nikiteas N. Single-session high-intensity focused ultrasound (HIFU) ablation for benign thyroid nodules: a systematic review. Expert Rev Med Devices 2020; 17:759-771. [PMID: 32749167 DOI: 10.1080/17434440.2020.1806053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Thyroid nodules are common; the majority of them are benign and asymptomatic. Thyroidectomy might be an option; however, the frequency of post-operative complications mandates the development of alternative approaches, such as high-intensity focused ultrasound ablation (HIFU). HIFU induces thermal destruction without penetrating the skin. The present systematic review aims to synthesize all available data, evaluating studies with single-session HIFU therapy and investigating its efficacy. MATERIALS AND METHODS This systematic review was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and MetaAnalyses). Eligible articles were identified by a search of Medline bibliographic database (PubMed) and Cochrane Library. Out of 39 results, 11 articles were considered to meet the inclusion criteria. RESULTS All eligible studies included patients with solid or predominantly solid benign thyroid nodules. All patients were treated with the same HIFU device. The success rate of the method was defined in the majority, with the volume reduction rate (VRR) over 50% from baseline. The mean or median VRR ranged from 48.7 to 70.41%, depending on the last follow-up date. No major complications were observed. CONCLUSION Single-session HIFU is safe and effective for the treatment of benign thyroid nodules.
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Affiliation(s)
- Eleftherios Spartalis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Sotirios P Karagiannis
- 4th Department of Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Nikolaos Plakopitis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Maria Anna Theodori
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Dimosthenis Chrysikos
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, Aghia Sophia Hospital, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Georgios Boutzios
- Endocrine Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens , Athens, Greece
| | - Michael Spartalis
- Laboratory of Experimental Surgery and Surgical Research "N.S Christeas", National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Theodore Troupis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Nikolaos Nikiteas
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
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8
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Papini E, Monpeyssen H, Frasoldati A, Hegedüs L. 2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules. Eur Thyroid J 2020; 9:172-185. [PMID: 32903999 PMCID: PMC7445670 DOI: 10.1159/000508484] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 12/17/2022] Open
Abstract
Standard therapeutic approaches for benign thyroid lesions that warrant intervention are surgery for cold and either surgery or radioiodine for autonomously functioning thyroid nodules (AFTN). Image-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for selected clinical conditions. Due to mounting scientific evidence and widening availability, ETA considered it appropriate to develop guidelines for the use of TA in adult patients. TA procedures are well tolerated, but a dedicated training of the operators is required and information on possible complications needs to be shared with the patients. The following factors should be considered when weighing between observation, surgery, and TA for benign thyroid nodules. In solid non-hyperfunctioning nodules, TA induces a decrease in thyroid nodule volume, paralleled by improvement in symptoms. Nodule re-growth is possible over time and may necessitate repeat treatment, or surgery, in a dialogue with the patient. In AFTN, radioactive iodine is the first-line treatment, but TA may be considered in young patients with small AFTN due to higher probability of restoring normal thyroid function and avoidance of irradiation. In cystic nodules, ethanol ablation (EA) is the most effective and least expensive treatment. TA may be considered for cystic lesions that relapse after EA or have a significant residual solid component following drainage and EA. TA should be restricted to benign lesions that cause symptoms or cosmetic concern. Presently, laser and radiofrequency ablation are the most thoroughly assessed techniques, with similar satisfactory clinical results. Microwaves and high-intensity focused ultrasound therapy options remain to be fully evaluated.
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Affiliation(s)
- Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | | | - Andrea Frasoldati
- Department of Endocrinology and Metabolism, Arcispedale Santa Maria Nuova IRCCS-ASL, Reggio Emilia, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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9
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Hegedüs L, Frasoldati A, Negro R, Papini E. European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules. Eur Thyroid J 2020; 9:194-204. [PMID: 32903971 PMCID: PMC7445736 DOI: 10.1159/000506513] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/14/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Image-guided interventional ultrasound (US) techniques represent diagnostic and therapeutic tools for non-surgical management of thyroid nodular disease. We sought to investigate the attitude of European Thyroid Association (ETA) members towards the use of minimally invasive techniques (MIT) in diagnosis/therapy of symptomatic nodular goitre. METHODS ETA members were invited to participate in an online survey investigating the use of MIT in benign and malignant thyroid nodular disease. Of 865 invited members, 221 (25.5%) completed the survey. The respondents were from 40 countries; 139 (74.7%) were from European countries. RESULTS Respondents personally performed thyroid US (91.6%), Fine needle aspiration (FNA; 75.3%), ethanol ablation (EA; 22.1%), core needle biopsy (CNB; 11%) and thermal treatments (4.8%). When skills and/or technology were unavailable, only 13.4% referred patients "often" or "always" to other centres with specific expertise in this field. Surgery was the preferred first option in patients with recurrent cysts, 4.0 cm benign nodules, local (radioiodine-avid or non-avid) lymph node metastases, or papillary cancers <1.0 cm. For autonomously functioning nodules radioactive iodine treatment was the preferred choice, followed by surgery. Thermal ablation (TA) was the preferred option only for a 4 cm benign nodule in old patients with comorbidities. CONCLUSIONS US, US-guided FNA and surgery were available to nearly all respondents, while MIT was not. CNB and EA were employed only by about 1/3 of the respondents and TA procedures were available and personally performed only by a minority. For most thyroid lesions, surgery was the preferred option versus thermal therapies. The ETA needs to develop guidelines and establish teaching to overcome geographic inequality and promote the use of MIT as a valid therapy option in appropriate cases.
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Affiliation(s)
- Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Andrea Frasoldati
- Division of Endocrinology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Roberto Negro
- Division of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy
- *Roberto Negro, MD, Division of Endocrinology, “V. Fazzi” Hospital, Piazza Muratore, 1, IT–73100 Lecce (Italy),
| | - Enrico Papini
- Division of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Italy
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Ben Hamou A, Ghanassia E, Espiard S, Abi Rached H, Jannin A, Correas JM, Do Cao C, Kyheng M, Vantyghem MC, Monpeyssen H. Safety and efficacy of thermal ablation (radiofrequency and laser): should we treat all types of thyroid nodules? †. Int J Hyperthermia 2020; 36:666-676. [PMID: 31317800 DOI: 10.1080/02656736.2019.1627432] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Thermal ablation is a minimally invasive technique that is gradually acknowledged as an effective alternative to surgery to treat thyroid nodules. Two main techniques have been described: radiofrequency (RFA) and laser ablation. Objective: To evaluate the safety and efficacy of the two main techniques (RFA and laser ablation) for the treatment of benign thyroid nodules. Patients: This bicentric retrospective study included 166 consecutive patients, who received clinical, biological and ultrasound evaluations for thyroid nodules, from October 2013 to November 2017. Methods: One of the two techniques was proposed if a nodule was proven to be benign after fine needle aspiration cytology or micro-biopsy. Adverse events and outcomes (symptoms, nodule reduction) were assessed at 6 weeks and 6, 12, and 18 months after treatment. Results: One hundred and eighty-nine nodules (mean size 17.5 ± 16.9 mL, 86.1% palpable) were treated by RFA (n = 108 (57.1%)) or laser ablation (n = 81 (42.9%)) in 166 patients (80.1% women, mean age 51.7 years). Two cases of transient recurrent laryngeal nerve palsy, one hematoma, and two successfully drained abscesses (5/166 = 3%) were observed. Clinical symptoms improved significantly in the two groups (anterior cervical discomfort -83.6%, esthetic complaints -84.9% and dysphagia -86.4%). Nodule volume (mL) decreased significantly (baseline vs. 18 months) from 20.4 ± 18.6 to 5.8 ± 6.6 (-75%) in the RFA, and from 13.6 ± 13.3 to 3.4 ± 4.1 (-83.9%) in the laser ablation groups. Conclusions: Transient but potentially serious adverse events were reported in 3% of patients. A significant volumetric reduction was achieved with both techniques, regardless of nodule's characteristics, at 18 months.
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Affiliation(s)
- Adrien Ben Hamou
- a Department of Endocrinology, Diabetology and Metabolism , CHU Lille , Lille , France
| | - Edouard Ghanassia
- a Department of Endocrinology, Diabetology and Metabolism , CHU Lille , Lille , France.,b American Hospital of Paris, Thyroid Unit , Neuilly-sur-Seine , France.,c Polyclinique Sainte-Thérèse , Sète , France
| | - Stephanie Espiard
- a Department of Endocrinology, Diabetology and Metabolism , CHU Lille , Lille , France
| | | | - Arnaud Jannin
- a Department of Endocrinology, Diabetology and Metabolism , CHU Lille , Lille , France
| | | | - Christine Do Cao
- a Department of Endocrinology, Diabetology and Metabolism , CHU Lille , Lille , France
| | - Maeva Kyheng
- f Public Health, Epidemiology and Quality of Care , Lille , France
| | - Marie Christine Vantyghem
- a Department of Endocrinology, Diabetology and Metabolism , CHU Lille , Lille , France.,g Inserm , University of Lille, CHU Lille , Lille , France
| | - Herve Monpeyssen
- b American Hospital of Paris, Thyroid Unit , Neuilly-sur-Seine , France
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11
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Effect of perithyroidal lignocaine infusion (PLI) to pain experienced during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Eur Radiol 2019; 29:5280-5287. [DOI: 10.1007/s00330-019-06160-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 02/27/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022]
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Lang BHH, Wong CKH, Ma EPM, Woo YC, Chiu KWH. A propensity-matched analysis of clinical outcomes between open thyroid lobectomy and high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Surgery 2018; 165:85-91. [PMID: 30392858 DOI: 10.1016/j.surg.2018.05.080] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/16/2018] [Accepted: 05/18/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND High-intensity focused ultrasound is a promising, nonoperative treatment for benign thyroid nodules. Our study aimed to compare treatment outcomes of single-session high-intensity focused ultrasound ablation with open lobectomy after propensity score matching. METHODS After propensity matching, we compared treatment-related morbidity, treatment time, duration of hospitalization, improvement in symptom score, cost, and acoustic parameters of consecutive patients who underwent high-intensity focused ultrasound ablation or lobectomy. All eligible patients completed the computerized, multidimensional voice program and Voice Handicap Index questionnaire before, and 3 and 6 months after treatment. RESULTS The matched cohort comprised 154 patients (77 in each group). Although treatment-related morbidity was comparable between the two groups (P = .368), treatment time (P <.001), duration of hospitalization (P <.001), and medical cost (P <.001) were less in the high-intensity focused ultrasound group. After high-intensity focused ultrasound ablation, the 6-month nodule shrinkage (mean ± SD) was 64% ± 26% and the 6-month symptom improvement score was comparable with lobectomy (P = .283). At 6 months, none of the acoustic parameters were changed from the baseline in both groups (P >.05), and the Voice Handicap Index questionnaire did not differ between the two groups (P >.05). CONCLUSION Despite having similar treatment-related morbidity and voice outcomes, there were possibly some advantages with high-intensity focused ultrasound during open lobectomy, including the avoidance of a neck scar, shorter treatment time and duration of hospitalization, and lower medical cost.
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Affiliation(s)
- Brian H H Lang
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.
| | - Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Estella P M Ma
- Division of Speech and Hearing Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Yu-Cho Woo
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
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13
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Lang BHH, Woo YC, Chiu KWH. Changes in serum thyroglobulin and antithyroglobulin shortly following high-intensity focused ablation of benign thyroid nodules in patients with positive antithyroglobulin status. Int J Hyperthermia 2018; 35:637-643. [DOI: 10.1080/02656736.2018.1516302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Brian H. H. Lang
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Yu-Cho Woo
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Giovanella L, Piccardo A, Pezzoli C, Bini F, Ricci R, Ruberto T, Trimboli P. Comparison of high intensity focused ultrasound and radioiodine for treating toxic thyroid nodules. Clin Endocrinol (Oxf) 2018; 89:219-225. [PMID: 29741290 DOI: 10.1111/cen.13738] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE We compared the effectiveness of high intensity focused ultrasound (HIFU) and radioiodine (RAI) to treat patients carrying toxic thyroid nodule (TTN). Normalization of serum thyrotropin (TSH) 1 year after treatment was the primary end-point; concurrent changes in nodules' volume and scintigraphic pattern were also evaluated as secondary end-points. MATERIALS AND METHODS Among patients ≥18 years old with TTN observed at our centre between January 1st, 2016 and December 31th, 2016 we prospectively enrolled 17 and 15 age and sex-matched patients treated with RAI and HIFU, respectively. Biochemical thyroid tests and nodules' volume were assessed before and 3, 6 and 12 months after treatments. A thyroid scintigraphy was performed before and 1 year after treatment, respectively. RESULTS The final series included 17 patients treated with RAI and 15 patients treated with HIFU, respectively. Neither demographic nor clinical differences were found at baseline. One year after treatment 14 of 17 RAI-treated and 4 of 15 HIFU-treated patients fulfilled criteria for response to treatment (P = .0008). Indeed, the median TSH value was 1.5 IU/mL and 0.2 IU/mL in HIFU and RAI groups, respectively (P < .0001). Finally, despite a similar decrease in nodules' volume in both groups, a scintigraphic response was achieved in 16 of 17 (94%) RAI-treated compared to 8 of 15 (53%) HIFU-treated patients (P = .024), respectively. CONCLUSIONS In our series, RAI clearly outperforms HIFU in treating patients carrying TTN and remains the first-line noninvasive treatment in such cases.
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Affiliation(s)
- Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Medical School, University of Zurich, Zurich, Switzerland
| | - Arnoldo Piccardo
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Cinzia Pezzoli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Riccardo Ricci
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Teresa Ruberto
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Nixon IJ, Angelos P, Shaha AR, Rinaldo A, Williams MD, Ferlito A. Image-guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications. Head Neck 2018; 40:2103-2115. [PMID: 29684251 DOI: 10.1002/hed.25181] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/03/2018] [Accepted: 02/20/2018] [Indexed: 01/03/2023] Open
Abstract
Image-guided ablation of thyroid disease is increasingly being commonly reported. Techniques including ethanol injection and thermal ablation using radio-frequency, laser, and microwave devices have been described. Minimally invasive approaches to the management of benign cystic, solid, and functional thyroid nodules as well as both primary and recurrent thyroid malignancy have been reported. The purpose of this article is to review the current evidence relating to image-guided ablation of thyroid disease with a focus on clinical outcomes and complication rates for patients treated with this minimally invasive approach.
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Affiliation(s)
- Iain J Nixon
- Ear, Nose, and Throat Department, NHS Lothian, Edinburgh, UK
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Ethics, The University of Chicago Medicine, Chicago, Illinois
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Michelle D Williams
- Department of Pathology, Division of Pathology/Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alfio Ferlito
- Coordinator of The International Head and Neck Scientific Group
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16
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Evaluation of pain during high-intensity focused ultrasound ablation of benign thyroid nodules. Eur Radiol 2018; 28:2620-2627. [PMID: 29330630 DOI: 10.1007/s00330-017-5200-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/15/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess severity and factors of pain during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. METHODS 128 patients who underwent a HIFU ablation for a benign thyroid nodule were analysed. All patients received a bolus of intravenous pethidine and diazepam before treatment. After treatment, patients were asked to rate their overall pain experience on a visual analogue scale (0-100) (0 = no pain; 100 = worse possible pain) during treatment, 2 h after treatment and the following morning. Binary logistic regression was performed to evaluate associated factors for pain including patient demographics, nodule size, body mass index (BMI) and treatment parameters. RESULTS At T1, median (range) pain score was 65.0 (0.00-100.00). Only 16 (12.5 %) patients had a pain score of zero. In multivariate analysis, only lower BMI (OR 1.265, 95 % CI 1.102-1.452, p=0.001) and longer nodule diameter (OR 1.462, 95 % CI 1.071-1.996, p=0.017) were independent factors for pain score at T1 ≤ 65.0. CONCLUSIONS A moderate to severe amount of pain was reported during ablation of benign thyroid nodules in over 50 % of patients. Patients' BMI and length of nodule diameter were independent variables for pain during HIFU ablation. KEY POINTS • Pain was moderate to severe during HIFU ablation of thyroid nodules. • Only one in eight patients reported no pain during ablation. • Level of energy per pulse did not affect pain. • Patients with lower BMI and larger nodules had less pain.
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Lang BHH, Woo YC, Chiu KWH. Significance of hyperechoic marks observed during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Eur Radiol 2018; 28:2675-2681. [PMID: 29313120 DOI: 10.1007/s00330-017-5207-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To examine the association between the appearance of hyperechoic marks (HEMs) during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules and nodule shrinkage at 6 months. METHODS One hundred and thirty-six patients who underwent HIFU for benign thyroid nodule were analysed. An independent person carefully examined the B-mode ultrasonography screen for the appearance of HEMs after each pulse. The proportion of HEMs (%) was calculated by: [(Number of pulses that resulted in HEMs) / (Total number of pulses given per treatment) × 100] while the nodule shrinkage was measured by volume reduction ratio (VRR) = [Baseline volume-volume at 6 months]/[Baseline volume] * 100. Treatment success was defined as VRR ≥ 50 %. RESULTS Patients with HEMs (n=91) had significantly greater 6-month VRR than those without HEMs (n=45) (65.76 % vs. 36.76 %, p<0.001). By regression analysis, after adjusting for age and energy per pulse, smaller nodule volume at baseline (OR 1.143, 95 % CI 1.038-1.256, p=0.006) and appearance of HEMs (OR 275.44, 95 % CI 26.63-2848.98, p<0.001) were independent predictors for treatment success. CONCLUSIONS The appearance of HEMs during treatment was an independent determinant of treatment success following single-session HIFU ablation of benign thyroid nodule. KEY POINTS • HIFU is a safe and effective treatment for benign thyroid nodules. • Lower BMI and greater applied power increase likelihood of hyperechoic marks. • The appearance of hyperechoic marks during HIFU affects subsequent treatment outcome.
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Affiliation(s)
- Brian H H Lang
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, SAR, China.
| | - Yu-Cho Woo
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China
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Dietrich CF, Müller T, Bojunga J, Dong Y, Mauri G, Radzina M, Dighe M, Cui XW, Grünwald F, Schuler A, Ignee A, Korkusuz H. Statement and Recommendations on Interventional Ultrasound as a Thyroid Diagnostic and Treatment Procedure. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:14-36. [PMID: 29126752 DOI: 10.1016/j.ultrasmedbio.2017.08.1889] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
The recently published guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on interventional ultrasound (INVUS)-guided procedures summarize the intended interdisciplinary and multiprofessional approach. Herewith, we report on recommendations for interventional procedures for diagnosis and treatment of the thyroid gland.
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Affiliation(s)
- Christoph F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany; Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Thomas Müller
- Medizinische Klinik I, Klinikum am Steinenberg, Reutlingen, Germany
| | - Jörg Bojunga
- 1st Medical Department, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Maija Radzina
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Riga, Latvia
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Frank Grünwald
- Department of Nuclear Medicine, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany; German Center for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas Schuler
- Zentrum für Innere Medizin, Alb Fils Kliniken, Helfenstein Klinik, Germany
| | - Andre Ignee
- Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Huedayi Korkusuz
- Department of Nuclear Medicine, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany; German Center for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
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Sennert M, Happel C, Korkusuz Y, Grünwald F, Polenz B, Gröner D. Further Investigation on High-intensity Focused Ultrasound (HIFU) Treatment for Thyroid Nodules: Effectiveness Related to Baseline Volumes. Acad Radiol 2018; 25:88-94. [PMID: 28844602 DOI: 10.1016/j.acra.2017.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 02/09/2023]
Abstract
RATIONALE AND OBJECTIVES Several minimally invasive thermal techniques have been developed for the treatment of benign thyroid nodules. A new technique for this indication is high-intensity focused ultrasound (HIFU). The aim of this study was to assess effectiveness in varying preablative nodule volumes and whether outcome patterns that were reported during studies with other thermal ablative procedures for thyroid nodule ablation would also apply to HIFU. MATERIALS AND METHODS Over the last 2 years, 19 nodules in 15 patients (12 women) whose average age was 58.7 years (36-80) were treated with HIFU in an ambulatory setting. Patients with more than one nodule were treated in multiple sessions on the same day. The mean nodule volume was 2.56 mL (range 0.13-7.67 mL). The therapeutic ultrasound probe (Echopulse THC900888-H) used in this series functions with a frequency of 3 MHz, reaching temperatures of approximately 80°C-90°C and delivering an energy ranging from 87.6 to 320.3 J per sonication. To assess the effectiveness of thermal ablation, nodular volume was measured at baseline and at 3-month follow-up. The end point of the study was the volume reduction assessment after 3 months' follow-up. Therapeutic success was defined as volume reduction of more than 50% compared to baseline. This study was retrospectively analyzed using the Wilcoxon signed rank test and Kendall tau. RESULTS The median percentage volume reduction of all 19 nodules after 3 months was 58%. An inverse correlation between preablative nodular volume and percentage volume shrinking was found (tau = -0.46, P < .05). Therapeutic success was achieved in 10 out of 19 patients (53%). CONCLUSIONS HIFU of benign thyroid nodules can be carried out as an alternative therapy for nodules ≤3 mL if patients are refusing surgery or radioiodine therapy.
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Lang BHH, Woo YC, Chiu KWH. The percentage of serum thyroglobulin rise in the first-week did not predict the eventual success of high-intensity focussed ablation (HIFU) for benign thyroid nodules. Int J Hyperthermia 2017; 33:882-887. [DOI: 10.1080/02656736.2017.1361047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Brian H. H. Lang
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Yu Cho Woo
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Keith W. H. Chiu
- Department of Radiology, The University of Hong Kong, Hong Kong SAR, China
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Lang BHH, Woo YC, Wong IYH, Chiu KWH. Single-Session High-Intensity Focused Ultrasound Treatment for Persistent or Relapsed Graves Disease: Preliminary Experience in a Prospective Study. Radiology 2017; 285:1011-1022. [PMID: 28727542 DOI: 10.1148/radiol.2017162776] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose To evaluate the safety and efficacy of ultrasonography (US)-guided high-intensity focused ultrasound (HIFU) ablation as a treatment for medically refractory Graves disease (GD). Materials and Methods After ethics approval, a prospective trial (NCT02685514) was performed from November 2015 to February 2016. Thirty patients underwent ablation of the entire right and left thyroid lobes, with areas near the tracheal-esophageal groove and common carotid artery left unablated. Serum thyroid-stimulating hormone (TSH), free T4 (FT4), antithyroid autoantibodies, and TSH receptor (TSHR) antibody levels were evaluated afterward, and US color Doppler, US volumetry, and eye assessment were performed. The primary outcome was the 12-month relapse rate. Relapse referred to hyperthyroidism (FT4 > 23 pmol/L) afterward. Variables associated with relapse were analyzed by using binary logistic regression. Results The technical success rate was 96.7%. The cohort comprised entirely women, with a median age of 38.2 years (interquartile range, 29.5-49.0 years). After 12 months, eight patients (26.7%; 95% confidence interval [CI]: 14.19%, 44.95%) experienced relapse. One patient (3.3%; 95% CI: 0.59%, 16.67%) experienced vocal cord palsy, while two patients (6.7%; 95% CI: 1.85%, 21.33%) experienced Horner syndrome, but none of these conditions were permanent. No changes in gland volume, antithyroid autoantibody levels, and ophthalmic parameters were found at 12-month follow-up. Baseline TSHR was found to have decreased significantly at 6- and 12-month follow-up (P < .001 for both). TSHR antibody (odds ratio [OR] = 1.414; 95% CI: 1.018, 1.965; P = .039) and gland volume (OR = 0.557; 95% CI: 0.353, 0.880; P = .012) were associated with 12-month relapse, with higher antibody levels conferring a higher likelihood and smaller gland volumes conferring a lower likelihood. Conclusion US-guided HIFU of the thyroid may be a safe and efficacious treatment in patients with persistent or relapsed GD. However, further study is warranted before it can become mainstream for this indication. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Brian Hung-Hin Lang
- From the Departments of Surgery (B.H.H.L.), Medicine (Y.C.W.), Ophthalmology (I.Y.H.W.), and Radiology (K.W.H.C.), The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong Special Administrative Region, China
| | - Yu-Cho Woo
- From the Departments of Surgery (B.H.H.L.), Medicine (Y.C.W.), Ophthalmology (I.Y.H.W.), and Radiology (K.W.H.C.), The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong Special Administrative Region, China
| | - Ian Yat-Hin Wong
- From the Departments of Surgery (B.H.H.L.), Medicine (Y.C.W.), Ophthalmology (I.Y.H.W.), and Radiology (K.W.H.C.), The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong Special Administrative Region, China
| | - Keith Wan-Hang Chiu
- From the Departments of Surgery (B.H.H.L.), Medicine (Y.C.W.), Ophthalmology (I.Y.H.W.), and Radiology (K.W.H.C.), The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong Special Administrative Region, China
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Lang BHH, Woo YC, Chiu KWH. Vocal cord paresis following single-session high intensity focused ablation (HIFU) treatment of benign thyroid nodules: incidence and risk factors. Int J Hyperthermia 2017; 33:888-894. [PMID: 28540836 DOI: 10.1080/02656736.2017.1328130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Vocal cord paresis (VCP) may occur following high intensity focused ultrasound (HIFU) of thyroid nodules. We hypothesised its occurrence relates to the distance of the focus point (FP) of the HIFU beams from the recurrent laryngeal nerve (RLN) and the thermal power that this point received. Their relationships were examined. METHODS One hundred and three patients who underwent HIFU for symptomatic benign thyroid nodule from October 2015 to March 2017 were analysed. All treatment images were captured and were later watched by 2 reviewers to identify three FPs closest to the tracheoesophageal groove (TEG) on transverse sonographic view. TEG was taken as the RLN position. After identifying these FPs, their distance (mm) from the TEG, thermal power (W) used and depth from skin (mm) were recorded. These parameters were compared between those with and without VCP. VCP was defined as a cord with reduced or no movement. RESULTS Four (3.9%) patients suffered from a unilateral VCP afterwards but they all recovered fully within 6 weeks. There were no significant differences in baseline characteristics and treatment efficacy between the two groups. The distance from TEG (OR = 1.706, 95%CI = 1.001 to 2.915, p = 0.050) was the only significant factor for VCP. None of the other variables including thermal power were significant. CONCLUSIONS The incidence of VCP was 3.9% (4/103) and they completely recovered within 6 weeks. The distance between the FP and the TEG was the only related factor for VCP. The safe distance between FP and TEG should be ≥1.1 cm.
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Affiliation(s)
- Brian H H Lang
- a Department of Surgery , The University of Hong Kong , Hong Kong , China
| | - Yu-Cho Woo
- b Department of Medicine , The University of Hong Kong , Hong Kong , China
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Lang BHH, Wu ALH. High intensity focused ultrasound (HIFU) ablation of benign thyroid nodules - a systematic review. J Ther Ultrasound 2017; 5:11. [PMID: 28523127 PMCID: PMC5434558 DOI: 10.1186/s40349-017-0091-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/09/2017] [Indexed: 12/13/2022] Open
Abstract
Background With an increasing number of imaging studies being done nowadays, the number of incidentally discovered thyroid nodules is expected to rise. Although many of these nodules are small and benign in nature, some do grow and may cause pressure and/or thyrotoxic symptoms. Surgical resection has traditionally been recommended for symptomatic nodules but is associated with risk of hypothyroidism, bleeding, infection, and nerve damage. High intensity focused ultrasound (HIFU) is one of the non-surgical thermal ablation techniques that may serve as an alternative in the treatment of benign thyroid nodules. The present review is to systematically evaluate the efficacy and safety of HIFU ablation. Methods We comprehensively searched all studies that evaluated the use of HIFU ablation as a treatment of benign thyroid nodules from Medline (PubMed) and Cochrane Library electronic databases using specific keywords. All titles identified by the search strategy were independently screened by two authors. Case reports, animal studies, editorials, expert opinions, reviews without original data and studies on pediatric population were excluded. Multiple reports of the same dataset were assessed and the most representative and updated report of a study was included. Results Five original studies were found. All treated thyroid nodules were confirmed to be benign cytologically and either appeared solid or predominantly (>70%) solid on ultrasonography. Only one type of commercially available US-guided device with an extracorporeal probe (3 MHz) was used in all the reported treatments. No major complications including recurrent laryngeal nerve injury, skin burn or haematoma were reported in all of the studies. The overall nodule volume reduction after single session of HIFU ablation ranged between 45 and 68%, depending on nodule size and length of follow-up. Conclusions Despite the few number of studies, our review appeared to suggest that HIFU is a safe and efficacious method of treating symptomatic benign thyroid nodules. However, larger-scale, prospective trials with longer follow-up period are indeed required to confirm this. In terms of the ablation itself, relative to other ablation techniques, there are still much room for improvements in shortening treatment duration and expanding the range of treatable nodules.
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Affiliation(s)
- Brian Hung-Hin Lang
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR China.,Department of Surgery, Division of Endocrine Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, SAR China
| | - Arnold L H Wu
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR China
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Lang BHH, Woo YC, Chiu KWH. High-intensity focused ablation (HIFU) of single benign thyroid nodule rarely alters underlying thyroid function. Int J Hyperthermia 2017; 33:875-881. [PMID: 28540804 DOI: 10.1080/02656736.2017.1318456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND High intensity focused ultrasound (HIFU) is a promising ablation technique for benign thyroid nodules. However, its effect on underlying thyroid function remains unknown. We aimed to evaluate the 6 months changes in serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) after HIFU treatment. METHODS Eighty-three consecutive patients who underwent single HIFU ablation for symptomatic benign thyroid nodule were analysed. Eligible patients had serum TSH and FT4 checked before treatment (baseline), 1 week, 3 and 6 months following HIFU treatment. Primary endpoints were hypothyroidism (FT4 < 12 pmol/L) and hyperthyroidism (FT4 > 23 pmol/L) in the 6 months following treatment. To express extent of nodule ablation relative to the total gland volume, an ablation volume ratio was calculated by [(Ablated nodule volume/total thyroid volume)/(total thyroid volume)] × 100. RESULTS Relative to baseline, 1-week serum TSH significantly dropped (from 1.16 to 0.76 mIU/L, p < 0.001) while 1-week serum FT4 significantly rose (from 16.0 to 17.8 pmol/L, p < 0.001). However, 3- and 6-months TSH and FT4 did not changed significantly from baseline (p > 0.05). No patients developed hyperthyroidism while one (1.4%) developed hypothyroidism (FT4 = 11 pmol/L) at 3 months and 6 months. Interestingly, this patient had a previous lobectomy and an ablation volume ratio of 64.00%. CONCLUSIONS Hypothyroidism following single HIFU ablation occurred rarely (1.4%) and resulted in little clinical relevance. Given that only one patient developed hypothyroidism following single HIFU ablation, it remains unclear how patients with different amount of parenchyma and relative extent of ablation may affect subsequent thyroid function.
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Affiliation(s)
- Brian H H Lang
- a Department of Surgery , The University of Hong Kong , Hong Kong SAR , PR China
| | - Yu-Cho Woo
- b Department of Medicine , The University of Hong Kong , Hong Kong SAR , PR China
| | - Keith Wan-Hang Chiu
- c Department of Radiology , The University of Hong Kong , Hong Kong SAR , PR China
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Lang BHH, Wong CKH, Ma EPM. Single-session high intensity focussed ablation (HIFU) versus open cervical hemithyroidectomy for benign thyroid nodule: analysis on early efficacy, safety and voice quality. Int J Hyperthermia 2017; 33:868-874. [PMID: 28540785 DOI: 10.1080/02656736.2017.1305127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND High intensity focussed ultrasound (HIFU) is a promising non-surgical treatment for symptomatic benign thyroid nodule. We aimed to compare early efficacy, safety and voice quality between HIFU ablation and open thyroidectomy. METHODS Consecutive patients who underwent single-session HIFU ablation or a hemithyroidectomy for symptomatic benign thyroid nodule were included. The 6-month extent of nodule shrinkage, symptom improvement score, thyroid function, hospital stay and cost were compared between the two procedures. Safety was defined by absence of major complications like recurrent laryngeal nerve injury and skin burn. Voice quality was assessed by a computerised multi-dimensional voice programme and a Voice Handicap Index (VHI) questionnaire 1-month after treatment. RESULTS Altogether, 43 patients had HIFU and 103 patients had a hemithyroidectomy. In the HIFU group, the extent of nodule shrinkage at 6-month was 51.71 ± 16.04%. No patients in the HIFU group suffered skin burn or hypothyroidism. The HIFU group had a significantly shorter length of hospital stay (0.3 vs. 1.0 day, p < 0.001), lower incidence of subclinical hypothyroidism (1/43 vs. 21/103, p = 0.008), higher symptom improvement score (p = 0.009) and was less costly (USD 1923.1 vs. USD 5384.6). Relative to HIFU, pitch quality also worsen after surgery (p < 0.05). CONCLUSIONS Relative to surgery, single HIFU ablation appeared efficacious and safe. Apart from shorter hospital stay, less subclinical hypothyroidism, being scar-less, lower cost and more symptom improvement, HIFU patients were less affected by a pitch problem in the first month. This study provides a strong argument for HIFU ablation as a treatment for symptomatic benign thyroid nodule.
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Affiliation(s)
- Brian H H Lang
- a Department of Surgery , The University of Hong Kong , Hong Kong , Hong Kong, China
| | - Carlos K H Wong
- b Department of Family Medicine and Primary Care , The University of Hong Kong , Ap Lei Chau , Hong Kong, China
| | - Estella P M Ma
- c Division of Speech and Hearing Sciences , The University of Hong Kong , Hong Kong , Hong Kong, China
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Wang B, Han ZY, Yu J, Cheng Z, Liu F, Yu XL, Chen C, Liu J, Liang P. Factors related to recurrence of the benign non-functioning thyroid nodules after percutaneous microwave ablation. Int J Hyperthermia 2017; 33:459-464. [PMID: 28081645 DOI: 10.1080/02656736.2016.1274058] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine the factors affecting the recurrence of the solitary benign thyroid nodules (BTN) after microwave ablation (MWA). MATERIALS AND METHODS Between January 2013 and January 2015, a total of 110 patients with at least one solid thyroid nodule (solid component ≥ 80%) were enrolled. MWA was performed under continuous ultrasound (US) guidance. Before and during the follow-up, the thyroid nodule volume, thyroid function and cosmetic complaints were evaluated. Recurrence is defined by the new blood flow in the total ablation area or/and > 50% increase in nodule volume. RESULTS Almost all thyroid nodules were significantly decreased in size after MWA. After 12 months, the average volume of thyroid nodules was decreased from 12.6 ± 15.1 to 3.2 ± 5.7 ml. Of the total 110 patients, 16 cases had recurrence 12 months after MWA, and these patients had a larger initial volume than that of the non-recurrence patients (11.6 ± 14.9 vs. 23.9 ± 12.5, p < 0.01). The recurrence group also demonstrated more irregular blood vessels (1.8 8 ± 1.1 vs. 2.8 5 ± 1.3, p < 0.05), and a lower energy (1575.5 ± 674.3 J/ml vs. 1172.3 ± 454.2 J/ml, p < 0.01). In addition, 81.2% (13/16) of the patients in the recurrence group were adjacent to the vital structures, which is significantly higher than that of the non-recurrence group 28.7% (27/94) (p < 0.01). CONCLUSIONS The US-guided MWA results in a satisfactory long-term outcome of the patients with a benign solitary thyroid nodule. We identified three risk factors for recurrence: initial volume, vascularity and the energy per 1 ml reduction in nodular volume.
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Affiliation(s)
- Bei Wang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China.,b Department of Ultrasound , Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan , Shandong , PR China
| | - Zhi-Yu Han
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
| | - Jie Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
| | - Zhigang Cheng
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
| | - Fangyi Liu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
| | - Xiao-Ling Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
| | - Chaonan Chen
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China.,d Department of Ultrasound , Beijing Friendship Hospital-Affiliate to Capital Medical University , Beijing , PR China
| | - Ju Liu
- c Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan , Shandong , PR China
| | - Ping Liang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
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Kohlhase KD, Korkusuz Y, Gröner D, Erbelding C, Happel C, Luboldt W, Grünwald F. Bipolar radiofrequency ablation of benign thyroid nodules using a multiple overlapping shot technique in a 3-month follow-up. Int J Hyperthermia 2016; 32:511-6. [PMID: 27126512 DOI: 10.3109/02656736.2016.1149234] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose The aim of this study was to evaluate the decrease of benign thyroid nodules after bipolar radiofrequency ablation (RFA) in a 3-month follow-up using a multiple overlapping shot technique ('MOST'). Methods A total of 18 patients with 20 symptomatic benign thyroid nodules (17 cold nodules, 3 hyperfunctioning nodules) were treated in one single session by bipolar RFA. Bipolar ablation was performed using MOST. The nodule volumes were measured prior to ablation and 3 months after the procedure using ultrasound. The population consisted of either solid (>80% solid tissue within the volume of interest), complex, or cystic nodules (<20% solid tissue within the volume of interest). Results Bipolar RFA resulted in a highly significant (p < 0.0001) decrease of nodule volume (ΔV), median 5.3 mL (range 0.13-43.1 mL), corresponding to a relative reduction in mean of 56 ± 17.9%. Median initial volume was 8 mL (range 0.48-62 mL); 3 months after ablation a median volume of 2.3 mL (range 0.3-32 mL) was measured. Nodule growth ≥50% occurred in 70% (14 nodules). At the follow-up no complications such as infections, persisting pain, nerve injuries or immunogen stimulation occurred. Patients with cold nodules (15) remained euthyroid, with hyperfunctioning nodules either euthyroid (2) or latent hypofunctional (1). Conclusion The use of bipolar RFA is an effective, safe and suitable thermoablative technique to treat benign thyroid nodules. Combined with the multiple overlapping shot technique it allows sufficient ablation.
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Affiliation(s)
| | - Yücel Korkusuz
- a Department of Nuclear Medicine , University Hospital , Frankfurt , Germany
| | - Daniel Gröner
- a Department of Nuclear Medicine , University Hospital , Frankfurt , Germany
| | - Christian Erbelding
- a Department of Nuclear Medicine , University Hospital , Frankfurt , Germany
| | - Christian Happel
- a Department of Nuclear Medicine , University Hospital , Frankfurt , Germany ;,b German Centre for Thermoablation of Thyroid Nodules, University Hospital , Frankfurt , Germany
| | - Wolfgang Luboldt
- c Department of Diagnostic and Interventional Radiology , University Hospital , Frankfurt , Germany
| | - Frank Grünwald
- a Department of Nuclear Medicine , University Hospital , Frankfurt , Germany ;,b German Centre for Thermoablation of Thyroid Nodules, University Hospital , Frankfurt , Germany
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Heck K, Happel C, Grünwald F, Korkusuz H. Percutaneous microwave ablation of thyroid nodules: effects on thyroid function and antibodies. Int J Hyperthermia 2015; 31:560-7. [DOI: 10.3109/02656736.2015.1032371] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Kristina Heck
- Department of Nuclear Medicine, University Hospital, Frankfurt am Main, and German Centre for Thermoablation of Thyroid Nodules, Frankfurt am Main, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital, Frankfurt am Main, and German Centre for Thermoablation of Thyroid Nodules, Frankfurt am Main, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital, Frankfurt am Main, and German Centre for Thermoablation of Thyroid Nodules, Frankfurt am Main, Germany
| | - Huedayi Korkusuz
- Department of Nuclear Medicine, University Hospital, Frankfurt am Main, and German Centre for Thermoablation of Thyroid Nodules, Frankfurt am Main, Germany
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