Long-Term Follow-Up of Single-Fiber Multiple Low-Intensity Energy Laser Ablation Technique of Benign Thyroid Nodules

AimThe short-term and long-term efficacy of different thermal percutaneous ablation techniques remains a topical issue. Our group implemented percutaneous laser ablation (LA), a moving-shot technique to increase efficiency and reduce costs and variability of LA by applying multiple lower-intensity energy illuminations (MLIEI) covering the nodular volume (V) through changes in position of a single laser fiber within the thyroid nodule. The aim of the present study was to evaluate the efficacy of the single-fiber LA-MLIEI during a 5-year follow-up and to identify possible predictors of the final outcome.MethodsProspective study: Thirty outpatients (23 women and seven men) with benign symptomatic thyroid nodules were assigned to single-fiber LA-MLIEI, between 2012 and 2015. A single LA session was performed under real-time ultrasound (US) guidance using a 1,064-nm continuous-wave laser at 3 W. A 400-µm optical fiber was inserted through a 21-gauge needle, and 3–10 illuminations were performed per nodule, administering between 400 and 850 J/illumination. The total administered energy was calculated on the initial V of the nodule and the estimated ablation area. US evaluation was performed after LA-MLIEI at 1 week and 1, 3, 6, and 12 months and after that annually up to 5 years. Clinical symptoms, laboratory thyroid function during follow-up, and acute and chronic complications of treatment were registered.ResultsOn follow-up, 67% (n: 20) were responders to single-fiber LA-MLIEI, while 33% (n: 10) were non-responders. The responder group initiated V reduction (ΔV) at 1 month, with remission of symptoms, and presented a 50% ΔV at 3 months of treatment; the maximum response was achieved at 24 months and remained stable until the end of the study. The non-responder group presented a ΔV of less than 50% at 12 months; though a tendency to >50% ΔV was observed at 24–36 months, there was subsequent regrowth, and 40% of this group required surgery. ΔV was positively correlated with the total administered energy/V (J/V) and inversely with nodule V. No severe adverse effects were observed. Thyroid function remained normal in all patients. Remission of symptoms occurred rapidly after 1 month.ConclusionsLA with multiple fractional discharges employing a single fiber in a unique session is a safe and inexpensive technique that allows rapid reduction of thyroid nodules, with a stable response up to 5 years, similarly to what has been reported with the conventional LA. Total nodule volume appears as a predictive factor of the reduction.

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Long-term Efficacy of Ultrasound-Guided Laser Ablation for Benign Solid Thyroid Nodules. Results of a Three-Year Multicenter Prospective Randomized Trial

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2014-1826 ◽

2014 ◽

Vol 99 (10) ◽

pp. 3653-3659 ◽

Cited By ~ 73

Author(s):

E. Papini ◽

T. Rago ◽

G. Gambelunghe ◽

R. Valcavi ◽

G. Bizzarri ◽

...

Keyword(s):

Laser Ablation ◽

Side Effects ◽

Thyroid Function ◽

Thyroid Nodules ◽

Local Symptom ◽

Group 2 ◽

Volume Decrease ◽

Group 1

Abstract Background: The aim of the present trial on ultrasound (US)-guided laser ablation therapy (LAT) of solid thyroid nodules is to assess long-term clinical efficacy, side effects, and predictability of outcomes in different centers operating with the same procedure. Patients: Two hundred consecutive patients were randomly assigned to a single LAT session (group 1, 101 cases) or to follow-up (group 2, 99 cases) at four thyroid referral centers. Entry criteria were: solid thyroid nodule with volume of 6–17 mL, repeat benign cytological findings, normal thyroid function, no autoimmunity, and no thyroid gland treatment. Methods: Group 1: LAT was performed in a single session with two optical fibers, a 1064 nm Nd-YAG laser source, and an output power of 3 W. Volume and local symptom changes were evaluated 1, 6, 12, 24, and 36 months after LAT. Side effects and tolerability of treatment were registered. Group 2: Follow-up with no treatment. Results: One patient was lost to follow-up in each group. Group 1: Volume decrease after LAT was −49 ± 22%, −59 ± 22%, −60 ± 24%, and −57 ± 25% at 6, 12, 24, and 36 months, respectively (P < .001 vs baseline). LAT resulted in a nodule reduction of >50% in 67.3% of cases (P < .001). Local symptoms decreased from 38 to 8% of cases (P = .002) and cosmetic signs from 72 to 16% of cases (P = .001). Baseline size, presence of goiter (P = .55), or US findings (fluid component ≤ 20% [P = .84], halo [P = .46], vascularization [P = .98], and calcifications [P = .06]) were not predictive factors of a volume decrease > 50%. The procedure was well tolerated in most (92%) cases. No changes in thyroid function or autoimmunity were observed. In group 2, nodule volume increased at 36 months (25 ± 42%; P = .04). The efficacy and tolerability of the procedure were similar in different centers. Conclusions: A single LAT treatment of solid nodules results in significant and persistent volume reduction and local symptom improvement, in the absence of thyroid function changes.

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

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530319666190206123156 ◽

2019 ◽

Vol 19 (7) ◽

pp. 1041-1045 ◽

Cited By ~ 6

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.

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Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules

Acta Endocrinologica ◽

10.1530/eje-11-0220 ◽

2011 ◽

Vol 165 (1) ◽

pp. 123-128 ◽

Cited By ~ 73

Author(s):

Helle Døssing ◽

Finn Noe Bennedbæk ◽

Laszlo Hegedüs

Keyword(s):

Thyroid Nodule ◽

Thyroid Function ◽

Thyroid Surgery ◽

Laser Photocoagulation ◽

Thyroid Nodules ◽

Interstitial Laser Photocoagulation ◽

Nodule Volume ◽

Interstitial Laser

AimTo evaluate the long-term efficacy of interstitial laser photocoagulation (ILP) in solitary benign thyroid nodules.Design and methodsA total of 78 euthyroid outpatients (45 participating in randomized trials) with a benign solitary solid and scintigraphically cold thyroid nodule causing local discomfort were assigned to ILP. ILP (using one laser fiber) was performed under continuous ultrasound (US) guidance and with an output power of 1.5–3.5 W. Thyroid nodule volume was assessed by US and thyroid function determined by routine assays, before and during follow-up. Pressure symptoms and cosmetic complaints were evaluated on a visual analogue scale (0–10 cm). Of the total patients, six had thyroid surgery 6 months after ILP and three were lost to follow-up. The median follow-up for the remaining 69 patients was 67 months (range 12–114).ResultsThe overall median nodule volume decreased from 8.2 ml (range 2.0–25.9) to 4.1 ml (range 0.6–33.0; P<0.001) at the final evaluation, corresponding to a median reduction of 51% (range: −194 to 95%). This correlated with a significant decrease in pressure as well as cosmetic complaints. After 12--96 months (median 38 months) of ILP, 21 patients (29%) had thyroid surgery because of an unsatisfactory result. All had benign histology. Thyroid function was unaltered throughout and side effects were restricted to mild local pain.ConclusionUS-guided ILP results in a satisfactory long-term clinical response in the majority of patients with a benign solitary solid cold thyroid nodule. Further large-scale studies should aim at optimizing selection criteria for ILP, preferably in randomized studies.

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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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Percutaneous, Ultrasound-guided Laser Ablation of Benign Thyroid Nodules: Results of 10-year Follow-up in 171 Patients

Journal of the Endocrine Society ◽

10.1210/jendso/bvab081 ◽

2021 ◽

Author(s):

Giovanni Gambelunghe ◽

Elisa Stefanetti ◽

Nicola Avenia ◽

Pierpaolo De Feo

Keyword(s):

Laser Ablation ◽

Thyroid Nodules ◽

Single Session ◽

Ultrasound Guided ◽

Prolonged Effect ◽

Nodule Volume ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Abstract Background Percutaneous, ultrasound-guided laser ablation is effective in nodular thyroid disease. The aim of this study was to evaluate the long-term (10-year) efficacy and safety of laser ablation in the treatment of benign thyroid nodules. Methods Between 2009 and 2010, 171 patients received a single session of laser ablation. Evaluation of nodule volume was performed before treatment, at 6 months, and every year. Results Technique efficacy was achieved in 92% of patients at 1 year. Median nodule volume significantly decreased from 16.7 mL (range: 11.0−97.0 mL) at baseline to 5.0 mL (range: 4.1−32.0 mL) at 1 year, a volume reduction ratio (VRR) of 68%. The benefit of the treatment was durable (p < 0.001 vs baseline at all timepoints), with a VRR of 59% after 10 years. No cases of nodule regrowth >50% were observed at 1 year, although such cases did occur after 4 years (n = 3; 1.7% of the overall cohort) and 7 years (n = 8; 4.7%). There were no further cases of regrowth beyond 7 years. When patients were stratified according to baseline nodule volume (<15 mL, 15−25 mL, or >25 mL), durable results were observed across all 3 categories, with the largest, most prolonged effect observed in patients with nodules <15 mL. Treatment was well tolerated, with only minor, transient complications of fever and local pain, and 98% of patients willing to recommend the treatment. Conclusions Percutaneous, ultrasound-guided laser ablation of benign thyroid nodules provides long-term benefits and the treatment is well tolerated.

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Long-term efficacy of ultrasound-guided laser ablation for solid thyroid nodules. A three-year multicenter prospective randomized trial

Endocrine Abstracts ◽

10.1530/endoabs.35.p988 ◽

2014 ◽

Author(s):

Enrico Papini ◽

Teresa Rago ◽

Giovanni Gambelunghe ◽

Roberto Valcavi ◽

Giancarlo Bizzarri ◽

...

Keyword(s):

Laser Ablation ◽

Randomized Trial ◽

Thyroid Nodules ◽

Prospective Randomized Trial ◽

Ultrasound Guided ◽

Term Efficacy

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Endoscopically controlled surgery with open hemilaminectomy for the treatment of intradural extramedullary tumors: an operative technique and short-term outcomes of 20 consecutive cases

Chinese Neurosurgical Journal ◽

10.1186/s41016-020-00222-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Xiaorong Yan ◽

Huiqing Wang ◽

Cai Li ◽

Yuanxiang Lin ◽

Lin Lin ◽

...

Keyword(s):

Surgical Technique ◽

Spinal Deformity ◽

Tumor Recurrence ◽

Clinical Symptoms ◽

Short Term ◽

Before And After ◽

Intradural Extramedullary ◽

Controlled Surgery

Abstract Background To present a surgical technique for the treatment of intradural extramedullary (IDEM) tumors by using endoscopically controlled surgery with open hemilaminectomy technique. Methods In this study, 20 patients with 22 IDEM tumors were enrolled. An endoscopically controlled surgery with open hemilaminectomy was employed to remove the tumors. Data related to clinical symptoms and medical images before and after surgery were collected for perioperative evaluation and follow-up analysis. Results All the tumors in 20 patients were well removed. The clinical symptoms were significantly reduced in all the patients as well. The short-term follow-up data showed that there was no tumor recurrence or spinal deformity. Conclusion The endoscopically controlled surgery with open hemilaminectomy technique provided favorable exposure and satisfactory resection to the IDEM tumors. It may be an effective surgical method for treating IDEM tumors. Larger samples and longer follow-up data are needed to verify its long-term effectiveness.

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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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