Percutaneous laser ablation of benign thyroid nodules: a one year follow-up study

Analysis of risk factors for intra-cystic hemorrhage in microwave ablation of partially cystic thyroid nodules

Objective

The aim of this study is to identify risk factors of intra-cystic hemorrhage in microwave ablation of mixed solid and cystic microwave ablation s, and to design a preoperative nomogram to predict the risk value of intraoperative bleeding with the goal of individualizing the surgical approach toward different types of cystic and solid thyroid nodules.

Methods

A total of 241 patients with cystic-solid thyroid nodules who underwent ultrasound-guided percutaneous microwave ablation were retrospectively divided into a bleeding group and a non-bleeding group to compare the diameter, cystic proportion, cystic fluid nature, color Doppler flow imaging, Contrast-enhanced ultrasound (CEUS) findings, and operative methods. Based on univariate and multivariate analysis, the important risk factors of nodular intracapsular hemorrhage in the ablation procedure were projected to a nomogram for predicting the possibility of intraoperative hemorrhage in the thyroid cystic solid nodules.

Results

Intra-cystic hemorrhage was developed in 37 cases during the ablation of mixed thyroid nodules with a total incidence of 15% (37/241). Significant differences were found statistically between the two groups on the diameter of the lesions, CEUS findings, the cystic fluid ratio, and operative methods (P = 0.000, P = 0.001, P = 0.024, P = 0.002). The possibility of intraoperative nodular intracapsular hemorrhage was predicted by the model based on the risk factors with the accuracy of 81% and prediction consistency index (C-index) of 0.78.

Conclusion

A new and efficient prediction model was developed based on the identified risk factors for intracapsular hemorrhage during microwave ablation of mixed thyroid nodules, which will aid in the development of targeted surgical planning for different types of cystic thyroid nodules, thus reducing the risk of hemorrhage during ablation.

Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules

Thyroid nodules are commonly encountered in health care practice. They are usually benign in nature, with few cases being malignant, and their detection has increased in the adult population with the help of ultrasonography. Thyroidectomy or surgery is the first-line treatment and traditional method for thyroid nodules; however, thyroidectomy leaves permanent scars and requires long-term use of levothyroxine after surgery, which makes patients more reticent to accept this treatment. Thermal ablation is a minimally-invasive technique that have been employed in the treatment of benign and malignant thyroid nodules nodules, and have been shown to be effective and safe. Several studies, including long-term, retrospective, and prospective studies, have investigated the use of ablation to treat benign thyroid nodules and malignant thyroid nodules, including papillary thyroid carcinoma. Here, we review the recent progress in thermal ablation techniques for treating benign and malignant nodules, including their technicalities, clinical applications, pitfalls and limitations, and factors that could affect treatment outcomes. Special in-depth elaboration on the recent progress of the application of thermal ablation therapy in malignant thyroid nodules.

Long-Term Efficacy of Ultrasound-Guided Percutaneous Laser Ablation for Low-Risk Papillary Thyroid Microcarcinoma: A 5-Year Follow-Up Study

Objective

To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous laser ablation (PLA) for the treatment of low-risk papillary thyroid microcarcinoma (PTMC).

Methods

From June 2012 to May 2015, 105 patients with solitary, pathologically confirmed PTMC lesions were treated with ultrasound-guided PLA. Nodule location, nodule volume, thyroid function, and clinical symptoms were evaluated before ablation. Contrast-enhanced ultrasound (CEUS) was performed 1 h after treatment to evaluate whether the ablation was complete. Ultrasound examination was performed at 1, 3, 6, and 12 months after ablation and every 6 months thereafter to determine the size of the ablation area and search for recurrence in the thyroid parenchyma and lymph node metastasis. Thyroid function was examined before and 1 month after ablation. Fine needle aspiration biopsy was performed for any suspicious metastatic lymph nodes and recurrent lesions in the thyroid.

Results

All 105 lesions were completely inactivated after one ablation, making the success rate for single ablation 100%. The average ablation time was 2.78 ± 1.05 min, and the average ablation energy was 505 ± 185 J. All patients could tolerate and complete the ablation. No serious complications occurred during the treatment; only minor side effects such as pain and local discomfort were reported. The volume reduction rates were −781.14 ± 653.29% at 1 h posttreatment and −268.65 ± 179.57%, −98.39 ± 76.58%, 36.78 ± 30.32%, 75.55 ± 21.81%, 96.79 ± 10.57%, and 100% at 1, 3, 6, 12, 18, and 24 months after ablation, respectively. This rate remained 100% at the later follow-up times. Overall, 28 (26.67%), 74 (70.48%), 96 (91.43%), and 103 (100%) were completely absorbed by 6, 12, 18, and 24 months after PLA. One patient developed another lesion 12 months after ablation, and two patients had central cervical lymph node metastasis 24 months after ablation.

Conclusion

PLA is a safe and effective alternative clinical treatment for low-risk PTMC.

Effects of energy-based ablation on thyroid function in treating benign thyroid nodules: a systematic review and meta-analysis

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.

Thermal Ablation of Benign Thyroid Nodules and Papillary Thyroid Microcarcinoma

Due to the increasing rates of physical examination and application of advanced ultrasound machines, incidences of benign thyroid nodules (BTNs) and papillary thyroid microcarcinoma (PTMC) were dramatically up-regulated in recent years. Thermal ablation (TA) has been widely used and regarded as a safe and effective method to eliminate or reduce BTNs and recurrent low-risk PTMC. However, conclusions using TA to treat primary PTMC are controversial. Recently, several long-term and prospective studies on TA treatment of BTNs and primary PTMC have been reported. Here, we review current literatures and progress on TA treatment of BTNs and PTMC and underline the way to get the best treatment outcomes, providing a comprehensive insight into the research progresses in this field.