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

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.

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

2017 ◽  
Vol 242 (15) ◽  
pp. 1515-1523 ◽  
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.

One-year outcomes of radiofrequency ablation of incompetent perforator veins using the radiofrequency stylet device: Cohort study from East Asia

2020 ◽  
pp. 026835552097348
Author(s):  
Chang-Ming Wang ◽  
Shi-Lu Zhao ◽  
Qi-Chen Feng ◽  
Shuo Gai ◽  
Xuan Li
Keyword(s):  
Cohort Study ◽  
Radiofrequency Ablation ◽  
Success Rate ◽  
Technical Success ◽  
Technical Success Rate ◽  
Sonographic Evaluation ◽  
Primary Endpoints ◽  
Secondary Endpoints ◽  
One Year

Objectives The present study was designed to assess outcomes of patients undergone radiofrequency ablation (RFA) for their incompetent perforator veins (IPVs) with ClosureFast stylets. Methods Data of 165 IPVs in 138 limbs of 117 consecutive patients between July 2017 to Nov. 2019 were retrospectively reviewed. Primary endpoints (technical success rate, complications) and secondary endpoints (VCSS) were analyzed. Results The immediate technical success rate was 100%. There were no major complications. The rate of ecchymosis and induration was 5.8%. 129/165 IPVs in 79.5% (93/117) patients had achieved sonographic evaluation at 1 year followed-up, in which 3 perforators were recanalized. VCSS scores at pre-operation and 1-year follow-up were 5.77 ± 1.88 and 2.70 ± 1.39, respectively ( t= 29.644, P= .000). Conclusions In conclusion, RFA is safe and effective for the treatment of IPVs. At the 1-year follow-up, the RFA of IPVs showed a low recanalization rate and had a satisfactory improvement on VCSS.

scholarly journals Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Hideki Kamada ◽  
Hideki Kobara ◽  
Naohito Uchida ◽  
Kiyohito Kato ◽  
Takayuki Fujimori ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Technical Success ◽  
Technical Success Rate ◽  
High Risk Patients ◽  
Risk Patients

Background. Endoscopic transpapillary gallbladder stenting (ETGBS) is an effective procedure for treating high-risk patients with acute cholecystitis and severe comorbidities. However, the efficacy of ETGBS for recurrent cholecystitis (RC) remains unclear. This study aimed to explore its efficacy in patients with RC for whom cholecystectomy is contraindicated because of its high surgical risk.Methods. Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. The primary outcome was the clinical success rate, which was defined as no recurrences of acute cholecystitis after ETGBS until death or the end of the follow-up period. Secondary outcomes were technical success rate and adverse events (AEs).Results. The clinical success rate of ETGBS was 100%, the technical success rate 94.7%, and AE rate 5%: one patient developed procedure-related mild acute pancreatitis. The clinical courses of all patients were as follows: four died of nonbiliary disease, and the remaining 15 were subsequently treated conservatively. The median duration of follow-up was 14.95 months (range 3–42 months).Conclusions. ETGBS is an effective alternative for managing RC in high-risk patients with severe comorbidities.

scholarly journals The Role of Intraarterial Chemotherapy in the Management of Retinoblastoma

2020 ◽  
Vol 2020 ◽  
pp. 1-16 ◽  
Author(s):  
Aleksandra Pekacka
Keyword(s):  
Success Rate ◽  
Retention Rate ◽  
Intraarterial Chemotherapy ◽  
Treatment Modalities ◽  
Technical Success ◽  
Secondary Neoplasms ◽  
Systemic Complications ◽  
Technical Success Rate

Introduction. Retinoblastoma is the most common primary intraocular neoplasm in children. With the advances in medicine, the armamentarium of available treatment modalities has grown. Intraarterial chemotherapy is a relatively new treatment method with promising outcomes. The purpose of this literature review is to evaluate its role in the management of retinoblastoma. Methods. A systematic online search was conducted using Ovid Embase and Ovid Medline. The final results included 23 studies. The studies were published between 2011 and 2019. The studies evaluated the technical success rate of IAC, globe salvage rate, and ocular and systemic complications, as well as the occurrence of deaths, metastasis, and secondary neoplasms. In total, 1827 eyes with retinoblastoma were analysed. The follow-up was between 0 and 252 months. Results. Overall globe retention rate ranged from 30% to 100%. Sixteen out of 23 studies reported ocular salvage between 60 and 80%. Eyelid oedema and erythema were the most commonly reported ocular complications following IAC. The most common systemic complications included nausea, vomiting, and neutropenia. Metastases and deaths were reported in 6 out of 23 studies. Three studies reported the development of secondary neoplasms. The technical success rate of IAC procedure ranged from 91% to 100%. Discussion. The studies have shown that IAC is a safe and effective treatment for advanced retinoblastoma, especially group D. It allows to save the globe without compromising patients’ survival. Local and systemic complications are acceptable. The role of IAC in less advanced tumours is yet to be established. Future work should focus on conducting larger prospective studies with longer follow-up. Multiple novel therapies for the management of retinoblastoma are currently being tested, including angiogenic inhibitors and targeted agents. The results seem to be promising. Future advances require a further in-depth understanding of unique genetics of retinoblastoma and complex interactions between tumour cells and their microenvironment.

scholarly journals Predictor Analysis in Radiofrequency Ablation of Benign Thyroid Nodules: A Single Center Experience

2021 ◽  
Vol 12 ◽  
Author(s):  
Alessandro Bisceglia ◽  
Ruth Rossetto ◽  
Sara Garberoglio ◽  
Angelica Franzin ◽  
Alice Cerato ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Thyroid Nodules ◽  
Neck Circumference ◽  
Volume Reduction ◽  
Single Center ◽  
Treatment Volume ◽  
Pre Treatment ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

PurposeTo confirm the efficacy of ultrasound (US) guided radiofrequency ablation (RFA) in the treatment of benign thyroid nodules, we evaluated as primary outcome the technical efficacy and clinical success in a single center dataset. The secondary outcome was to find a correlation between nodules’ pre-treatment features and volume reduction rate (VRR) ≥75% at 12 months after RFA and during follow-up period.MethodsThis retrospective study included 119 consecutive patients (99 females, 20 males, 51.5 ± 14.4 years) with benign thyroid nodules treated in our hospital between October 2014 and December 2018 with a mean follow-up of 26.8 months (range 3–48). Clinical and US features before and after RFA were evaluated by a US examination at 1, 3, 6, 12 months and annually thereafter up to 48 months.ResultsThe median pre-treatment volume was 22.4 ml; after RFA we observed a statistically significant volume reduction from the first month (11.7 ml) to the last follow-up (p &lt; 0.001 for all follow-up times). The median VRR was 47.1, 55.3, 61.2, 67.6, 72.8, 71.3, and 62.9% at 1, 3, 6, 12, 24, 36, and 48 months of follow-up respectively, showing a progressive significant improvement up to 24 months (VRRs 1 vs 3 months, 3 vs 6 months and 6 vs 12 months p &lt; 0.001, 12 vs 24 months p = 0.05) while no differences at 24 vs 36 and 36 vs 48 months were observed. Symptoms improved significantly (complete resolution 64.35%, partial resolution 35.65%), and neck circumference was reduced as compared to pre-treatment (p &lt; 0.001). Lower pre-treatment neck circumference (37.5 vs 36.0 cm, p = 0.01) was a positive predictor of VRR ≥75% at 12 months. Macrocystic echostructure (HR 2.48, p 0.046) and pre-treatment volume &gt;22.4 ml (HR 0.54, p 0.036) were found to be independent positive and negative predictors of VRR ≥75% respectively. One-month post RFA VRR ≥50% represented the best positive predictor of technical success.ConclusionsThis study confirmed the efficacy of RFA in the treatment of benign thyroid nodules. In particular we show that by selecting macrocystic nodules smaller than 22.4 ml better long-term response can be achieved, which is predicted by an early shrinkage of the nodule.

scholarly journals Efficacy and Safety of Single-Session Radiofrequency Ablation in Treating Benign Thyroid Nodules: A Short-Term Prospective Cohort Study

2021 ◽  
Author(s):  
Bang Nguyen Van ◽  
Xuan Thi Nguyen ◽  
Hau Van Vy Nguyen ◽  
Thuy Hai Nguyen ◽  
Toan Dinh Nguyen ◽  
...  
Keyword(s):  
Success Rate ◽  
Thyroid Nodules ◽  
Reduction Ratio ◽  
Volume Reduction ◽  
Thyroid Function Tests ◽  
Short Term ◽  
Therapeutic Success ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Abstract Objective:The aims of this study are to evaluate the safety and efficacy of RFA in the treatment of benign thyroid nodule(s) and to find independent factors related to the volume reduction rate of the nodule(s).Materials and methods: This short-term prospective study from a single medical center was conducted on 93 benign thyroid nodules in 93 patients treated with RFA. Two basic techniques were used: the trans-isthmic approach, moving-shot technique. Clinical and ultrasonography examinations were performed at 1; 3 months follow-up after the treatment session. Primary outcomes included volume reduction ratio (VRR) at 1 month and 3 months follow-ups; Secondary outcomes were therapeutic success rate and complications. Multiple linear regression analysis was used to determine independent factors associated with VRR. Results: A final sample of 78 patients with 78 nodules, given participant rate 83.8%, (included 60 solid nodules, 16 predominantly cystic nodules, and 2 thyroid cysts) was followed for 3 months. The mean volume reduction ratio was 41.47% and 64.72% after 1 month and 3 months follow-ups, respectively. The therapeutic success rate was 30.8% at 1 month and 84.6% at 3-month follow-ups. Symptom score and cosmetic score improved significantly. There was no change in thyroid function tests. Two minor complications (transient voice change) were found. The only internal component of nodules significantly related to the VRR during the 3 months follow-up (b = 23.00; 95%CI (7.59 - 38.45)).Conclusion: RFA was demonstrated as a safe and effective option for benign thyroid nodules treatment. It can be used as an alternative treatment with encouraging results.

scholarly journals Long-term outcomes of fluoroscopy-guided tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas and tracheal stenosis

2020 ◽  
Author(s):  
Yonghua Bi ◽  
Jindong Li ◽  
Liangliang Bai ◽  
Xinwei Han ◽  
Jianzhuang Ren
Keyword(s):  
Success Rate ◽  
Tracheal Stenosis ◽  
Survival Rates ◽  
Technical Success ◽  
Technical Success Rate ◽  
Stent Removal ◽  
Total Incidence ◽  
Significant Difference

Abstract Background: Endoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal fistula and tracheal stenosis. We aimed to study the safety and efficacy of fluoroscopy-guided stent removal as well as the optimal duration for stent usage.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Reasons for stent implantation were tracheal fistula in 85 patients (TF group), and tracheal stenosis in 67 patients (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, and survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4%, respectively for the TF and TS group. Removal was routine for half of patients, and in the remainder, excessive granulation tissue was the common indications for stent removal, which was found after stenting at 142.1±25.9 days in the TF group, and at 89.9±15.0 day in the TS group. The total incidence of complications was 21.1% and 22.4%, respectively, for the TF and TS groups. Perioperative death occurred in one patient in the TF group, and two patients in the TS group. Recurrence of fistula or stenosis requiring re-stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stents is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference in outcomes. Recurrence of fistula or stenosis requiring re-stenting was the most common complication.

scholarly journals Unfavorable Outcomes in Solid and Spongiform Thyroid Nodules Treated with Laser Ablation. A 5-Year Follow-up Retrospective Study

2019 ◽  
Vol 19 (7) ◽  
pp. 1041-1045 ◽  
Author(s):  
Roberto Negro ◽  
Gabriele Greco
Keyword(s):  
Retrospective Study ◽  
Laser Ablation ◽  
Thyroid Nodules ◽  
False Negative ◽  
Thyroid Function Test ◽  
Final Diagnosis ◽  
Therapeutic Modality ◽  
Nodule Volume

Objective: Laser Ablation (LA) is a therapeutic modality for reducing the volume of large benign thyroid nodules. This retrospective study was aimed at assessing the outcome of LA in patients with benign nonfunctioning thyroid nodules in a 5-years follow-up. Methods: Sixty-two patients (47 females; mean age 54.7±12 yr) with benign cold thyroid nodules underwent LA from July 2009 to March 2012. Nodule volume, thyroid function test, and ultrasound were monitored at baseline, and at 3, 6 and 12 months after the procedure, then annually. After dividing nodules in solid and spongiform, we evaluated unfavourable outcomes: 1) nodule’s volume reduction <50%; 2) need for surgery; 3) need for additive LA session (due to nodule re-growth with persistence of cosmetic concern or compressive symptoms). Results: Baseline volume did not differ between solid and spongiform nodules as well as energy delivered and the number of needles used. Unfavourable outcomes occurred in 24 patients (38.7%). Nineteen/ 24 (79.2%) patients who experienced unfavourable outcomes belonged to the solid nodules group (P<0.01). When considering only those who benefited from LA, the 5-years reduction was 59.7% for solid and 78.6% for spongiform nodules (P<0.05). One/6 patients who underwent surgery (solid nodules group) had a final diagnosis of Follicular Variant of Papillary Thyroid Cancer (FVPTC). Conclusion: Large solid nodules, unlike spongiform, submitted to LA are characterized by a long-term unfavourable outcome and entail a potential risk of false negative cytologic results.

scholarly journals Medium-term results of undersized angioplasty and stenting for symptomatic high-grade intracranial atherosclerotic stenosis with Enterprise

2019 ◽  
Vol 25 (5) ◽  
pp. 484-490 ◽  
Author(s):  
Aysun Erbahceci Salik ◽  
Hatem H Selcuk ◽  
Hasanagha Zalov ◽  
Fatih Kilinc ◽  
Musa Cirak ◽  
...  
Keyword(s):  
Success Rate ◽  
Balloon Angioplasty ◽  
High Grade ◽  
Intracranial Artery ◽  
Technical Success ◽  
Medium Term ◽  
Stent Deployment ◽  
Technical Success Rate ◽  
Angioplasty And Stenting

Purpose The aim of this retrospective study is to evaluate medium-term results of undersized balloon angioplasty and stenting for symptomatic high-grade (70–99%) stenosis of a major intracranial artery with Enterprise stent. Methods This study included 68 consecutive symptomatic (recurrent transient ischemic attack (TIA) or ischemic stroke under dual antiplatelet treatment) patients with high-grade (70–99%) stenosis of a major intracranial artery who were endovascularly treated with undersized balloon angioplasty and Enterprise stent deployment between July 2012 and December 2017. Primary outcomes were any stroke or death within 30 days after procedure. Secondary outcomes were technical success rates, stroke and restenosis during the follow-up period. Results A total of 68 lesions in 68 patients (mean age: 62 ± 7 years) were treated with a technical success rate of 99%. The degree of pre-procedural stenosis was 92 ± 6% and dropped to 12 ± 10% after stent deployment. No patient developed any stroke or death during the periprocedural period. Intracranial hemorrhage was observed in 1 (1.5%) patient. In 60 (88%) patients with available imaging follow-up in-stent restenosis was observed in 2 patients. Mean follow-up period was 22 ± 17 months (range 6–72) and none of the patients experienced recurrent TIA or stroke during the follow-up period. Conclusion In this retrospective single-center study undersized balloon angioplasty and deployment of a self-expandable stent with relatively low radial force was safe and effective for endovascular treatment of high-grade intracranial arterial stenosis with high technical success rate, low periprocedural complication rates and favorable medium-term follow-up results.

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