Radiofrequency ablation for symptomatic, non-functioning, thyroid nodules: a single center learning curve

Objective: Radiofrequency ablation (RFA) is increasingly considered the prime option for treating symptomatic, benign, non-functioning thyroid nodules (NFTN). However, little is known about the degree of operator experience required to achieve optimal results. This study describes the RFA learning curve of a single-centre team. Methods: Retrospective cohort study of the first 103 patients receiving RFA treatment for a single, symptomatic, and benign NFTN, with a follow-up of at least one year. Primary outcome measure was technique efficacy, defined as the percentage of patients with a 6-month nodal volume reduction ratio (VRR) > 50% after single-session RFA. Optimal treatment efficacy was defined as a 6-month VRR > 50% achieved in at least 75% of patients. Secondary outcomes were complications of RFA and indications of secondary interventions. Results: Median nodal volume at baseline was 12.0 ml (range 2.0–58.0 ml). A 6-month VRR > 50% was achieved in 45% of the first 20 patients, 75% of the next 20, and 79% of the following 63 patients. Complications included minor bleeding (N = 4), transient hyperthyroidism (N = 4), and transient loss of voice (N = 1). Poor volume reduction or nodular regrowth led to diagnostic lobectomy in 11 patients and a second RFA in five. Lobectomy revealed a follicular carcinoma (T2N0M0) in two patients. In one patient, nodule regrowth was caused by an intranodular solitary B-cell lymphoma. Conclusion: About 40 procedures are required to achieve a 6-month VRR > 50% in the majority of patients. Appropriate follow-up with re-evaluation is recommended for all patients with a VRR < 50% and in those with regrowth to exclude underlying malignancy.

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

Frontiers in Endocrinology ◽

10.3389/fendo.2021.638880 ◽

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 < 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 < 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 < 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 >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.

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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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Learning curve in performing radiofrequency ablation of accessory pathways in patients with Wolf-Parkinson-White syndrome

Medicinski pregled ◽

10.2298/mpns0610468v ◽

2006 ◽

Vol 59 (9-10) ◽

pp. 468-471

Author(s):

Dejan Vukajlovic ◽

Aleksandar Neskovic

Keyword(s):

Radiofrequency Ablation ◽

Learning Curve ◽

Success Rate ◽

Radiofrequency Energy ◽

Operator Experience ◽

Wpw Syndrome ◽

Accessory Pathways ◽

Group A ◽

Group B

Introduction. This study examines the effect of operator experience on radiofrequency ablation (RFA) of accessory pathways success rate in patients with Wolff-Parkinson-White (WPW) syndrome. Material and methods. The first 100 consecutive patients with WPW syndrome treated by radiofrequency ablation at our Clinic, were divided into group A (first 50 patients) and group B (the following 50 patients). Various parameters were compared between these 2 groups. Results. The success rate in group A was 69% and in group B 92%, p<0,01. There were 6 patients with recurrent WPW syndrome, after 3 months of follow-up, 5 were from group A and 1 from group B, p<0,05. Significantly more applications of radiofrequency energy were delivered in group A (10,0?4,8 in group A and 6,2 ?3,1 in group B, p<0,05). Two patients from group A presented with complications: one had intermittent complete AV-block, and the other pericardial effusion. Conclusion. This study shows a clear learning curve in performing RFA of accessory pathways in patients with WPW syndrome. .

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Efficacy and safety of radiofrequency ablation for benign thyroid nodules in patients with previous thyroid lobectomy

BMC Medical Imaging ◽

10.1186/s12880-021-00577-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lin Yan ◽

Mingbo Zhang ◽

Fang Xie ◽

Jun Ma ◽

Jing Xiao ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Symptom Score ◽

Thyroid Function ◽

Thyroid Nodules ◽

Efficacy And Safety ◽

Thyroid Lobectomy ◽

The Mean ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Abstract Background Radiofrequency ablation (RFA) is recommended for the treatment of benign thyroid nodules. However, data on the clinical role of RFA for benign thyroid nodules in patients with history of thyroid lobectomy are insufficient. The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign thyroid nodules in patients who had previously undergoing thyroid lobectomy. Methods From May 2015 to October 2018, a total of 20 patients (19 females, 1 male, mean age 49.50 ± 14.26 years, range 22–74 years) with 20 benign thyroid nodules (mean volume 15.04 ± 21.17 ml, range 0.40–69.67 ml) who had undergone previous thyroid lobectomy were included in this retrospective study. Patients were followed up at 3, 6, 12 months after RFA and every 12 months thereafter by ultrasound, clinical evaluation and thyroid function. Volume, volume reduction rate (VRR), symptom score and cosmetic score were evaluated. Results During the mean follow-up time of 21.24 ± 16.41 months, the mean nodule volume decreased significantly from 15.04 ± 21.17 ml to 1.29 ± 1.17 ml (P = 0.018) with a mean VRR of 85.41 ± 12.17%. Therapeutic success was achieved in a single session for all thyroid nodules. The symptom score (P = 0.001) and cosmetic score (P = 0.001) were both significantly reduced at the last follow-up. The levels of free triiodothyronine (fT3), free thyroxine (fT4) and thyroid stimulating hormone were not significantly different at the last follow-up from those prior to treatment (all P > 0.05). No life-threatening complications or sequelae occurred after RFA. Conclusions As a minimally invasive modality, RFA was a safe, effective, and thyroid function-preserving option for patients with symptomatic benign thyroid nodules after a previous lobectomy.

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Ultrasound-Guided Moving Shot Radiofrequency Ablation of Benign Soft Tissue Neoplasm

Medicina ◽

10.3390/medicina57080830 ◽

2021 ◽

Vol 57 (8) ◽

pp. 830

Author(s):

Wei-Che Lin ◽

Yi-Fan Tai ◽

Meng-Hsiang Chen ◽

Sheng-Dean Luo ◽

Faye Huang ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Soft Tissue ◽

General Anesthesia ◽

Local Anesthesia ◽

Venous Malformation ◽

Volume Reduction ◽

The Other ◽

Invasive Treatment ◽

Soft Tissue Neoplasm

Background and Objective: To evaluate the effectiveness of radiofrequency ablation (RFA) using the moving-shot technique for benign soft tissue neoplasm. Materials and Methods: This retrospective study reviewed eight patients with benign soft tissue neoplasm presenting with cosmetic concerns and/or symptomatic issues who refused surgery. Six patients had vascular malformation, including four with venous malformation and two with congenital hemangioma. The other two patients had neurofibroma. All patients underwent RFA using the moving-shot technique. Imaging and clinical follow-up were performed in all patients. Follow-up image modalities included ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging. The volume reduction ratio (VRR), cosmetic scale (CS), and complications were evaluated. Results: Among the seven patients having received single-stage RFA, there were significant volume reductions between baseline (33.3 ± 21.2 cm3), midterm follow-up (5.1 ± 3.8 cm3, p = 0.020), and final follow-up (3.6 ± 1.4 cm3, p = 0.022) volumes. The VRR was 84.5 ± 9.2% at final follow-up. There were also significant improvements in the CS (from 3.71 to 1.57, p = 0.017). The remaining patient, in the process of a scheduled two-stage RFA, had a 33.8% VRR after the first RFA. The overall VRR among the eight patients was 77.5%. No complications or re-growth of the targeted lesions were noted during the follow-up period. Of the eight patients, two received RFA under local anesthesia, while the other six patients were under general anesthesia. Conclusions: RFA using the moving-shot technique is an effective, safe, and minimally invasive treatment for benign soft tissue neoplasms, achieving mass volume reduction within 6 months and significant esthetic improvement, either with local anesthesia or with general anesthesia under certain conditions.

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Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients

European Radiology ◽

10.1007/s00330-008-0880-6 ◽

2008 ◽

Vol 18 (6) ◽

pp. 1244-1250 ◽

Cited By ~ 224

Author(s):

Woo Kyoung Jeong ◽

Jung Hwan Baek ◽

Hyunchul Rhim ◽

Yoon Suk Kim ◽

Min Sook Kwak ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Thyroid Nodules ◽

Benign Thyroid Nodules ◽

Benign Thyroid

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Afirma Testing in Thyroid Nodules with Indeterminate Cytology: A single Medical Institute Experience

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.207 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S94-S95

Author(s):

Z Yang ◽

T Zhang ◽

L Layfield ◽

M Esebua

Keyword(s):

Predictive Value ◽

Thyroid Nodules ◽

False Negative ◽

Follicular Adenoma ◽

Follicular Carcinoma ◽

Medical Institute ◽

Cell Adenoma ◽

Indeterminate Cytology ◽

Thyroid Fna

Abstract Introduction/Objective About 10 to 30% of thyroid fine needle aspiration (FNA) nodules have indeterminate cytology, including Bethesda III, IV, and V. Afirma Gene Expression Classifier (GEC) measuring the expression of 167 mRNA was designed to classify the indeterminate thyroid nodules into benign and suspicious categories. This study aimed to evaluate the clinical performance of the Afirma GEC testing in these indeterminate thyroid lesions. Methods Medical records of patients with indeterminate thyroid FNA results and corresponding Afirma GEC results from November 2012 to December 2019 were retrieved. Subsequent surgical follow-up results were obtained. GEC results were compared to the histologic diagnoses. Results 1. There were 77 cases with indeterminate thyroid FNA results. Cytology diagnosis included 67 Bethesda III and 10 Bethesda IV. Afirma GEC results were benign for 41 cases (53%), suspicious for 32 cases (42%), and non- diagnostic for 4 cases (5%). Twenty seven of 32 cases (84%) with suspicious GEC results had surgical follow-up which revealed 12 malignant and 15 benign histologic diagnoses. Only 11 of 41 cases (27%) with benign GEC results had surgery which showed 8 benign and 3 malignant diagnoses. Based on the data, the sensitivity of this test is 80% and specificity is 65%. Positive predictive value (PPV) is 44% and negative predictive value (NPV) is 73%. The false positive cases include 5 Hurthle cell adenoma, 4 nodular hyperplasia, 3 follicular adenoma, 2 Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFPT), and 1 lymphocytic thyroiditis. The false negative cases include 2 minimally invasive follicular carcinoma (from same patient) and 1 papillary thyroid carcinoma. Conclusion 1. We demonstrated in this study that a little more than half of the cases with indeterminate thyroid cytology had negative Afirma GEC results. 2.Afirma test has relatively low specificity (65%) and PPV (44%). The sensitivity (80%) and NPV (73%) is relatively higher but is lower than the values in most literature. This could be due to the fact that majority of the Afirma GEC negative cases in this study did not have surgical follow-up and the sample size is small. 3.Afirma GEC test is a relatively good “rule-out” molecular test for indeterminate thyroid nodules but is not a reliable “rule-in” test due to the low specificity and PPV.

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Management of bleeding associated with radiofrequency ablation of benign thyroid nodules

Journal of International Medical Research ◽

10.1177/0300060520937526 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052093752

Author(s):

Kunpeng Hu ◽

Yufan Lian ◽

Jinfen Wang ◽

Wenchao Li ◽

Zhicheng Yao ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Thyroid Nodules ◽

Effective Management ◽

Voice Change ◽

Life Threatening ◽

The Mean ◽

Benign Thyroid Nodules ◽

Benign Thyroid ◽

Clinical Strategy

Objective This study was performed to explore the effective management of bleeding associated with radiofrequency ablation (RFA) of benign thyroid nodules. Methods Thirty-five patients with benign thyroid nodules who were treated with ultrasound-guided RFA from July 2015 to December 2016 at the Third Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed. The technique efficacy, bleeding, and other complications were assessed during the follow-up period. Results The mean technique efficacy was 55.6%±22.8% at 1 month and 24.1%±17.1% at 6 months after the procedure. One case of an intranodular haematoma and two cases of voice change (>1 month) were observed. All patients recovered with corresponding treatment. Conclusion Although the incidence of haemorrhage is low, serious haematomas are life-threatening. Therefore, having a comprehensive understanding of the potential complications, an accurate clinical strategy, and adequate technical skills may prevent or help to properly manage these complications.

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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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Clinicopathologic Characteristics of Thyroid Nodules Positive for PTEN Mutations on Preoperative Molecular Testing

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.2073 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A1013-A1014

Author(s):

Jacob Quaytman ◽

Yuri E Nikiforov ◽

Marina Nikiforova ◽

Elena Morariu

Keyword(s):

Thyroid Nodules ◽

Follicular Carcinoma ◽

Retrospective Chart Review ◽

Needle Aspiration ◽

Follicular Neoplasm ◽

Molecular Testing ◽

Nras Mutation ◽

Clinicopathologic Characteristics ◽

Nodule Size

Abstract Somatic and germline mutations of PTEN tumor suppressor gene are associated with follicular-pattern thyroid tumors and PTEN Hamartoma Tumor Syndrome (PHTS). The incidence of cancer in thyroid nodules positive for PTEN mutations on fine-needle aspiration (FNA) is not well defined. The aim of this study was to characterize diagnostic and phenotypic features of thyroid nodules with preoperatively detected PTEN mutations and their impact on management. Thyroid nodules with PTEN mutations on ThyroSeq v3 GC testing of FNA and core needle biopsy specimens from November 2017 to July 2020 were identified from the ThyroSeq Molecular Database. Demographic and clinicopathologic data were obtained through retrospective chart review. We identified 49 PTEN mutation-positive nodules from 48 patients. Patients were 57 years old on average (range 14-88) and 80% female. Cytology was predominantly indeterminate (73% atypia of undermined significance, 18% follicular neoplasm). There were 18 (29%) frameshift, 6 (10%) splice site, and 39 (62%) single nucleotide variant PTEN mutations. Fourteen (29%) nodules had two PTEN mutations, 5 (10%) had copy number alterations, and single cases had concurrent BRAF K601N, EZH1, and NRAS mutations. Surveillance was pursued for 27 (56%) and surgery for 21 (44%) patients (16 lobectomies, 5 total thyroidectomies). There were 14 follicular adenomas (FA), 4 oncocytic FA’s, 1 oncocytic hyperplastic nodule, and 1 encapsulated follicular variant papillary thyroid carcinoma (EFVPTC). The EFVPTC had two low-frequency PTEN mutations, PTEN locus loss, an NRAS mutation, and was a low-risk tumor with capsular but no angiolymphatic invasion. Four (8.3%) patients had confirmed or suspected PHTS, all with multiple nodules. Two had surgery finding no malignancies (2 FA). One PHTS patient had a prior thyroidectomy for a MET mutation-positive nodule that was follicular carcinoma. On US, the mean nodule size of patients who had surgery was larger than the surveillance group (3.2 cm vs. 2.3 cm, p=0.02) but there was no difference in TI-RADS level (p=0.54). There was no difference in mean nodule size (3.5 cm vs. 2.6 cm, p=0.35) or TI-RADS level (p=0.81) between PHTS and non-PHTS patients. Among surveillance patients, follow-up US was done at 1 year in 13/19 (68%) and 2 years in 3/6 (50%) of eligible cases. Only 1/19 (5%) underwent repeat FNA for increased nodule size. No thyroid malignancy was found with a mean of 1.75 years of follow-up (range 1.00-2.78). The EFVPTC patient had no recurrence after 1.05 years of follow-up. In summary, thyroid nodules with isolated somatic PTEN mutations are primarily benign and can be safely followed with serial imaging. Nodules with multiple PTEN mutations were only associated with malignancy when accompanied by an additional NRAS mutation. About 8% of patients with PTEN mutations may be PHTS patients who may be at greater risk for malignancy.

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