Radiofrequency Ablation of Thyroid Nodules: A Long-Term Prospective Study of 24 Patients

BackgroundNearly 20 years after the first feasibility study, minimally invasive ultrasound (US)-guided therapeutic techniques are now considered as a safe and effective alternative to surgery for symptomatic benign thyroid nodules. Radiofrequency ablation (RFA) is one of the most widely used treatment in specialized thyroid centers but, due to the relatively recent introduction into clinical practice, there are limited long-term follow-up studies. Aim of our work was to review the outcomes of RFA on solid nonfunctioning and on autonomous thyroid nodules (AFTN) on a long-time period for assessing the results in term of efficacy, complications, and costs and to compare them to the current indications of RFA.MethodsA systematic review was performed using EMBASE and Medline library data between 2008 and 2021. Seventeen studies evaluated RFA for the treatment of benign solid (nonfunctioning or autonomous) thyroid nodules, with an at least 18 months of follow-up. Data extraction and quality assessment were performed by two endocrinologist according to PRISMA guidelines. Anthropometric data, safety and efficacy parameters were collected.ResultsThe majority of the studies was retrospective study and reported 933 nodules, mostly solid. Baseline volume ranged between 6.1 ± 9.6 and 36.3 ± 59.8 ml. Local analgesia was used and the time duration of the treatment was between 5 ± 2 and 22.1 ± 10.9 min. The volume reduction rate at 12 months ranged from 67% to 75% for the nodule treated with a single procedure and reached to 93.6 ± 9.7% for nodules treated with repeat ablations. The regrowth rate at 12 months ranged from 0% to 34%.ConclusionAll the studies under examination consistently validated the long-term clinical efficacy and the substantial safety of RFA for the treatment of benign thyroid nodules. Thermal ablation, however, is an operator-dependent technique and should be performed in centers with specific expertise. The selection of the patients should be rigorous because the nodule size and the structural and functional characteristics influence the appropriateness and the outcomes of the treatment. Future perspectives as the treatment of micro-papillary thyroid cancer or cervical recurrence need further investigations.

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Current Status and Challenges of US-Guided Radiofrequency Ablation of Thyroid Nodules in the Long Term: A Systematic Review

Cancers ◽

10.3390/cancers13112746 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2746

Author(s):

Stella Bernardi ◽

Andrea Palermo ◽

Rosario Francesco Grasso ◽

Bruno Fabris ◽

Fulvio Stacul ◽

...

Keyword(s):

Systematic Review ◽

Radiofrequency Ablation ◽

Thyroid Nodules ◽

Current Status ◽

Complete Disappearance ◽

Thyroid Microcarcinoma ◽

Lower Complication ◽

Benign Thyroid Nodules ◽

Benign Thyroid

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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Long-term results of ultrasound (US)-guided radiofrequency ablation (RFA) of benign thyroid nodules: State of the art and future perspectives–A systematic review

Annales d Endocrinologie ◽

10.1016/j.ando.2021.08.399 ◽

2021 ◽

Vol 82 (5) ◽

pp. 394

Author(s):

A. Ben Hamou ◽

H. Monpeyssen ◽

A. Alamri

Keyword(s):

Systematic Review ◽

Radiofrequency Ablation ◽

Thyroid Nodules ◽

State Of The Art ◽

Long Term Results ◽

Future Perspectives ◽

Benign Thyroid Nodules ◽

Benign Thyroid

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Prospective Study of Effectiveness of Ultrasound-Guided Radiofrequency Ablation Versus Control Group in Patients Affected by Benign Thyroid Nodules

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2014-2186 ◽

2015 ◽

Vol 100 (2) ◽

pp. 460-466 ◽

Cited By ~ 58

Author(s):

Roberto Cesareo ◽

Valerio Pasqualini ◽

Carla Simeoni ◽

Marco Sacchi ◽

Erminio Saralli ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Prospective Study ◽

Thyroid Nodules ◽

Control Group ◽

Ultrasound Guided ◽

Benign Thyroid Nodules ◽

Benign Thyroid

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Radiofrequency ablation for benign thyroid nodules according to different ultrasound features: an Italian multicentre prospective study

Acta Endocrinologica ◽

10.1530/eje-18-0685 ◽

2019 ◽

Vol 180 (1) ◽

pp. 79-87 ◽

Cited By ~ 16

Author(s):

Maurilio Deandrea ◽

Francesca Garino ◽

Mormile Alberto ◽

Roberto Garberoglio ◽

Ruth Rossetto ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Prospective Study ◽

Thyroid Nodules ◽

Secondary Outcome ◽

Italian Population ◽

Efficacy And Safety ◽

Data Set ◽

Us Findings ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Background The purpose of this study was to confirm the generalisation of radiofrequency ablation (RFA) in the treatment of benign thyroid nodules (BTN) and to look for a correlation between final shrinkage and some ultrasound (US) findings in a large Italian population data set. Methods This prospective study included 337 patients with solid cold BTN from six Italian institutions. Nodule volume, US pattern, thyroid function, symptom/cosmetic scores and complications were evaluated before treatment and at 6 and 12 months. The primary outcome was to find a correlation between basal volume and US pattern of the nodules and final shrinkage. The secondary outcome was to confirm the efficacy and safety of RFA in a large data set. Results The median basal volume was 20.7 mL, and this significantly decreased after RFA at 6 months (7.3 mL (−63.5%), P < 0.001) and at 12 months (6 mL (−70%), P vs 6 months = 0.009). A significant correlation was found for US structure (a spongiform pattern showing a 76% reduction vs 67 and 66% of mix and solid patterns respectively, P < 0.01) as well as for vascularity (intense peripheral and intranodal patterns showing 71 vs 68 and 67% of weak peripheral and intranodal and peripheral patterns respectively, P < 0.03), but not for macrocalcifications. A slight inverse correlation was found between nodule basal volume and shrinkage (Spearman: −0.23). Mean symptoms/cosmetic scores were significantly reduced. No major complications were encountered. Conclusions This multicentre study validated the efficacy and safety of RFA for treating BTN and showed a clear correlation between final shrinkage and some common US findings.

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