Unresolved Clinical Issues in Thermal Ablation of Benign Thyroid Nodules: Regrowth at Long-Term Follow-Up

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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Effectiveness of High-intensity Focused Ultrasound (HIFU) Therapy of Solid and Complex Benign Thyroid Nodules – A Long-term Follow up Two-center Study

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1719-4441 ◽

2022 ◽

Author(s):

Anne Fischer ◽

Christian Vorländer ◽

Hüdayi Korkusuz

Keyword(s):

Thyroid Nodules ◽

High Intensity Focused Ultrasound ◽

Rank Test ◽

Signed Rank ◽

Wilcoxon Signed Rank Test ◽

Signed Rank Test ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Abstract Purpose To investigate the effectiveness of high-intensity focused ultrasound (HIFU) of solid and complex benign thyroid nodules. Methods Fifty-eight patients with benign thyroid nodules were treated with HIFU at two centers from 2014–2019. The device, EchoPulse (Teraclion, Malakoff, France), heats the nodes to 80–90 °C. Nodal volumes were measured by ultrasound at regular intervals before and up to 12 months after therapy. In a retrospective long-term two-center study, average volume reductions in relation to baseline volume were statistically analyzed by the Wilcoxon signed-rank test. Side effects were documented. Results In solid nodules, the average percent volume reductions at the 3, 6, 9, and 12-months follow-up were 49.98%, 46.40%, 65.77%, and 63.88%, respectively. The results were significant with p<0.05 in the Wilcoxon signed-rank test at the 3, 6, and 9-months follow-up. In complex nodules, the average percent volume reduction was 35.2% at 3 months, 36.89% at 6 months, and 63.64% at twelve months follow up. The results were significant with p<0.05 in the Wilcoxon signed-rank test at the 3- and 6-months follow-up. The complication rate was 5.2%. All complications occurred in patients with solid nodules. Conclusion The study showed that HIFU is an effective treatment method for both solid and complex nodules. The complication rate is relatively high at 5.2%. No long-term complications occurred. The solid nodules responded better to HIFU than complex nodules.

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Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth

Endocrinology and Metabolism ◽

10.3803/enm.2019.34.2.117 ◽

2019 ◽

Vol 34 (2) ◽

pp. 117 ◽

Cited By ~ 21

Author(s):

Jung Suk Sim ◽

Jung Hwan Baek

Keyword(s):

Thermal Ablation ◽

Thyroid Nodules ◽

Long Term Outcomes ◽

Benign Thyroid Nodules ◽

Benign Thyroid

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Radiofrequency Thermal Ablation of Benign Thyroid Nodules: The Correlation Between Ultrasound Nodule Characteristics and Results

Surgical Innovation ◽

10.1177/1553350620913134 ◽

2020 ◽

pp. 155335062091313

Author(s):

Francesco Feroci ◽

Tommaso Guagni ◽

Angela Coppola ◽

Davina Perini ◽

Barbara Conforti ◽

...

Keyword(s):

Thermal Ablation ◽

Thyroid Nodules ◽

Reduction Rate ◽

Response To Treatment ◽

Initial Size ◽

Benign Nodules ◽

Benign Thyroid Nodules ◽

Radiofrequency Thermoablation ◽

Benign Thyroid

Background. The aim of this observational study was to investigate for which nodules a better response to radiofrequency thermoablation (RFA) for nonfunctioning benign thyroid nodules is likely. Methods. Aesthetic score, compressive score, and volume of 32 benign nodules from 32 patients were registered during follow-up at baseline, 1, 3, 6, and 12 months. Results. A volume reduction rate (VRR) of 72.56% at 12 months after the procedure ( P = .009) was registered. A significant ( P < .001) improvement in the compressive and aesthetic scores was observed. Nodules with a baseline volume <20 mL had VRRs at 3 and 6 months that were significantly greater than those with volume >20 mL ( P = .037). Conclusions. RFA was shown to be a safe and effective procedure for the management of benign thyroid nodules and that there is a correlation between the initial size of the nodule and the response to treatment.

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Long-Term Outcome of Microwave Ablation for Benign Thyroid Nodules: A 48-Month Follow-up Study

10.21203/rs.3.rs-1070053/v1 ◽

2021 ◽

Author(s):

Jia-Rui Du ◽

Wen-Hui Li ◽

Cheng-Hai Quan ◽

Deng-Ke Teng ◽

Hui Wang

Keyword(s):

Thyroid Function ◽

Microwave Ablation ◽

Thyroid Nodules ◽

Reduction Rate ◽

Long Term Results ◽

Long Term Outcome ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Abstract Purpose The short-term effects of microwave ablation (MWA) in the treatment of benign thyroid nodules (BTNs) were satisfactory in previous studies. However, as a slowly progressing disease, the long-term efficacy of MWA for BTNs at present is not clear. Our study aim was to assess the long-term results of MWA for BTNs after a 48-month follow-up. Methods From June 2015 to September 2017, 148 patients had 148 BTNs lesions. All patients were from China-Japan Union Hospital of Jilin University. Careful ultrasound examinations were performed 1 day, 1 month, 3 months, 6 months, 12 months, and every 6 months after MWA. The volume, volume reduction rate (VRR) recurrence rate of the ablated area and thyroid function were recorded. Results The mean volume of the 148 nodules were 15.6±9.4 cm3 (range: 1.3-48.9 cm3) and 0.6±0.6 cm3 (range: 0-3.5 cm3) before and 48 months after MWA, respectively, for a nodule VRR of 96.9±2.5% (range: 90.4-100%). Two patients (1.35%) had recurrence after MWA. Compared with that before MWA, no significant variation in thyroid function was observed after MWA. Five patients experienced complications (3.38%): two patients (1.35%) had bleeding, two patients (1.35%) had ear pain and toothache during MWA, and one patient (0.68%) had hoarseness after MWA. No cases of oesophageal injury, tracheal injury, infection, skin burn, etc., were reported during or after MWA. Conclusions Over long-term follow-up, MWA is an effective method for treating BTNs and is expected to be a potential first-line treatment.

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Response: Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth (Endocrinol Metab 2019;34:117–23, Jung Suk Sim et al.)

Endocrinology and Metabolism ◽

10.3803/enm.2019.34.3.325 ◽

2019 ◽

Vol 34 (3) ◽

pp. 325

Author(s):

Jung Suk Sim ◽

Jung Hwan Baek

Keyword(s):

Thermal Ablation ◽

Thyroid Nodules ◽

Long Term Outcomes ◽

Benign Thyroid Nodules ◽

Benign Thyroid

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