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Xu S, He H, Jiang M. Comparison of the effects of contrast-enhanced ultrasound and conventional ultrasound-guided radiofrequency ablation on benign thyroid nodules. Pak J Med Sci 2023; 39:1661-1665. [PMID: 37936746 PMCID: PMC10626072 DOI: 10.12669/pjms.39.6.8250] [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: 05/15/2023] [Revised: 05/30/2023] [Accepted: 09/03/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To compare the effect of contrast-enhanced ultrasound (CEUS) and conventional ultrasound-guided radiofrequency ablation (RFA) on benign thyroid nodules (BTNs). Methods In this retrospective observational study, the data of 72 patients with BTNs who received RFA treatment in The Fourth Affiliated Hospital of Zhejiang University School of Medicine from January 2020 to December 2021 were retrospectively reviewed and selected. The records showed that 34 patients received RFA under the guidance of conventional ultrasound (conventional ultrasound group) and 38 patients received RFA under the guidance of CEUS (CEUS group). The effect of treatment, complications and recurrence of the two groups were compared and analyzed. Results There was a smaller volume of thyroid nodules in the two groups immediately post-operation. The incidence of complications was lower in the CEUS group (5.26%) compared to the conventional ultrasound group (23.53%) (P<0.05). The recurrence rate at 6-months (0.00% vs 11.76%) and 12- months (2.63% vs 20.59%) post-operation was lower in the CEUS group compared to the conventional ultrasound group (P<0.05). Conclusions Compared with conventional ultrasound, CEUS-guided RFA is effective in treating BTNs, with smaller postoperative nodule volume, reduced occurrence of surgical complications, and reduced recurrence rate of thyroid nodules.
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Affiliation(s)
- Shouxing Xu
- Shouxing Xu, Department of Ultrasound Medicine, Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, P.R. China
| | - Huiling He
- Huiling He, Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, P.R. China
| | - Meijuan Jiang
- Meijuan Jiang, Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, P.R. China
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2
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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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Fite BZ, Wang J, Ghanouni P, Ferrara KW. A Review of Imaging Methods to Assess Ultrasound-Mediated Ablation. BME FRONTIERS 2022; 2022:9758652. [PMID: 35957844 PMCID: PMC9364780 DOI: 10.34133/2022/9758652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/21/2022] [Indexed: 12/18/2022] Open
Abstract
Ultrasound ablation techniques are minimally invasive alternatives to surgical resection and have rapidly increased in use. The response of tissue to HIFU ablation differs based on the relative contributions of thermal and mechanical effects, which can be varied to achieve optimal ablation parameters for a given tissue type and location. In tumor ablation, similar to surgical resection, it is desirable to include a safety margin of ablated tissue around the entirety of the tumor. A factor in optimizing ablative techniques is minimizing the recurrence rate, which can be due to incomplete ablation of the target tissue. Further, combining focal ablation with immunotherapy is likely to be key for effective treatment of metastatic cancer, and therefore characterizing the impact of ablation on the tumor microenvironment will be important. Thus, visualization and quantification of the extent of ablation is an integral component of ablative procedures. The aim of this review article is to describe the radiological findings after ultrasound ablation across multiple imaging modalities. This review presents readers with a general overview of the current and emerging imaging methods to assess the efficacy of ultrasound ablative treatments.
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Affiliation(s)
- Brett Z. Fite
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
| | - James Wang
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
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4
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Geoghegan R, Ter Haar G, Nightingale K, Marks L, Natarajan S. Methods of monitoring thermal ablation of soft tissue tumors - A comprehensive review. Med Phys 2022; 49:769-791. [PMID: 34965307 DOI: 10.1002/mp.15439] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 11/30/2020] [Accepted: 12/15/2021] [Indexed: 11/12/2022] Open
Abstract
Thermal ablation is a form of hyperthermia in which oncologic control can be achieved by briefly inducing elevated temperatures, typically in the range 50-80°C, within a target tissue. Ablation modalities include high intensity focused ultrasound, radiofrequency ablation, microwave ablation, and laser interstitial thermal therapy which are all capable of generating confined zones of tissue destruction, resulting in fewer complications than conventional cancer therapies. Oncologic control is contingent upon achieving predefined coagulation zones; therefore, intraoperative assessment of treatment progress is highly desirable. Consequently, there is a growing interest in the development of ablation monitoring modalities. The first section of this review presents the mechanism of action and common applications of the primary ablation modalities. The following section outlines the state-of-the-art in thermal dosimetry which includes interstitial thermal probes and radiologic imaging. Both the physical mechanism of measurement and clinical or pre-clinical performance are discussed for each ablation modality. Thermal dosimetry must be coupled with a thermal damage model as outlined in Section 4. These models estimate cell death based on temperature-time history and are inherently tissue specific. In the absence of a reliable thermal model, the utility of thermal monitoring is greatly reduced. The final section of this review paper covers technologies that have been developed to directly assess tissue conditions. These approaches include visualization of non-perfused tissue with contrast-enhanced imaging, assessment of tissue mechanical properties using ultrasound and magnetic resonance elastography, and finally interrogation of tissue optical properties with interstitial probes. In summary, monitoring thermal ablation is critical for consistent clinical success and many promising technologies are under development but an optimal solution has yet to achieve widespread adoption.
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Affiliation(s)
- Rory Geoghegan
- Department of Urology, University of California Los Angeles, Los Angeles, California, USA
| | - Gail Ter Haar
- Department of Physics, Institute of Cancer Research, University of London, Sutton, UK
| | - Kathryn Nightingale
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Leonard Marks
- Department of Urology, University of California Los Angeles, Los Angeles, California, USA
| | - Shyam Natarajan
- Departments of Urology & Bioengineering, University of California Los Angeles, Los Angeles, California, USA
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5
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Wang XS, Xu XH, Jiang G, Ling YH, Ye TT, Zhao YW, Li K, Lei YT, Hu HQ, Chen MW, Wang H. Lack of Association Between Helicobacter pylori Infection and the Risk of Thyroid Nodule Types: A Multicenter Case-Control Studyin China. Front Cell Infect Microbiol 2022; 11:766427. [PMID: 34970506 PMCID: PMC8713074 DOI: 10.3389/fcimb.2021.766427] [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: 08/29/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
The prevalence of Helicobacter pylori infection is high worldwide, while numerous research has focused on unraveling the relationship between H. pylori infection and extragastric diseases. Although H. pylori infection has been associated with thyroid diseases, including thyroid nodule (TN), the relationship has mainly focused on potential physiological mechanisms and has not been validated by large population epidemiological investigations. Therefore, we thus designed a case-control study comprising participants who received regular health examination between 2017 and 2019. The cases and controls were diagnosed via ultrasound, while TN types were classified according to the guidelines of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). Moreover, H. pylori infection was determined by C14 urea breath test, while its relationship with TN type risk and severity was analyzed using binary and ordinal logistic regression analyses. A total of 43,411 participants, including 13,036 TN patients and 30,375 controls, were finally recruited in the study. The crude odds ratio (OR) was 1.07 in Model 1 (95% CI = 1.03-1.14) without adjustment compared to the H. pylori non-infection group. However, it was negative in Model 2 (OR = 1.02, 95% CI = 0.97-1.06) after being adjusted for gender, age, body mass index (BMI), and blood pressure and in Model 3 (OR = 1.01, 95% CI = 0.97-1.06) after being adjusted for total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein on the basis of Model 2. Control variables, including gender, age, BMI, and diastolic pressure, were significantly correlated with the risk of TN types. Additionally, ordinal logistic regression results revealed that H. pylori infection was positively correlated with malignant differentiation of TN (Model 1: OR = 1.06, 95% CI = 1.02-1.11), while Model 2 and Model 3 showed negative results (Model 2: OR = 1.01, 95% CI = 0.96-1.06; Model 3: OR = 1.01, 95% CI = 0.96-1.05). In conclusion, H. pylori infection was not significantly associated with both TN type risk and severity of its malignant differentiation. These findings provide relevant insights for correcting possible misconceptions regarding TN type pathogenesis and will help guide optimization of therapeutic strategies for thyroid diseases.
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Affiliation(s)
- Xiao-Song Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xi-Hai Xu
- The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Health Management Center, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Gang Jiang
- Department of Social Medicine and Health Management, School of Health Management, Anhui Medical University, Hefei, China
| | - Yu-Huan Ling
- Department of Social Medicine and Health Management, School of Health Management, Anhui Medical University, Hefei, China
| | - Tian-Tian Ye
- Department of Social Medicine and Health Management, School of Health Management, Anhui Medical University, Hefei, China
| | - Yun-Wu Zhao
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kun Li
- Health Management Center, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu-Ting Lei
- Health Management Center, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hua-Qing Hu
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ming-Wei Chen
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Heng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,The First Affiliated Hospital of Anhui Medical University, Hefei, China
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6
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Yan L, Li X, Xiao J, Li Y, Zhu Y, He H, Luo Y. Contrast-enhanced ultrasound is a reliable and reproducible assessment of necrotic ablated volume after radiofrequency ablation for benign thyroid nodules: a retrospective study. Int J Hyperthermia 2021; 39:40-47. [PMID: 34936850 DOI: 10.1080/02656736.2021.1991009] [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: 10/19/2022] Open
Abstract
PURPOSE To investigate the intra- and inter-observer reliability and agreement of contrast-enhanced ultrasound (CEUS) in measuring ablated volume (Va) after radiofrequency ablation (RFA) for benign thyroid nodules. MATERIALS This retrospective study evaluated 65 patients with 74 benign thyroid nodules who underwent RFA. Patients were followed up at 1, 3, 6, and 12 months and every 12 months thereafter. Two independent observers measured the Va using CEUS during the same follow-up visit. The intra- and inter-observer reliability was assessed using intraclass correlation coefficient (ICC) with 95% confidence interval. The Bland-Altman analysis was used to evaluate the inter-observer agreement, which was expressed as a mean difference with 95% limit of agreement (LOA). RESULTS No significant difference was found in Va measurements by the two observers with a mean follow-up time of 41.17 ± 16.80 months (all p > 0.05). The intra- and inter-observer reliability were both excellent (ICC >0.90) at each follow-up period. The 95% LOA became wider over the follow-up period. The smallest 95% LOA was found at 1 month with a LOA from 0.8117 to 1.122, and the largest 95% LOA was from 0.5694 to 1.343 at 36 months. CONCLUSIONS CEUS could provide a reliable and reproducible assessment of Va after RFA for benign thyroid nodules. In clinical post-ablation follow-up, the irregular morphology of ablated area and the variation by different observers could not affect the assessment of Va by CEUS.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - XinYang Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - YingYing Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yaqiong Zhu
- 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.,School of Medicine, Nankai University, Tianjin, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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7
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Mauri G, Papini E, Bernardi S, Barbaro D, Cesareo R, De Feo P, Deandrea M, Fugazzola L, Gambelunghe G, Greco G, Messina C, Monti S, Mormile A, Negro R, Offi C, Palermo A, Persani L, Presciuttini F, Solbiati LA, Spiezia S, Stacul F, Viganò M, Sconfienza LM. Image-guided thermal ablation in autonomously functioning thyroid nodules. A retrospective multicenter three-year follow-up study from the Italian Minimally Invasive Treatment of the Thyroid (MITT) Group. Eur Radiol 2021; 32:1738-1746. [PMID: 34751793 DOI: 10.1007/s00330-021-08289-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/12/2021] [Accepted: 07/29/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To report the results of a multicenter retrospective evaluation of the clinical outcomes of thermal ablation (TA) in a large series of autonomously functioning thyroid nodules (AFTN) with a follow-up protracted up to 3 years. METHODS Patients treated with single TA for an AFTN in Italy were included. Changes in nodule volume, TSH values, and ongoing anti-thyroid therapy were assessed at the 2-, 6-, 12-, 24-, and 36-month follow-up controls. Complications and need of any additional therapy after TA were also registered. RESULTS A total of 361 patients (244 females, 117 males, median age 58 years, IQR 46-70 years) were included. Nodule volume was significantly reduced at all time points (p < 0.001) (median volume reduction 58% at 6-month and 60% at 12-month). Serum TSH values increased significantly at all time points. After TA, anti-thyroid therapy was withdrawn in 32.5% of patients at 2 months, in 38.9% at 6 months, and in 41.3% at 12 months. A significant difference in the rate of patients who withdrawn medical therapy at 12 months was registered between small (< 10 mL) (74%), medium (49%), or large (> 30 mL) nodules (19%). A single major complication occurred (0.25%). Additional treatments were needed in 34/361 (9.4%) of cases including 4 (1.1%) surgical treatment. CONCLUSIONS Image-guided thermal ablation offers a further safe and effective therapeutic option in patients with AFTN. Clinical outcomes are significantly more favorable in small than in large size AFTN. KEY POINTS • Thermal ablations (TA) can be safely and effectively used in patients with autonomously functioning thyroid nodules (AFTN). • TA results in a clinically significant nodule volume reduction that is paralleled by TSH level normalization and anti-thyroid drug therapy discontinuation (after TA anti-thyroid therapy was withdrawn in 41.3% at 12 months). • Clinical outcomes after TA are more favorable in small nodules, and when a large amount of thyroid nodule tissue is ablated.
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Affiliation(s)
- Giovanni Mauri
- Dipartimento Di Oncologia Ed Emato-Oncologia, Università Degli Studi Di Milano, Milan, Italy.
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), via Ripamonti 435, Milan, Italy.
| | - Enrico Papini
- Dipartimento Di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Stella Bernardi
- UCO Medicina Clinica, Ospedale Di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
- Dipartimento Di Scienze Mediche, Università Degli Studi Di Trieste, Trieste, Italy
| | | | - Roberto Cesareo
- Unit of metabolic diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milano, Italy
- Department of Patophysiology and Transplantation, Università Degli Studi Di Milano, Milano, Italy
| | | | | | | | - Salvatore Monti
- UOC Di Endocrinologia, Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | | | | | - Chiara Offi
- Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Andrea Palermo
- Unit of endocrinology and Diabetes, Campus Bio-Medico university, Roma, Italy
| | - Luca Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milano, Italy
- Department of Medical Biotechnology and Translational Medicine, Università Degli Studi Di Milano, Milano, Italy
| | | | - Luigi Alessandro Solbiati
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Stefano Spiezia
- Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Fulvio Stacul
- SC Radiologia, Ospedale Maggiore, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Marco Viganò
- Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milano, Italy
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8
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Radzina M, Ratniece M, Putrins DS, Saule L, Cantisani V. Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives. Cancers (Basel) 2021; 13:5469. [PMID: 34771632 PMCID: PMC8582579 DOI: 10.3390/cancers13215469] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
Ultrasound has been established as a baseline imaging technique for thyroid nodules. The main advantage of adding CEUS is the ability to assess the sequence and intensity of vascular perfusion and hemodynamics in the thyroid nodule, thus providing real-time characterization of nodule features, considered a valuable new approach in the determination of benign vs. malignant nodules. Original studies, reviews and six meta-analyses were included in this article. A total of 624 studies were retrieved, and 107 were included in the study. As recognized for thyroid nodule malignancy risk stratification by US, for acceptable accuracy in malignancy a combination of several CEUS parameters should be applied: hypo-enhancement, heterogeneous, peripheral irregular enhancement in combination with internal enhancement patterns, and slow wash-in and wash-out curve lower than in normal thyroid tissue. In contrast, homogeneous, intense enhancement with smooth rim enhancement and "fast-in and slow-out" are indicative of the benignity of the thyroid nodule. Even though overlapping features require standardization, with further research, CEUS may achieve reliable performance in detecting or excluding thyroid cancer. It can also play an operative role in guiding ablation procedures of benign and malignant thyroid nodules and metastatic lymph nodes, and providing accurate follow-up imaging to assess treatment efficacy.
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Affiliation(s)
- Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Madara Ratniece
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
| | - Davis Simanis Putrins
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Laura Saule
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Vito Cantisani
- Department of Radiological, Anatomopathological and Oncological Sciences, Sapienza University of Rome, 00100 Rome, Italy;
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9
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Boers T, Braak SJ, Versluis M, Manohar S. Matrix 3D ultrasound-assisted thyroid nodule volume estimation and radiofrequency ablation: a phantom study. Eur Radiol Exp 2021; 5:31. [PMID: 34322765 PMCID: PMC8319281 DOI: 10.1186/s41747-021-00230-4] [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: 02/22/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Two-dimensional (2D) ultrasound is well established for thyroid nodule assessment and treatment guidance. However, it is hampered by a limited field of view and observer variability that may lead to inaccurate nodule classification and treatment. To cope with these limitations, we investigated the use of real-time three-dimensional (3D) ultrasound to improve the accuracy of volume estimation and needle placement during radiofrequency ablation. We assess a new 3D matrix transducer for nodule volume estimation and image-guided radiofrequency ablation. Methods Thirty thyroid nodule phantoms with thermochromic dye underwent volume estimation and ablation guided by a 2D linear and 3D mechanically-swept array and a 3D matrix transducer. Results The 3D matrix nodule volume estimations had a lower median difference with the ground truth (0.4 mL) compared to the standard 2D approach (2.2 mL, p < 0.001) and mechanically swept 3D transducer (2.0 mL, p = 0.016). The 3D matrix-guided ablation resulted in a similar nodule ablation coverage when compared to 2D-guidance (76.7% versus 80.8%, p = 0.542). The 3D mechanically swept transducer performed worse (60.1%, p = 0.015). However, 3D matrix and 2D guidance ablations lead to a larger ablated volume outside the nodule than 3D mechanically swept (5.1 mL, 4.2 mL (p = 0.274), 0.5 mL (p < 0.001), respectively). The 3D matrix and mechanically swept approaches were faster with 80 and 72.5 s/mL ablated than 2D with 105.5 s/mL ablated. Conclusions The 3D matrix transducer estimates volumes more accurately and can facilitate accurate needle placement while reducing procedure time.
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Affiliation(s)
- T Boers
- Multi-Modality Medical Imaging group, TechMed Centre, University of Twente, Enschede, The Netherlands.
| | - S J Braak
- Department of Radiology, Ziekenhuis Groep Twente, Almelo, The Netherlands
| | - M Versluis
- Physics of Fluids group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - S Manohar
- Multi-Modality Medical Imaging group, TechMed Centre, University of Twente, Enschede, The Netherlands
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10
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Yan L, Luo Y. Prediction of nodule regrowth after radiofrequency ablation of benign thyroid nodules. Int J Hyperthermia 2021; 38:11-12. [PMID: 33400887 DOI: 10.1080/02656736.2020.1867243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Lin Yan
- 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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11
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Yan L, Luo Y. Response to letter to the editor from Dr. Bernardi regarding suitability of residual vital ratio for prediction of local regrowth following radiofrequency ablation for benign thyroid nodules. Int J Hyperthermia 2021; 38:189-190. [PMID: 33576298 DOI: 10.1080/02656736.2021.1883128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Lin Yan
- 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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12
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Yan L, Luo Y, Xie F, Zhang M, Xiao J. Residual vital ratio: predicting regrowth after radiofrequency ablation for benign thyroid nodules. Int J Hyperthermia 2021; 37:1139-1148. [PMID: 32996790 DOI: 10.1080/02656736.2020.1825835] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine a novel quantitative index, residual vital ratio(RVR) by contrast-enhanced ultrasound(CEUS) with conventional Ultrasound(US), to early predict nodule regrowth after radiofrequency ablation (RFA)for benign thyroid nodules. METHODS This retrospective study evaluated 186 patients with 206 benign thyroid nodules underwent RFA. Patients were followed at 1, 3, 6, 12 months and every 12 months thereafter by conventional US, CEUS and clinical evaluation. RVR was defined as the initial ratio of residual vital volume to the total volume calculated by CEUS and conventional US at the first follow-up period after RFA. The relationship between RVR and regrowth was investigated. RESULTS The mean volume of thyroid nodules was 10.09 ± 12.90 ml (range 0.40-71.39 ml), which decreased significantly to 2.33 ± 4.65 ml (range 0-36.75 ml) (p < .001) after a mean follow-up time of 22.50 ± 13.29 months (range 6-68 months) with a mean VRR as 85.26 ± 15.02% (range 32.23-100%). The overall incidence of regrowth was 12.62% (26/206) and the mean timing of regrowth was 20.77 ± 12.03 months (range 6-48 months). Multivariate logistic regression revealed that RVR (OR = 1.050, 95%CI 1.025-1.075), initial volume(OR = 1.033, 95%CI 1.000-1.066), location close to critical structures (OR = 5.967, 95%CI 1.898-18.760) and vascularity (OR = 2.216, 95%CI 1.185-4.143) were independent factors associated with regrowth. According to receiver-operating characteristic curve, the area under curve for RVR to regrowth was 0.819 (95% CI 0.740-0.897, p < .001) with the optimal cutoff value of 44.5% (sensitivity 80.8%, specificity 74.7%). CONCLUSION RVR was not only an independent factor but also an early quantitative predictor for regrowth. If RVR was larger than 44.5%, the nodule tended to regrowth in the follow-up.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.,Health Management Center, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fang Xie
- 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
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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13
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Bernardi S, Palermo A, Grasso RF, Fabris B, Stacul F, Cesareo R. Current Status and Challenges of US-Guided Radiofrequency Ablation of Thyroid Nodules in the Long Term: A Systematic Review. Cancers (Basel) 2021; 13:2746. [PMID: 34205994 PMCID: PMC8199252 DOI: 10.3390/cancers13112746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/22/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND US-guided minimally-invasive techniques, such as radiofrequency ablation (RFA) have emerged as an alternative treatment for benign and malignant thyroid nodules. This systematic review aims to provide an overview on the long-term outcomes of US-guided RFA in patients with benign and malignant thyroid nodules. METHODS We systematically searched PubMed/MEDLINE, EMBASE, and Scopus to identify articles reporting the outcomes of thyroid RFA after a follow-up of at least 3 years. RESULTS A total of 20 studies met the inclusion criteria and were included in the review. In patients with benign thyroid nodules, RFA significantly reduced nodule volume and this was generally maintained for the following 5 years. However, a small but not negligible proportion of nodules regrew and some of them required further treatments over time. In patients with malignant nodules, RFA has been used not only to treat differentiated thyroid cancer (DTC) neck recurrences, but also to treat papillary thyroid microcarcinoma (PTMC). In most patients with PTMC, RFA led to complete disappearance of the tumor. When it was compared to surgery, RFA was not inferior in terms of oncologic efficacy but it had a lower complication rate. However, RFA did not allow for final pathology, disease staging and accurate risk stratification. CONCLUSIONS US-guided RFA significantly reduces benign thyroid nodules and destroys most PTMC, and this is generally maintained for at least 5 years after the initial treatment. Further studies addressing the risk of regrowths in patients with benign thyroid nodules, as well as the risk of recurrence in patients with PTMC are needed.
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Affiliation(s)
- Stella Bernardi
- Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy;
- U.C.O. Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, 34149 Trieste, Italy
| | - Andrea Palermo
- Unità di Endocrinologia e Diabete, Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
| | - Rosario Francesco Grasso
- U.O.S. Radiologia Interventistica, Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
| | - Bruno Fabris
- Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy;
- U.C.O. Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, 34149 Trieste, Italy
| | - Fulvio Stacul
- S.C. Radiologia, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Maggiore Hospital, 34125 Trieste, Italy;
| | - Roberto Cesareo
- U.O.S. Malattie Metaboliche, Ospedale Santa Maria Goretti, 04100 Latina, Italy;
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14
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Yan L, Luo Y, Song Q, Li N, Xiao J, Zhang Y, Zhu Y. Inter-observer reliability in ultrasound measurement of benign thyroid nodules in the follow-up of radiofrequency ablation: a retrospective study. Int J Hyperthermia 2020; 37:1336-1344. [PMID: 33251890 DOI: 10.1080/02656736.2020.1849826] [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: 02/08/2023] Open
Abstract
PURPOSE To investigate the inter-observer reliability of ultrasound (US) measurement in volume and volume reduction rate (VRR) of benign thyroid nodules during the follow-up of radiofrequency ablation (RFA). MATERIALS This retrospective study evaluated 76 patients with 88 benign thyroid nodules who underwent RFA. Two independent observers performed the US measurements during the same follow-up visit. The Bland-Altman analysis was used to evaluate the inter-observer reliability of volume and VRR (logarithmic transformation). The mean difference and 95% limits-of-agreement (LOA) were obtained after antilogarithm. RESULTS No significant differences were found in the volume and VRR measurements during a mean follow-up time of 35.52 ± 12.82 months. After antilogarithms, the mean difference of volume was 0.9961, 0.9987, 1.0016, 0.9972, 0.9977 and 0.9969 at 1, 3, 6, 12, 24 and 36 months, respectively. The 95% LOA of volume became wider over the follow-up period, and the largest one was between 0.8471 and 1.1733 at 36 months. The 95% LOA of VRR became narrower over the follow-up period, and the largest one was between 0.9541 and 1.0469 at 1 month. The incidence of regrowth was 20.45% and the largest 95% LOA of regrowth nodules was between 0.9028 and 1.284 at 12 months. At the same follow-up period, VRR had a narrower 95% LOA than volume. Compared with volume ≥10 ml, nodules <10 ml revealed a larger 95% LOA in both the volume and VRR. CONCLUSION The inter-observer reliability of the US measurements of benign thyroid nodules during the follow-up period of RFA was acceptable. The variation by different observers could not affect the evaluation of efficacy.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.,Health Management Center, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, 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
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yaqiong Zhu
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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15
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Park SI, Baek JH. How to Monitor and Manage Nodule Regrowth after Thermal Ablation of Benign Thyroid Nodules. Korean J Radiol 2020; 22:293-295. [PMID: 32932568 PMCID: PMC7817640 DOI: 10.3348/kjr.2020.0690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Sang Ik Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Korea.
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16
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Bernardi S, Cavallaro M, Colombin G, Giudici F, Zuolo G, Zdjelar A, Dobrinja C, De Manzini N, Zanconati F, Cova MA, Stacul F, Fabris B. Initial Ablation Ratio Predicts Volume Reduction and Retreatment After 5 Years From Radiofrequency Ablation of Benign Thyroid Nodules. Front Endocrinol (Lausanne) 2020; 11:582550. [PMID: 33597921 PMCID: PMC7883676 DOI: 10.3389/fendo.2020.582550] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) has gained ground as an effective and well-tolerated technique to treat benign thyroid nodules. Most of the available studies have described the short-term outcomes of RFA, whereas there is a limited number of studies evaluating long-term issues, such as regrowth and the likelihood of retreatments. In addition, risk markers of regrowth and retreatment remain to be defined. The initial ablation ratio (IAR) is an index that measures the amount of ablation after RFA, which has been associated with technique efficacy (i.e. volume reduction >50% after 1 year from the procedure). This study aimed at evaluating i) IAR reproducibility and ii) IAR predictive value for RFA 5-year outcomes. MATERIALS AND METHODS This is a retrospective single center study on patients with benign thyroid nodules treated with RFA and followed for 5 years after initial treatment. IAR interobserver reproducibility was evaluated with Bland-Altman method and Lin's concordance correlation coefficient (ρc). IAR predictive value for RFA 5-year outcomes was evaluated with linear and logistic regression models, as well as with Cox models, while receiver operating characteristic (ROC) analyses were used for cut-offs. RESULTS We selected 78 patients with 82 benign thyroid nodules. The procedure significantly reduced nodule volume and this reduction was generally maintained over time. Technique efficacy was achieved in 92% of patients, while 23% of nodules regrew and 12% of nodules were retreated. Median IAR was 83%. Lin's concordance and Pearson's correlation coefficients suggested a good interobserver reproducibility of this index, consistent with the limits of agreement of the Bland-Altman plot. IAR was significantly associated with technique efficacy, 1- and 5-year volume reduction ratio, and with the likelihood of a retreatment, but not with nodule regrowth. ROC analyses showed that IAR cut-off was 49% for technique efficacy and 73% for retreatment. CONCLUSIONS Our results show for the first time that IAR is reproducible and that it predicts the volume reduction and the likelihood of a retreatment after 5 years from RFA.
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Affiliation(s)
- Stella Bernardi
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Institute of Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
- *Correspondence: Stella Bernardi,
| | - Marco Cavallaro
- Unit of Radiology, Ospedale Maggiore, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Giacomo Colombin
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Fabiola Giudici
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giulia Zuolo
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Institute of Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Adrian Zdjelar
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Department of Radiology, Ospedale di Cattinara, Azienda Sanitaria Giuliano-Isontina, Trieste, Trieste, Italy
| | - Chiara Dobrinja
- Department of General Surgery, Ospedale di Cattinara, Azienda Sanitaria Giuliano-Isontina, Trieste, Trieste, Italy
| | - Nicolò De Manzini
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Department of General Surgery, Ospedale di Cattinara, Azienda Sanitaria Giuliano-Isontina, Trieste, Trieste, Italy
| | - Fabrizio Zanconati
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Department of Anatomical and Histo-pathology—Ospedale di Cattinara, Azienda Sanitaria Giuliano-Isontina, Trieste, Trieste, Italy
| | - Maria Assunta Cova
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Department of Radiology, Ospedale di Cattinara, Azienda Sanitaria Giuliano-Isontina, Trieste, Trieste, Italy
| | - Fulvio Stacul
- Unit of Radiology, Ospedale Maggiore, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Bruno Fabris
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Institute of Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
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