Ultrasound Elastography Predicts Thyroid Nodule Volume Reduction Rate After Percutaneous Ethanol Ablation

Objectives To evaluate the safety and efficacy of percutaneous ethanol ablation (PEA) on indeterminate thyroid nodules (Bethesda III and IV) based on ultrasound (US) elastography by assessing the volume reduction rate (VRR), relative reduction in size, resolution of compressive symptoms, and post-procedural complications. Materials and Methods This is a retrospective cohort study of all thyroid nodules treated with PEA by a single surgeon at a North American tertiary referral center. Study variables included demographics, nodule characteristics, Bethesda classification, US elastography, presence of compressive symptoms, thyroid function, and post-procedural complications. Relative volume reductions and VRR were calculated at 3- and 6-month follow-ups. Results Thirty-four thyroid nodules were evaluated in 22 patients. All thyroid nodules underwent a fine needle aspiration prior to PEA. After 6 months, 45% of all thyroid nodules exhibited a VRR of ≥50%. A significant VRR was achieved in the soft thyroid nodules at 6 months (42.15% ± 31), compared to the stiff nodules with 30.92% ± 91.53, P < .05. Post-PEA thyroid stimulating hormone levels did not significantly change after the procedure. Compressive symptoms resolved in all 5 patients who reported it. One patient developed transient vocal cord paresis that resolved in 3 months. Discussion To the best of our knowledge, this is the largest series of PEA for thyroid nodules in North America. Ultrasound elastography is a useful adjunct in predicting the success of PEA for nonmalignant thyroid nodules. Percutaneous ethanol ablation is both a safe and effective alternative to surgery for relief of compressive symptoms in select patients.

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Efficacy of ethanol ablation for treatment of benign cystic thyroid nodules: the first hospital-based study in Vietnam

MedPharmRes ◽

10.32895/ump.mpr.4.1.5 ◽

2020 ◽

Vol 4 (1) ◽

pp. 18-22

Author(s):

Van Bang Nguyen ◽

Van Vy Hau Nguyen ◽

Binh Thang Tran ◽

Chi Van Le

Keyword(s):

Thyroid Nodules ◽

Multiple Logistic Regression Analysis ◽

Volume Reduction ◽

Efficacy And Safety ◽

Inclusion Criteria ◽

Ethanol Ablation ◽

Institutional Review ◽

Thyroid Cyst ◽

Secondary Endpoints ◽

Written Informed Consent

Background: In Vietnam, surgery or aspiration is preferred to treat thyroid cysts however each of them still have limitations. Purposes of this study were to evaluate the efficacy and safety of ethanol ablation in treating thyroid cysts and determine factors that predict the outcome of treatment. Methods: This prospective study was approved by the Ethics Committee of the Institutional Review Board of Family hospital and written informed consent for procedures was obtained. From May 2018 to March 2019, 23 patients who underwent treatment for thyroid cysts by EA were enrolled in this study and were followed up for 1 month at Family hospital. The primary endpoint was efficient after one month as the volume reduction ratio was ≥ 50%. Secondary endpoints were improvements in symptoms, cosmetic scores, and safety. Multiple logistic regression analysis was used. Results: In the finding, from May 2018 to March 2019, only 17 patients who matched inclusion criteria were included in the analyst, including 7 purely thyroid cysts, and 10 predominantly cystic nodules. Mean volume decreased significantly from 5.21 ± 3.37 ml to 2.35 ± 2.52 ml in corresponding to 52.87% of volume reduction with p < 0.05. Ethanol ablation (EA) success rate was 52.90% after 1 month. Symptoms and cosmetic scores were improved significantly. The thyroid function was constant. No adverse events occurred. Purely thyroid cyst was a predictive factor contributing to the success of EA. Conclusion: EA seems likely to be a safe and an efficient therapy for patients who had purely or predominantly cystic thyroid nodules.

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Treating thyroid nodules by radiofrequency: is the delivered energy correlated with the volume reduction rate? A pilot study

Endocrine ◽

10.1007/s12020-020-02275-8 ◽

2020 ◽

Vol 69 (3) ◽

pp. 682-687 ◽

Cited By ~ 2

Author(s):

Pierpaolo Trimboli ◽

Maurilio Deandrea

Keyword(s):

Pilot Study ◽

Thyroid Nodules ◽

Reduction Rate ◽

Volume Reduction

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Ultrasound-guided microwave ablation in the treatment of benign thyroid nodules in 435 patients

Experimental Biology and Medicine ◽

10.1177/1535370217727477 ◽

2017 ◽

Vol 242 (15) ◽

pp. 1515-1523 ◽

Cited By ~ 21

Author(s):

Yu-Jiang Liu ◽

Lin-Xue Qian ◽

Dong Liu ◽

Jun-Feng Zhao

Keyword(s):

Microwave Ablation ◽

Thyroid Nodules ◽

Reduction Rate ◽

Volume Reduction ◽

Ultrasound Guided ◽

Nodule Volume ◽

Safe Technique ◽

Benign Thyroid Nodules ◽

Benign Thyroid

The objective of the present study was to investigate the effectiveness and safety of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules. A total of 474 benign thyroid nodules in 435 patients who underwent ultrasound-guided microwave ablation from September 2012 to August 2015 were included. Nodule volume and thyroid function were measured before treatment and at 1, 3, 6, and 12 months and subsequently after every 6 months. The nodule volume reduction rate and changes of thyroid function were evaluated. The volume of all thyroid nodules significantly decreased after ultrasound-guided microwave ablation. The average volume was 13.07 ± 0.95 ml before treatment, and 1.14 ± 0.26 ml at 12-months follow-up. The mean volume reduction rate was 90% and the final volume reduction rate was 94%. The volume reduction rate of mainly cystic nodules was significantly higher than that of simple solid and mainly solid nodules (all P < 0.05). The pretreatment volume of nodules was positively correlated with the final volume reduction rate at final follow-up ( P = 0.004). No serious complications were observed after treatment. In conclusion, ultrasound-guided microwave ablation is an effective and safe technique for treatment of benign thyroid nodules, and has the potential for clinical applications. Impact statement Ultrasound-guided MWA is an effective and safe technique for the treatment of benign thyroid nodules. It can significantly reduce the nodule volume, improve the patients’ clinical symptoms, has less complication, guarantees quick recovery, meets patients' aesthetic needs, and shows less interference on the physiological and psychological aspects of the body. MWA should be a good complement to traditional open surgery and has potentials in clinical applications.

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Laser Ablation Versus Radiofrequency Ablation for Thyroid Nodules: 12-Month Results of a Randomized Trial (LARA II Study)

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab102 ◽

2021 ◽

Author(s):

Roberto Cesareo ◽

Silvia Manfrini ◽

Valerio Pasqualini ◽

Cesare Ambrogi ◽

Gianfranco Sanson ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Laser Ablation ◽

Success Rate ◽

Thyroid Nodules ◽

Reduction Rate ◽

Volume Reduction ◽

Technical Success ◽

Technical Success Rate ◽

Nodule Volume

Abstract Context Radiofrequency ablation (RFA) seems to achieve a significantly larger nodule volume reduction rate (VRR) than laser ablation (LA) in benign nonfunctioning thyroid nodules (BNTNs) Objective To compare the efficacy and safety of both treatments at 12-month follow-up in patients with solid or predominantly solid BNTN. Methods This was a single-center, 12-month, randomized, superiority, open-label, parallel-group trial conducted in an outpatient clinic. Sixty patients with a solitary BNTN or dominant nodule characterized by pressure symptoms/cosmetic problems were randomly assigned (1:1 ratio) to receive either a single session of RFA or LA. Twenty-9 patients per group completed the study. The main outcome measures were VRR and proportion of nodules with more than 50% reduction (technical success rate). Results At 12 months, VRR was 70.9 ± 16.9% and 60.0 ± 19.0% in the RFA and LA groups, respectively (P = .024). This effect was confirmed in the linear regression model that was adjusted for age, sex, nodule baseline volume, and proportion of cellular components (RFA treatment: β = .390; P = .009). No significant between-group difference was observed in the technical success rate at 12 months after treatment. A statistically significant improvement was observed from the baseline to the 12-month follow-up for compression (RFA: 4.6 ± 2.6 and 1.3 ± 0.8, P < .001; and LA: 4.6 ± 2.1 and 1.6 ± 0.8, respectively, P < .001) and cosmetic (RFA: 3.4 ± 0.6 and 1.3 ± 0.5, P < .001; and LA: 3.4 ± 0.5 and 1.4 ± 0.6, P < .001) scores although the between-group differences were not significant. Conclusion RFA achieved a significantly larger nodule volume reduction at 12 months; however, the technical success rate was similar in the RFA and LA groups.

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Efficacy of Ultrasound Elastography in Predicting the Success Rate of Ethanol Ablation of Non-Malignant Thyroid Nodules

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.181 ◽

2019 ◽

Vol 229 (4) ◽

pp. S76-S77

Author(s):

Mohamed Abdelgawad ◽

Emad Kandil

Keyword(s):

Success Rate ◽

Thyroid Nodules ◽

Ultrasound Elastography ◽

Ethanol Ablation

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Superb Microvascular Imaging Compared with Contrast-Enhanced Ultrasound for Assessing Laser Ablation Treatment of Benign Thyroid Nodules

BioMed Research International ◽

10.1155/2018/1025657 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Wengang Liu ◽

Ping Zhou ◽

Yongfeng Zhao ◽

Shuangming Tian ◽

Xiaomin Wu

Keyword(s):

Laser Ablation ◽

Thyroid Nodules ◽

Reduction Rate ◽

Microvascular Perfusion ◽

Volume Reduction ◽

Contrast Enhanced ◽

Superb Microvascular Imaging ◽

Microvascular Imaging ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Purpose. To compare superb microvascular imaging (SMI) with contrast-enhanced ultrasonography (CEUS) for evaluating the ablation of benign thyroid nodules. Methods. 225 Patients with 256 benign thyroid nodules underwent conventional ultrasound, color Doppler flow imaging (CDFI), CEUS, and SMI before and after laser ablation. They were routinely followed up at 1, 3, 6, and 12 months. The volume and volume reduction rate of the ablated nodules was calculated. Results. On SMI, the complete ablated nodules had no microvascular perfusion, while the incompletely ablated nodules had microvascular perfusion at the edge of the nodule. The percentages of the detected incompletely ablated nodules of SMI (37/256, 14.45%) and CEUS (41/256, 16.02%) were comparable, and both were significantly higher than CDFI (P< 0.001). CEUS was used as the criterion to determine whether the nodules were completely ablated. The sensitivity, specificity, and accuracy of SMI for detecting incompletely ablated nodules were 90.2, 98.2, and 100%, respectively. The volume of ablated nodules, as measured on ultrasound, was greater than that on CEUS or SMI (both P< 0.001), while CEUS and SMI were similar. The average volume reduction rate of nodules at 1, 3, 6, and 12 months was 40.25, 54.98, 76.83, and 95.43%, respectively. Conclusion. SMI sensitively detected the capillaries within residual thyroid nodules after laser ablation. The lesion size and detection rate of incompletely ablated nodules via SMI was consistent with that of CEUS. SMI may replace CEUS in certain cases for monitoring the curative effect of laser ablation for benign thyroid nodules.

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Machine Learning Prediction of Radiofrequency Thermal Ablation Efficacy: A New Option to Optimize Thyroid Nodule Selection

European Thyroid Journal ◽

10.1159/000504882 ◽

2019 ◽

Vol 9 (4) ◽

pp. 205-212 ◽

Cited By ~ 5

Author(s):

Roberto Negro ◽

Matteo Rucco ◽

Annalisa Creanza ◽

Alberto Mormile ◽

Paolo Piero Limone ◽

...

Keyword(s):

Machine Learning ◽

Predictive Value ◽

Thermal Ablation ◽

Thyroid Nodules ◽

Reduction Rate ◽

Learning Model ◽

Volume Reduction ◽

Machine Learning Model ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Background: Radiofrequency (RF) is a therapeutic modality for reducing the volume of large benign thyroid nodules. If thermal therapies are interpreted as an alternative strategy to surgery, critical issues in their use are represented by the extent of nodule reduction and by the durability of nodule reduction over a long period of time. Objective: To assess the ability of machine learning to discriminate nodules with volume reduction rate (VRR) < or ≥50% at 12 months following RF treatment. Methods: A machine learning model was trained with a dataset of 402 cytologically benign thyroid nodules subjected to RF at six Italian Institutions. The model was trained with the following variables: baseline nodule volume, echostructure, macrocalcalcifications, vascularity, and 12-month VRR. Results: After training, the model could distinguish between nodules having VRR <50% from those having VRR ≥50% in 85% of cases (accuracy: 0.85; 95% confidence interval [CI]: 0.80–0.90; sensitivity: 0.70; 95% CI: 0.62–0.75; specificity: 0.99; 95% CI: 0.98–1.0; positive predictive value: 0.95; 95% CI: 0.92–0.98; negative predictive value: 0.95; 95% CI: 0.92–0.98). Conclusions: This study demonstrates that a machine learning model can reliably identify those nodules that will have VRR < or ≥50% at 12 months after one RF treatment session. Predicting which nodules will be poor or good responders represents valuable data that may help physicians and patients decide on the best treatment option between thermal ablation and surgery or in predicting if more than one session might be necessary to obtain a significant volume reduction.

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