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Mauri G. Is sharpest scalpel more important than a good surgeon? Exp Gerontol 2024; 194:112521. [PMID: 39009324 DOI: 10.1016/j.exger.2024.112521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/11/2024] [Indexed: 07/17/2024]
Affiliation(s)
- Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, Irccs, Milan, Italy.
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2
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Wang YH, Chiang PL, Lin AN, Wang CK, Lee CY, Chou CK, Chang YH, Chi SY, Luo SD, Lin WC. Long-term outcomes of radiofrequency ablation for intrathoracic goiter up to 5 years: evaluated by computed tomography/magnetic resonance imaging and ultrasound. Int J Hyperthermia 2024; 41:2378865. [PMID: 39004424 DOI: 10.1080/02656736.2024.2378865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVES This study evaluated the long-term efficacy and safety of radiofrequency ablation (RFA) for intrathoracic goiter (ITG) over a follow-up period exceeding six months. METHODS From 2017 to 2022, 22 patients (6 males, 16 females) with 24 ITGs treated with RFA at a single medical center were evaluated. All patients underwent ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI) before RFA. Follow-up CT/MRI was performed six months after the initial RFA and then every 6-12 months. The primary outcomes measured were the degree of extension, goiter volume, volume reduction rate (VRR), tracheal deviation, and tracheal lumen. Additionally, we assessed the outcomes of single-session RFA (n = 16) vs. multiple sessions (n = 8) on goiters and explored the correlation between ITG volume measurements obtained using ultrasonography and CT/MRI. RESULTS The median follow-up period was 12 months (interquartile range: 6-36.8 months). At the last follow-up, the nodule volume measured by CT/MRI had significantly decreased (76.2 vs. 24.6 mL; p < 0.05), with a VRR of 64.6%. Patients who underwent multiple RFA sessions showed a significantly higher VRR than the single-session patients (63.8 vs. 80.1%, p < 0.05). The intraclass correlation between goiter volumes measured using US and CT/MRI was moderate. CONCLUSION This study affirms the long-term efficacy and safety of RFA for ITG, providing an alternative treatment for nonsurgical candidates. Multiple RFA sessions may be beneficial for achieving better volume reduction. Sole reliance on ultrasonography is inadequate; therefore, integrating CT/MRI is essential for accurate pre-RFA and follow-up assessments.
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Affiliation(s)
- Yu-Hsin Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Ying Lee
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Kai Chou
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Radiology, Jen-Ai Hospital, Dali Branch, Taichung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
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3
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Xu H, Yang JY, Zhao X, Ma Z. Advances in clinical research on ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma. Front Oncol 2024; 14:1422634. [PMID: 39040438 PMCID: PMC11260605 DOI: 10.3389/fonc.2024.1422634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
Ultrasound-guided radiofrequency ablation (RFA) emerges as a minimally invasive strategy for papillary thyroid microcarcinoma (PTMC), offering advantages over traditional surgical approaches. RFA employs high-frequency electric currents under precise ultrasound guidance to ablate cancerous tissue. Clinical trials consistently demonstrate RFA's efficacy in tumor control and patient-reported outcomes. However, long-term studies are essential to validate its durability and monitor for potential complications. Collaborative efforts among various medical disciplines ensure procedural accuracy and comprehensive postoperative care. Technological innovations, such as enhanced ultrasound imaging and temperature control, promise to refine RFA's precision and effectiveness. Nevertheless, challenges persist, including the need for standardized protocols and comparative studies with traditional treatments. Future research should focus on long-term outcomes, patient selection criteria, and optimization of procedural techniques to solidify RFA's role in PTMC management. RFA presents a promising avenue for PTMC treatment, warranting further investigation and refinement in clinical practice.
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Affiliation(s)
- Hua Xu
- Department of Ultrasound, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Jin-yan Yang
- Department of Ultrasound, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Xing Zhao
- Department of Medical Technology, Shaanxi Energy Institute, Xianyang, China
| | - Zhe Ma
- Department of Ultrasound, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China
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4
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Sun X, Chen J, Zou Y, Lei J, Liu W. Assessing the relative effectiveness of various ultrasound-guided ablation techniques for treating benign thyroid nodules: A systematic review and network meta-analysis. Medicine (Baltimore) 2024; 103:e38014. [PMID: 38701262 PMCID: PMC11062690 DOI: 10.1097/md.0000000000038014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Benign thyroid nodules (BTNs) represent a prevalent clinical challenge globally, with various ultrasound-guided ablation techniques developed for their management. Despite the availability of these methods, a comprehensive evaluation to identify the most effective technique remains absent. This study endeavors to bridge this knowledge gap through a network meta-analysis (NMA), aiming to enhance the understanding of the comparative effectiveness of different ultrasound-guided ablation methods in treating BTNs. METHODS We comprehensively searched PubMed, Embase, Cochrane, Web of Science, Ovid, SCOPUS, and ProQuest for studies involving 16 ablation methods, control groups, and head-to-head trials. NMA was utilized to evaluate methods based on the percentage change in nodule volume, symptom score, and cosmetic score. This study is registered in INPLASY (registration number 202260061). RESULTS Among 35 eligible studies involving 5655 patients, NMA indicated that RFA2 (radiofrequency ablation, 2 sessions) exhibited the best outcomes at 6 months for percentage change in BTN volume (SUCRA value 74.6), closely followed by RFA (SUCRA value 73.7). At 12 months, RFA was identified as the most effective (SUCRA value 81.3). Subgroup analysis showed RFA2 as the most effective for solid nodule volume reduction at 6 months (SUCRA value 75.6), and polidocanol ablation for cystic nodules (SUCRA value 66.5). CONCLUSION Various ablation methods are effective in treating BTNs, with RFA showing notable advantages. RFA with 2 sessions is particularly optimal for solid BTNs, while polidocanol ablation stands out for cystic nodules.
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Affiliation(s)
- Xiangmei Sun
- Department of Ultrasound, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Jiaojiao Chen
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Ultrasound, Shenzhen Futian District Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yan Zou
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Jiahao Lei
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Weizong Liu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, China
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5
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Bernardi S, Rosolen V, Barbone F, Borgato S, Deandrea M, De Feo P, Fugazzola L, Gambelunghe G, Negro R, Oleandri S, Papi G, Papini E, Retta F, Rossetto R, Sansone D, Serra G, Sconfienza LM, Solbiati L, Spiezia S, Stacul F, Mauri G. Clinical Outcomes of Thermal Ablation Re-Treatment of Benign Thyroid Nodules: A Multicenter Study from the Italian Minimally Invasive Treatments of the Thyroid Group. Thyroid 2024; 34:360-370. [PMID: 38149599 DOI: 10.1089/thy.2023.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Background: Thermal ablation (TA) is an established therapeutic option alternative to surgery in patients with solid benign thyroid nodules causing local symptoms. However, a variable part of thyroid nodules remain viable after these nonsurgical treatments, and as many as 15% of nodules treated with TA may require a second treatment over time. This study aimed to evaluate the outcomes of TA re-treatment on symptomatic benign thyroid nodules where the volume decreased by <50% after the first procedure ( = technique inefficacy). Methods: We performed a multicenter retrospective cohort study including patients who underwent re-treatment with TA for benign thyroid nodules, whose volume decreased by <50% after initial treatment. The primary aim was to evaluate volume and volume reduction ratio (VRR) over time and compare the 6- and 12-month VRR after first versus second treatment. The secondary aim was to identify protective or risk factors for technique inefficacy, regrowth, and further treatments, expressed as adjusted hazard ratios (HRs) and confidence interval [CI], after adjustment for sex, age, nodule volume, structure and function, nodule regrowth or symptom relapse, technique used and if the same technique was used for the first and second TA and time between them. Results: We included 135 patients. Re-treatment led to VRR of 50% and 52.2% after 6 and 12 months. VRR after re-treatment was greater than after first treatment in small and medium size nodules (<30 mL), while there were no differences for large nodules (>30 mL). After re-treatment technique inefficacy rate was 51.9%, regrowth rate was 12.6%, and further treatment rate was 15.6%. Radiofrequency ablation (RFA) was protective toward technique inefficacy (HR = 0.40 [CI 0.24-0.65]) and need of further treatments (HR = 0.30 [CI 0.12-0.76]). Large nodule volume (>30 mL) was associated with increased risk of re-treatment (HR = 4.52 [CI 1.38-14.82]). Conclusions: This is the first study evaluating the outcomes of re-treatment on symptomatic benign thyroid nodules with a VRR <50% after the initial TA treatment. Best results were seen in small and medium nodules (<30 mL) and after RFA. Prospective confirmatory studies are needed.
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Affiliation(s)
- Stella Bernardi
- Dipartimento di Scienze Mediche, Università degli Studi di Trieste, Trieste, Italy
- UO Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Valentina Rosolen
- Direzione centrale salute, politiche sociali e disabilità, Regione Friuli Venezia Giulia, Trieste, Italy
| | - Fabio Barbone
- Dipartimento di Scienze Mediche, Università degli Studi di Trieste, Trieste, Italy
| | - Stefano Borgato
- Divisione Endocrinologia e Metabolismo, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Maurilio Deandrea
- SC Endocrinologia Diabetologia e Malattie del Metabolismo, Ospedale Mauriziano Umberto I, Torino, Italy
| | | | - Laura Fugazzola
- Divisione Endocrinologia e Metabolismo, IRCCS Istituto Auxologico Italiano, Milano, Italy
- Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
| | | | - Roberto Negro
- UO Endocrinologia, Ospedale Vito Fazzi, Lecce, Italy
| | - Salvatore Oleandri
- SC Endocrinologia e Malattie Metaboliche, Azienda Sanitaria Locale Città di Torino, Torino, Italy
| | | | - Enrico Papini
- Dipartimento di Endocrinologia e Metabolismo, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Francesca Retta
- SC Endocrinologia Diabetologia e Malattie del Metabolismo, Ospedale Mauriziano Umberto I, Torino, Italy
| | - Ruth Rossetto
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Azienda ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniela Sansone
- SC Endocrinologia e Malattie Metaboliche, Azienda Sanitaria Locale Città di Torino, Torino, Italy
| | - Giuseppe Serra
- Dipartimento di Medicina, Università degli Studi di Udine, Udine, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Luigi Solbiati
- Dipartimento di Scienze Biomediche, Università Humanitas, Milano, Italy
| | - Stefano Spiezia
- UO Chirurgia Endocrina e Ecoguidata, Ospedale del Mare, ASL Napoli1, Napoli, Italy
| | - Fulvio Stacul
- UO Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Giovanni Mauri
- Divisione di Radiologia Interventistica, IRCCS Istituto Europeo di Oncologia (IEO), Milano, Italy
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Bojunga J, Trimboli P. Thyroid ultrasound and its ancillary techniques. Rev Endocr Metab Disord 2024; 25:161-173. [PMID: 37946091 DOI: 10.1007/s11154-023-09841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
Ultrasound (US) of the thyroid has been used as a diagnostic tool since the late 1960s. US is the most important imaging tool for diagnosing thyroid disease. In the majority of cases a correct diagnosis can already be made in synopsis of the sonographic together with clinical findings and basal thyroid hormone parameters. However, the characterization of thyroid nodules by US remains challenging. The introduction of Thyroid Imaging Reporting and Data Systems (TIRADSs) has improved diagnostic accuracy of thyroid cancer significantly. Newer techniques such as elastography, superb microvascular imaging (SMI), contrast enhanced ultrasound (CEUS) and multiparametric ultrasound (MPUS) expand diagnostic options and tools further. In addition, the use of artificial intelligence (AI) is a promising tool to improve and simplify diagnostics of thyroid nodules and there is evidence that AI can exceed the performance of humans. Combining different US techniques with the introduction of new software, the use of AI, FNB as well as molecular markers might pave the way for a completely new area of diagnostic accuracy in thyroid disease. Finally, interventional ultrasound using US-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for benign as well as malignant thyroid diseases.
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Affiliation(s)
- Joerg Bojunga
- Department of Medicine I, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt am Main, 60590, Germany.
| | - Pierpaolo Trimboli
- Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Pace-Asciak P, Tufano RP. Future Directions in the Treatment of Thyroid and Parathyroid Disease. Otolaryngol Clin North Am 2024; 57:155-170. [PMID: 37634983 DOI: 10.1016/j.otc.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
The surgical management of thyroid and parathyroid disease has evolved considerably since the era of Theodor Kocher. We review the current trends in thyroid and parathyroid surgery concerning robotic surgery for remote access, the use of parathyroid autofluorescence detection technology to aid in the prevention of hypocalcemia as well as the use of thermal ablation to target thyroid nodules in a minimally invasive way. We also discuss how artificial intelligence is being used to improve the workflow and diagnostics preoperatively as well as for intraoperative decision-making. We also discuss potential areas where future research may enhance outcomes.
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Affiliation(s)
- Pia Pace-Asciak
- Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Ralph P Tufano
- Sarasota Memorial Health Care System Multidisciplinary Thyroid and Parathyroid Center, Sarasota, FL, USA
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Xu X, Peng Y, Han G. Five-year follow-up results of thermal ablation for benign thyroid nodules: Systematic review and meta-analysis. Am J Otolaryngol 2024; 45:104025. [PMID: 37639985 DOI: 10.1016/j.amjoto.2023.104025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES Confidence in long-term treatment results of thermal ablation for benign thyroid nodules (BTNs) is required in comparison with surgery. The objective of this meta-analysis is to report 5-year follow-up results of thermal ablation for BTNs. METHODS Ovid PUBMED, COCHRANE, and EMBASE databases were searched through Feb 30, 2023, for studies reporting outcomes in patients with BTNs treated with thermal ablation and followed up for about 5 years. Pooled volume reduction rates (VRRs) at 6, 12, 24, 36, 48, and 60 months after thermal ablation were assessed. Data were extracted and methodological quality was assessed independently by two radiologists according to the PRISMA guidelines. RESULTS Five studies, involving 939 patients, met the inclusion criteria through database searches. 137 patients experienced local nodules recurrence during a mean pooled 59.25-month follow-up. Seventeen of them proved to be non-benign. Fifty of all patients with nodules regrowth had a secondary surgery, while 35 had a secondary thermal ablation. The pooled mean major complication rate was 7.70 %, with no patient experiencing life-threatening or delayed complications. CONCLUSIONS Thermal ablation is an excellent local nodules control method in patients with BTNs, and results in a clinically significant and long-lasting volume reduction of BTNs. The risk of regrowth and needing retreatment was lower after thermal ablation.
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Affiliation(s)
- Xidong Xu
- Department of Thyroid Surgery, the Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Ying Peng
- The Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Guoxin Han
- Department of Thyroid Surgery, the Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China.
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Noel JE, Sinclair CF. Radiofrequency Ablation for Benign Thyroid Nodules. J Clin Endocrinol Metab 2023; 109:e12-e17. [PMID: 37401778 DOI: 10.1210/clinem/dgad357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Indexed: 07/05/2023]
Abstract
CONTEXT Thermal ablative techniques of the thyroid have recently gained clinical traction as a therapeutic alternative that provides symptomatic relief and confers potential advantages over surgery. A truly multidisciplinary technique, thyroid ablation is currently performed by endocrinologists, interventional radiologists, otolaryngologists, and endocrine surgeons. Radiofrequency ablation (RFA), specifically, has seen widespread adoption, particularly in the treatment of benign thyroid nodules. This review summarizes current evidence on the application of RFA in benign thyroid nodules, and provides a start to finish overview of procedural preparation, performance, and outcomes. EVIDENCE ACQUISITION A narrative review of literature focusing on RFA in the treatment of benign nodular disease was performed. Emphasis was placed on consensus statements, best practice guidelines, multi-institutional studies, and systematic reviews to summarize key concepts in candidacy, techniques, expectations, and outcomes. FINDINGS RFA is increasingly recognized as a first-line treatment strategy in the management of symptomatic nonfunctional benign thyroid nodules. It can also be considered in functional thyroid nodules with small volumes or in patients ineligible for surgery. A targeted and efficacious technique, RFA results in gradual volume reduction that preserves the function of the surrounding thyroid parenchyma. Proper procedural technique, proficiency in ultrasound, and experience in ultrasound-guided procedures are instrumental to maintaining low complication rates and achieving successful ablation outcomes. CONCLUSIONS In pursuit of a personalized approach, physicians across disciplines are increasingly incorporating RFA into their treatment algorithms, most commonly for benign nodules. As with any intervention, thoughtful selection and implementation ensure a safe procedure with optimal patient benefit.
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Affiliation(s)
- Julia E Noel
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Catherine F Sinclair
- Department of Otolaryngology-Head & Neck Surgery, Monash University Melbourne, Clayton, VIC 3800, Australia , and Mount Sinai School of Medicine: Icahn School of Medicine at Mount Sinai, New York, NY 10019, USA
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10
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Richter JP, Richter CP, Gröner D. [Ultrasound-guided ablation techniques for thyroid lesions]. Laryngorhinootologie 2023; 102:916-927. [PMID: 37734389 DOI: 10.1055/a-2144-4132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Ultrasound-guided ablation techniques have been increasingly introduced into routine treatment of thyroid lesions as a complement to existing surgical therapies and radioiodine treatment. In cystic or predominantly cystic lesions instillation therapy (ethanol/polidocanol ablation) has yielded good results. Novel thermal ablation techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA) and high intensity focused ultrasound (HIFU), induce irreversible cellular effects by locally applying temperatures ≥ 60 °C to the targeted thyroid region. Lesions causing local symptoms or focal hyperfunctionality can thus be selectively treated under continuous sonographic monitoring. While a considerable body of evidence supports the efficacy and safety of various local ablative techniques, future challenges lie in initiating comparative prospective trials and in standardizing clinical practice, training and continuous quality assessment on a regional and superregional level. In the future, it shall be indicated to include local ablative techniques - so far not known to all patients in Germany - into the informed decision-making process as a suitable alternative or supplement to existing therapies.
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Affiliation(s)
- Johannes-Paul Richter
- Klinik für Nuklearmedizin, Universitätsklinikum Magdeburg, Otto-von-Guericke-Universität, Magdeburg
| | - Carl-Philip Richter
- Chirurgische Klinik am Rathenauplatz, Schilddrüsenzentrum Baden-Württemberg, Heilbronn
| | - Daniel Gröner
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt am Main, Frankfurt am Main
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11
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Klimek K, Mader N, Happel C, Sabet A, Grünwald F, Groener D. Heat sink effects in thyroid bipolar radiofrequency ablation: an ex vivo study. Sci Rep 2023; 13:19288. [PMID: 37935715 PMCID: PMC10630443 DOI: 10.1038/s41598-023-45926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
The study aimed to investigate heat sink effects in radiofrequency ablation (RFA) under thyroid-specific conditions. In an ex vivo model, bovine thyroid lobes were ablated using bipolar RFA with 2.0 kJ energy input at a power level set to 10 W (n = 35) and 25 W (n = 35). Glass vessels (3.0 mm outer diameter) placed within the ablation zone were used to deliver tissue perfusion at various flow rates (0, 0.25, 0.5, 1, 5, 10, 20 ml/min). Temperature was measured in the proximity of the vessel (Tv) and in the non-perfused contralateral region of the ablation zone (Tc), at equal distances to the ablation electrode (d = 8 mm). Maximum temperature within the perfused zone was significantly lowered with Tv ranging from 54.1 ± 1.5 °C (20 ml/min) to 56.9 ± 1.5 °C (0.25 ml/min), compared to Tc from 63.2 ± 3.5 °C (20 ml/min) to 63.2 ± 2.6 °C (0.25 ml/min) (10 W group). The cross-sectional ablation zone area decreased with increasing flow rates from 184 ± 12 mm2 (0 ml/min) to 141 ± 20 mm2 (20 ml/min) at 10 W, and from 207 ± 22 mm2 (0 ml/min) to 158 ± 31 mm2 (20 ml/min) in the 25 W group. Significant heat sink effects were observed under thyroid-specific conditions even at flow rates ≤ 1 ml/min. In thyroid nodules with prominent vasculature, heat dissipation through perfusion may therefore result in clinically relevant limitations to ablation efficacy.
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Affiliation(s)
- Konrad Klimek
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Nicolai Mader
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
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Wang L, Wang P, Chen Z, Lin Y, Liu Y, Peng R, Li J, Luo W, Kuang J. Image-guided Thermal Ablation as a Promising Approach to Both Nontoxic and Toxic Autonomously Functioning Thyroid Nodules. Acad Radiol 2023; 30:2636-2646. [PMID: 36872180 DOI: 10.1016/j.acra.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 03/06/2023]
Abstract
RATIONALE AND OBJECTIVES Although thermal ablation has been recommended as an alternative therapy option for autonomously functioning thyroid nodules (AFTN), current clinical evidence mainly focuses on toxic AFTN. This study aims to evaluate and compare the efficacy and safety of thermal ablation (percutaneous radiofrequency ablation or microwave ablation) in treating nontoxic and toxic AFTN. MATERIALS AND METHODS AFTN patients who received a single session of thermal ablation with a follow-up period ≥12 months were recruited. Changes in nodule volume and thyroid function, and complications were evaluated. Technical efficacy was defined as the maintenance or restoration of euthyroidism with a volume reduction rate (VRR) ≥80% at the last follow-up. RESULTS In total, 51 AFTN patients (age: 43.8±13.9 years, female: 88.2%) with a median follow-up period of 18.0 (12.0-24.0) months were included, where 31 were nontoxic (nontoxic group), and 20 were toxic (toxic group) before ablation. The median VRR was 96.3% (80.1%-98.5%) and 88.3% (78.3%-96.2%) in the nontoxic and toxic groups, respectively, and the respective euthyroidism rates were 93.5% (29/31, 2 evolved to toxic) and 75.0% (15/20, 5 remained toxic). The corresponding technical efficacy was 77.4% (24/31) and 55.0% (11/20, p=0.126). Except for one case of stress-induced cardiomyopathy in the toxic group, no permanent hypothyroidism or other major complications occurred in both groups. CONCLUSION Image-guided thermal ablation is efficacious and safe in treating AFTN, both nontoxic and toxic. Recognition of nontoxic AFTN would be helpful for treatment, efficacy evaluation, and follow-up.
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Affiliation(s)
- Long Wang
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
| | - Peiqing Wang
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China; Shantou University Medical College, Shantou, Guangdong Province, China
| | - Zhijiang Chen
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yinghe Lin
- Department of Endocrinology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong Province, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yingshan Liu
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Rong Peng
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jinlian Li
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Wenfeng Luo
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jian Kuang
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China.
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Papi G, Novizio R, Brunetti M, Mauri G. Impact of the introduction of minimally invasive treatments of the thyroid (MITT) for benign thyroid nodules in an Italian hospital: a cost-minimization analysis. Endocrine 2023; 82:126-133. [PMID: 37258994 DOI: 10.1007/s12020-023-03403-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Prevalence of thyroid nodules is high in the adult population, approaching 60% in women and older people. Most thyroid nodules are benign and asymptomatic. However, a not negligible part of them causes compressive symptoms and/or cosmetic concerns and need to be treated. In the last two decades, minimally-invasive treatments of the thyroid (MITT) have been proposed in routine clinical practice as a reliable cost-effective alternative to surgery in patients with symptomatic benign thyroid nodules (SBTNs). AIM OF THE STUDY To perform a cost-minimization analysis comparing direct, indirect and intangible costs of radiofrequency (RFA) and laser thermal ablation (LTA) with traditional surgery in patients with SBTNs. METHODS Data of patients treated by MITT for SBTNs from October 1st 2019 to September 30th 2022 in a single Italian tertiary Center were analyzed. Costs were compared to those of traditional surgery reported in the 2022 Associazione Medici Endocrinologi Guidelines on the Management of SBTNs. RESULTS In the study lapse, 157 MITT of SBTNs were performed in 148 patients, 114 females and 34 males (mean age: 59 yrs; median age: 57 yrs). Before MITT, the mean thyroid nodule volume was 19 ml; 1 year after MITT, volume reduction rate >50% and symptom relief were achieved in 89% and 93% of patients, respectively. No major complications occurred. Adding up pre-operative, operative and post-operative costs, total direct costs per single procedure are the following: 1361.43 € for LTA when using one optic fiber; 1761.43 € for LTA when using two optic fibers; 1968.53 € for RFA; 3338.39 € for hemithyroidectomy plus isthmectomy; 4034.99 € for total thyroidectomy. Surgery was impactful on direct-i.e., preoperative, operative and postoperative-costs, due to longer operating room occupation time and hospital stay. Overall, a total saving for the Italian National Health Service of 285,377.15 € has been obtained treating the 148 patients by MITT instead of surgery. Likewise, MITT was advantageous also for indirect costs-i.e., those related to "loss of productivity" caused by time off work due to hospital stay and recovery time-, for both the self-employed workers and the Government, the latter saving 53,838.50 € overall. Finally, intangible costs, related to patients' quality of life-e.g., residual surgical scar, stress related to general anesthesia, convalescence, and life-long intake of L-Thyroxine replacement therapy-were all in favor of MITT. CONCLUSIONS This real-life cost-minimization analysis demonstrates that LTA and RFA are safe and cost-effective procedures for the treatment of SBTNs. In our 3 years experience, adding the savings of 285,377.15 € for direct costs to those of 53.838,50 € for indirect costs, in total 339,215.65 € were saved. The saving concern patients, the National Health System and the Government.
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Affiliation(s)
- Giampaolo Papi
- Endocrinology Unit, Department of Internal Medicine, Azienda USL Modena, Modena, Italy
| | - Roberto Novizio
- Endocrinology Unit, Department of Internal Medicine, Azienda USL Modena, Modena, Italy.
| | | | - Giovanni Mauri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
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14
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van der Meeren MMD, Joosten FBM, Roerink SHPP, Deden LN, Oyen WJG. Radiofrequency ablation for autonomously functioning nodules as treatment for hyperthyroidism: subgroup analysis of toxic adenoma and multinodular goitre and predictors for treatment success. Eur J Nucl Med Mol Imaging 2023; 50:3675-3683. [PMID: 37466647 PMCID: PMC10547644 DOI: 10.1007/s00259-023-06319-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/23/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Treatment of hyperthyroidism caused by autonomously functioning thyroid nodules (AFTN) with 131I often leads to undesirable hypothyroidism. Radiofrequency ablation (RFA) has emerged as a promising alternative. This retrospective analysis aimed to examine the efficacy of, and postprocedural hypothyroidism after, RFA for AFTN. METHODS Patients with hyperthyroidism caused by AFTN and treated with RFA were included if follow-up of at least 1 year was available. Cure was defined as thyroid medication-free biochemical euthyroidism. To predict cure, patient and treatment factors were analysed. A distinction was made between solitary toxic adenoma (STA) and toxic multinodular goitre (TMG). RESULTS Forty-eight patients (36 STA, 12 TMG) were included. One year post-RFA cure rate was 72% in STA versus 25% in TMG (p = 0.004). One patient developed hypothyroidism. In 11 patients that remained hyperthyroid, a second RFA was successful in 83% of STA and 40% of TMG patients. At last available follow-up, this amounted to a total cure rate of 81% in STA and 33% in TMG (p = 0.002). In STA, cured patients had a higher baseline TSH and a lower FT3 than non-cured patients (p = 0.026 and 0.031). Cure was observed in 91% of patients when > 2.1 kJ/mL was delivered during RFA, compared to 44% when less energy was administered. CONCLUSION The efficacy of RFA was nearly 3 times higher in STA patients compared to TMG. Severity of hyperthyroidism and kJ/mL delivered during RFA predicts cure. Direct comparison to the current standard of care is needed to implement RFA in treatment of hyperthyroidism caused by AFTN.
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Affiliation(s)
- M M D van der Meeren
- Department of Radiology and Nuclear Medicine, Arnhem, The Netherlands.
- Department of Internal Medicine, Arnhem, The Netherlands.
| | - F B M Joosten
- Department of Radiology and Nuclear Medicine, Arnhem, The Netherlands
| | | | - L N Deden
- Department of Radiology and Nuclear Medicine, Arnhem, The Netherlands
| | - W J G Oyen
- Department of Radiology and Nuclear Medicine, Arnhem, The Netherlands
- Department of Biomedical Sciences, and Humanitas Clinical and Research Center, Department of Nuclear Medicine, Humanitas University, Milan, Italy
- Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands
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15
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Sim JS. [Clinical Approach for Thyroid Radiofrequency Ablation]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1017-1030. [PMID: 37869113 PMCID: PMC10585077 DOI: 10.3348/jksr.2023.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/18/2023] [Indexed: 10/24/2023]
Abstract
Radiofrequency ablation (RFA) is a non-surgical treatment for symptomatic, benign thyroid nodules. This treatment works by heating and destroying the nodule tissue, which results in reduction of its size and alleviation of the symptoms involved. RFA is indicated for nodules which are confirmed to be benign on two or more cytological or histological examinations, and which result in clinical symptoms requiring medical treatment. It is associated with good short-term outcomes on one-year follow-up; however, 20%-30% of the nodules regrow after more than three years. Therefore, on the basis of long-term follow-up, management of regrowth is key to patient care following RFA. Regrowth is more likely to occur in nodules that are large in size prior to RFA, and in those with high or increased vascularity. Recently, new techniques such as hydrodissection, artery-first ablation, and venous ablation have been introduced to inhibit regrowth. In addition, appropriate criteria for additional RFA should be applied to manage regrowth and prolong its therapeutic effects. RFA is essentially an alternative to surgery; therefore, the ultimate goal of this procedure is to avoid surgery permanently, rather than to achieve temporary effects.
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Del Rio P, Polistena A, Chiofalo MG, De Pasquale L, Dionigi G, Docimo G, Graceffa G, Iacobone M, Medas F, Pezzolla A, Sorrenti S, Spiezia S, Calò PG. Management of surgical diseases of thyroid gland indications of the United Italian Society of Endocrine Surgery (SIUEC). Updates Surg 2023; 75:1393-1417. [PMID: 37198359 PMCID: PMC10435599 DOI: 10.1007/s13304-023-01522-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/23/2023] [Indexed: 05/19/2023]
Abstract
A task force of the United Italian society of Endocrine Surgery (SIUEC) was commissioned to review the position statement on diagnostic, therapeutic and health‑care management protocol in thyroid surgery published in 2016, at the light of new technologies, recent oncological concepts, and tailored approaches. The objective of this publication was to support surgeons with modern rational protocols of treatment that can be shared by health-care professionals, taking into account important clinical, healthcare and therapeutic aspects, as well as potential sequelae and complications. The task force consists of 13 members of the SIUEC highly trained and experienced in thyroid surgery. The main topics concern clinical evaluation and preoperative workup, patient preparation for surgery, surgical treatment, non-surgical options, postoperative management, prevention and management of major complications, outpatient care and follow-up.
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Affiliation(s)
- P Del Rio
- Unit of General Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - A Polistena
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - M G Chiofalo
- Department Head and Neck, Thyroid Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - L De Pasquale
- Thyroid and Parathyroid Service, Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - G Dionigi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Division of Surgery, Istituto Auxologico Italiano Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - G Docimo
- Division of Thyroid Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - G Graceffa
- Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - M Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - A Pezzolla
- Division of Videolaparoscopic Surgery, Department of Emergency and Organ Transplanatation, University of Bari "A. Moro", Bari, Italy
| | - S Sorrenti
- Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - S Spiezia
- Department of Endocrine and Ultrasound-guided Surgery, Ospedale del Mare, Naples, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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17
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Sung JY. [Effective and Safe Application of Radiofrequency Ablation for Benign Thyroid Nodules]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:985-998. [PMID: 37869123 PMCID: PMC10585069 DOI: 10.3348/jksr.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/30/2023] [Indexed: 10/24/2023]
Abstract
Radiofrequency ablation (RFA) has been a representative, non-surgical treatment for benign thyroid nodules that cause cosmetic problems or compression symptoms. The procedure of RFA should be performed effectively and safely. This review discusses the patient selection, pre-procedure evaluation and planning, principles, devices, techniques, and complications with reference to the guidelines and research on thyroid RFA. In particular, this review will devote to introduce RFA techniques and to provide practical help in the implementation of this procedure.
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18
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Kim MK, Shin JH, Hahn SY, Kim H. Delayed Cancer Diagnosis in Thyroid Nodules Initially Treated as Benign With Radiofrequency Ablation: Ultrasound Characteristics and Predictors for Cancer. Korean J Radiol 2023; 24:903-911. [PMID: 37634644 PMCID: PMC10462893 DOI: 10.3348/kjr.2023.0386] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE Regrowth after radiofrequency ablation (RFA) of symptomatic large thyroid nodules, initially treated as benign, sometimes turns out to be malignancies. This study aimed to assess the ultrasound (US) characteristics of thyroid nodules initially treated as benign with RFA and later diagnosed as cancers, predictive factors for cancers masquerading as benign, and methods to avoid RFA in these cancers. MATERIALS AND METHODS We reviewed the medical records of 134 consecutive patients with 148 nodules who underwent RFA between February 2008 and November 2016 for the debulking of symptomatic thyroid nodules diagnosed as benign using US-guided biopsy. We investigated the pre-RFA characteristics of the thyroid nodules, changes at follow-up after RFA, and the final surgical pathology. RESULTS Nodule regrowth after RFA was observed in 36 (24.3%) of the 148 benign nodules. Twenty-two of the 36 nodules were surgically removed, and malignancies were confirmed in seven (19.4% of 36). Of the 22 nodules removed surgically, pre-RFA median volume (range) was significantly larger for malignant nodules than for benign nodules: 22.4 (13.9-84.5) vs. 13.4 (7.3-16.8) mL (P = 0.04). There was no significant difference in the regrowth interval between benign and malignant nodules (P = 0.49). The median volume reduction rate (range) at 12 months was significantly lower for malignant nodules than for benign nodules (51.4% [0-57.8] vs. 83.8% [47.9-89.6]) (P = 0.01). The pre-RFA benignity of all seven malignant nodules was confirmed using two US-guided fine-needle aspirations (FNAs), except for one nodule, which was confirmed using US-guided core-needle biopsy (CNB). Regrown malignant nodules were diagnosed as suspicious follicular neoplasms by CNB. Histological examination of the malignant nodules revealed follicular thyroid carcinomas, except for one follicular variant, a papillary thyroid carcinoma. CONCLUSION Symptomatic large benign thyroid nodules showing regrowth or suboptimal reduction after RFA may have malignant potential. The confirmation of these nodules is better with CNB than with FNA.
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Affiliation(s)
- Myoung Kyoung Kim
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Haejung Kim
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Min X, Zhang Z, Chen Y, Zhao S, Ge J, Zhao H, Cai Y, Chen H, Shao J, Jing Y, Chen B. Comparison of the effectiveness of lauromacrogol injection for ablation and microwave ablation in the treatment of predominantly cystic thyroid nodules: a multicentre study. BMC Cancer 2023; 23:785. [PMID: 37612615 PMCID: PMC10464182 DOI: 10.1186/s12885-023-11301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE To compare the therapeutic efficacy and safety of microwave ablation (MWA) and lauromacrogol injection for ablation (LIA) for benign predominantly cystic thyroid nodules. MATERIALS AND METHODS In this retrospective study, 85 patients with predominantly cystic thyroid nodules (PCTNs) who underwent microwave ablation (MWA) or lauromacrogol injection for ablation (LIA) between June 2019 and August 2022 at three hospitals were included in our research. Forty-six patients were treated with microwave ablation, and thirty-nine patients were treated with lauromacrogol injection for ablation. The baseline characteristics, nodal volume, volume reduction rate (VRR), and incidence of postoperative complications were compared between these two groups. RESULTS After treatment, there were significant differences in the thyroid nodule volume and the volume reduction rate (VRR) at different follow-up times between the groups (p < 0.001). There were no significant differences in the nodal volume or the volume reduction rate (VRR) between the MWA group and the LIA group at 1, 3, 6, and 12 months (p > 0.05). Of note, no serious intraoperative or postoperative complications occurred in the corresponding group. CONCLUSION MWA and LIA are very effective and safe strategies for the treatment of predominantly cystic thyroid nodules. However, LIA is more advantageous in that it is less expensive and has a shorter length of hospital stay than MWA.
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Affiliation(s)
- Xin Min
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Zheng Zhang
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Yanwei Chen
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Shuangshuang Zhao
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Jingwen Ge
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Huajiao Zhao
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Yun Cai
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
| | - Hui Chen
- Department of Medical Ultrasound, Changzhou First People’s Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003 China
| | - Jun Shao
- Department of Medical Ultrasound, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, 215132 China
| | - Yanfei Jing
- Department of Medical Ultrasound, The Fifth People’s Hospital of Wuxi, The Medical School of Jiangnan University, Wuxi, 214000 Jiangsu China
| | - Baoding Chen
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000 China
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Papini E, Hegedüs L. Minimally Invasive Ablative Treatments for Benign Thyroid Nodules: Current Evidence and Future Directions. Thyroid 2023; 33:890-893. [PMID: 37265153 DOI: 10.1089/thy.2023.0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Enrico Papini
- Department of Endocrinology, Regina Apostolorum Hospital, Albano, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University, Odense, Denmark
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Chorti A, Bontinis V, Tzikos G, Bontinis A, Ioannidis A, Michalopoulos A, Papavramidis T. Minimally Invasive Treatments of Benign Thyroid Nodules: A Network Meta-Analysis of Short-Term Outcomes. Thyroid 2023; 33:950-964. [PMID: 37166390 DOI: 10.1089/thy.2022.0671] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Background: Image-guided thermal ablation interventions are novel thermal-based modalities used for the treatment of benign thyroid nodules. Methods: We conducted a systematic review and a Bayesian network meta-analysis, examining studies using thermal ablation interventions in the treatment of benign nodular thyroid disease (PROSPERO CRD42022367680). The primary endpoints included volume reduction rate (VRR), and symptomatic score and cosmetic score improvement. Secondary endpoints included vocal disturbances, laryngeal nerve palsy, hypothyroidism, and nodular regrowth (defined by increased nodular volume of >50% for thermal ablation or new nodules arising in remaining thyroid tissue conventional surgery [CS]). Results: We included 16 studies (3 randomized controlled trials [RCTs] and 13 comparative case series), describing radiofrequency ablation (RFA), laser ablation (LA), microwave ablation (MWA), high-intensity focus ultrasound (HIFU), and CS, respectively. The review included data from 4112 patients followed for a mean of 11.9 months. Meta-analyses showed no significant differences among RFA, LA, MWA, HIFU, and CS regarding any of the primary endpoints of VRR, symptomatic score, and cosmetic score. In examining the surface under the cumulative ranking area (SUCRA) ranking, CS (SUCRA, 98.49), LA (SUCRA, 51.58), and MWA (SUCRA, 57.0) were identified as the three interventions that were most likely to result in the largest VRR, symptomatic and cosmetic score reduction. RFA, relative risk (RR) 0.19 [95% credibility interval (CI): 0.06 to 0.48], LA RR 0.23 [CI: 0.06 to 0.79], and MWA RR 0.25 [CI: 0.09 to 0.60] were associated with the greatest reduction in risk for postintervention vocal complications compared with CS, with RFA (SUCRA, 61.62) being ranked as the highest in safety. RFA RR 0.05 [CI: 0.00 to 0.40] and MWA RR 0.16 [CI: 0.02 to 0.73] were associated with a reduced risk of transient laryngeal nerve injury compared with CS. RFA RR 0.00 [CI: 0.00 to 0.00] and MWA RR 0.00 [CI: 0.00 to 0.03] were associated with a reduced risk of hypothyroidism occurrence compared with CS, with RFA (SUCRA, 99.86) yielding the highest safety ranking. RFA was associated with a reduced risk for nodular regrowth RR 0.09 [CI: 0.00 to 0.85], compared with CS. Conclusion: We have comprehensively reviewed the published literature on the efficacy and safety of thermal ablation modalities for benign thyroid nodules. Important research gaps remain regarding a paucity of both long-term data and high-quality RCTs.
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Affiliation(s)
- Angeliki Chorti
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vangelis Bontinis
- Department of Vascular Surgery, AHEPA University Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tzikos
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alkis Bontinis
- Department of Vascular Surgery, AHEPA University Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristeidis Ioannidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodossis Papavramidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Minimal Invasive Endocrine Surgery Department, Kyanos Stavros, Euromedica, Thessaloniki, Greece
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22
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Yan L, Li XY, Li Y, Luo Y. Ultrasound-Guided Radiofrequency Ablation versus Thyroidectomy for the Treatment of Benign Thyroid Nodules in Elderly Patients: A Propensity-Matched Cohort Study. AJNR Am J Neuroradiol 2023; 44:693-699. [PMID: 37230539 PMCID: PMC10249697 DOI: 10.3174/ajnr.a7890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/28/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND PURPOSE Ultrasound-guided radiofrequency ablation has been recommended as an alternative to surgery for benign thyroid nodules. However, little is known about the benefit from the application of radiofrequency ablation for benign thyroid nodules in elderly patients. The purpose of this study was to compare the clinical outcomes of radiofrequency ablation versus thyroidectomy for elderly patients with benign thyroid nodules. MATERIALS AND METHODS This retrospective study evaluated 230 elderly patients (60 years of age or older) with benign thyroid nodules treated with radiofrequency ablation (R group, n = 49) or thyroidectomy (T group, n = 181). Complications, thyroid function, and treatment variables, including procedural time, estimated blood loss, hospitalization, and cost, were compared after propensity score matching. The volume, volume reduction rate, symptoms, and cosmetic score were also evaluated in the R group. RESULTS After 1:1 matching, each group had 49 elderly patients. The rate of overall complications and hypothyroidism was 26.5% and 20.4% in the T group, respectively, but these complications were totally absent from the R group (P < .001, P = .001). Patients in the R group had a significantly shorter procedural time (median, 4.8 versus 95.0 minutes, P < .001) and lower cost (US $1979.02 versus US $2208.80, P = .013) than those treated by thyroidectomy. After radiofrequency ablation, the volume reduction rate was 94.1%, and 12.2% of nodules had completely disappeared. The symptom and cosmetic scores were both significantly reduced at the last follow-up. CONCLUSIONS Radiofrequency ablation could be considered as a first-line treatment for elderly patients with benign thyroid nodules.
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Affiliation(s)
- L Yan
- From the Department of Ultrasound, The First Medical Centre, Chinese People's Liberation Army General Hospital, Haidian District, Beijing, China
| | - X Y Li
- From the Department of Ultrasound, The First Medical Centre, Chinese People's Liberation Army General Hospital, Haidian District, Beijing, China
| | - Y Li
- From the Department of Ultrasound, The First Medical Centre, Chinese People's Liberation Army General Hospital, Haidian District, Beijing, China
| | - Y Luo
- From the Department of Ultrasound, The First Medical Centre, Chinese People's Liberation Army General Hospital, Haidian District, Beijing, China
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Robb L, Hey SY, Reid H, Nixon IJ. Introducing ethanol ablation as a treatment for thyroid cysts in the emergency setting. J Laryngol Otol 2023; 137:467-470. [PMID: 35975295 DOI: 10.1017/s002221512200189x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Ethanol ablation for the treatment of thyroid cysts has been well documented in the literature as a safe, effective treatment option in the elective setting. This study demonstrates the use of ethanol ablation in the emergency setting. METHODS Three patients presenting with airway-threatening compressive symptoms secondary to a thyroid cyst were treated with ethanol ablation within 24 hours of presentation to hospital. RESULTS All patients had symptom resolution at a median of nine months follow up post procedure. Sixty-six per cent of patients required only one treatment. There was a median of 100 per cent radiological resolution of the cystic component. The median Glasgow Benefit Inventory score was +27.7, similar to that for tonsillectomy. CONCLUSION Ethanol ablation is a safe, cost-effective and efficient treatment option for thyroid cysts in the acute setting.
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Affiliation(s)
- L Robb
- Department of Plastic and Reconstructive Surgery, Ninewells Hospital, NHS Tayside, Dundee, Scotland, UK
| | - S Y Hey
- Department of Otolaryngology, St John's Hospital at Howden, NHS Lothian, Livingston, Scotland, UK
| | - H Reid
- Department of Radiology, St John's Hospital at Howden, NHS Lothian, Livingston, Scotland, UK
| | - I J Nixon
- Department of Otolaryngology, St John's Hospital at Howden, NHS Lothian, Livingston, Scotland, UK
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24
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Bernardi S, Taccogna S, D'Angelo M, Giudici F, Mauri G, Raggiunti B, Tina D, Zanconati F, Papini E, Negro R. Immunocytochemistry Profile of Benign Thyroid Nodules Not Responding to Thermal Ablation: A Retrospective Study. Int J Endocrinol 2023; 2023:7951942. [PMID: 37082757 PMCID: PMC10113047 DOI: 10.1155/2023/7951942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/22/2023] Open
Abstract
Purpose Thermal ablations (TA) are gaining ground as alternative options to conventional therapies for symptomatic benign thyroid nodules. Little is known about the impact of nodule biology on the outcomes of TA. The aim of our study was to evaluate the baseline immunocytochemistry profile of thyroid nodules that were poorly responsive to TA in order to identify potential predictors of the treatment response. Methods From a cohort of 406 patients with benign thyroid nodules treated with TA and followed for 5 years, we retrospectively selected two groups of patients: NONRESPONDERS (patients who did not respond to TA and were later surgically treated) and RESPONDERS (patients who responded to TA). The fine-needle aspiration cytology (FNAC) slides obtained before TA were stained for Galectin-3, HBME-1, CK-19, and Ki-67. Results Benign nodules of NONRESPONDERS (n = 19) did not express CK-19 (p = 0.03), as compared to RESPONDERS (n = 26). We combined the absence of CK-19 and the presence of Ki-67 to obtain a composite biomarker of resistance to TA, which discriminated between likelihood of retreatment and no retreatment with an AUC of 0.68 (95%CI: 0.55-0.81) and a sensitivity, specificity, PPV, and NPV of 29%, 91%, 71%, and 64%, respectively. Conclusion In benign thyroid nodules, the absence of CK-19 was associated with resistance to TA, while the presence of CK-19 was predictive of response to TA. If confirmed, this finding could provide rapid and inexpensive information about the potential outcome of TA on benign thyroid nodules. In addition, as CK-19 can be expressed in adenomatous hyperplasia, it could be speculated that these nodules, rather than follicular adenomas, might be better candidates for TA.
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Affiliation(s)
- Stella Bernardi
- Department of Medical Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, Trieste 34149, Italy
- SS Endocrinologia UCO Medicina Clinica, Cattinara Teaching Hospital, Strada di Fiume, Trieste 34149, Italy
| | - Silvia Taccogna
- Pathology Unit, Regina Apostolorum Hospital, Albano Laziale (RM) 00041, Italy
| | - Martina D'Angelo
- Pathology Unit, Regina Apostolorum Hospital, Albano Laziale (RM) 00041, Italy
| | - Fabiola Giudici
- Bureau Biostatistique et Epidémiologie, Gustave-Roussy Institute, Rue Eduard Vaillant, Villejuif 94805, France
| | - Giovanni Mauri
- IRCCS European Institute of Oncology, Milano 20141, Italy
- Department of Oncology, University of Milan, Milan 20100, Italy
| | - Bruno Raggiunti
- UOC Malattie Endocrine e Diabetologia, PO di Atri, ASL Teramo, Teramo, Italy
| | - Doris Tina
- UOC Malattie Endocrine e Diabetologia, PO di Atri, ASL Teramo, Teramo, Italy
| | - Fabrizio Zanconati
- Department of Medical Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, Trieste 34149, Italy
- UCO Anatomia Patologica, Cattinara Teaching Hospital, Strada di Fiume, Trieste 34149, Italy
| | - Enrico Papini
- Endocrinology Department, Regina Apostolorum Hospital, Albano Laziale (RM) 00041, Italy
| | - Roberto Negro
- UO Endocrinologia, “V. Fazzi” Hospital, Lecce 73100, Italy
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Sheremet MI, Lazaruk OV, Shidlovskyi OV, Shidlovskyi VO, Savin VV, Olinik YV, Olinik OY, Lazaruk TY. Outcomes of laser-induced thermotherapy for thyroid nodules at the West Vascular Center, Ukraine. J Med Life 2023; 16:35-41. [PMID: 36873136 PMCID: PMC9979181 DOI: 10.25122/jml-2022-0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/13/2022] [Indexed: 03/07/2023] Open
Abstract
Thyroid nodules are common, occurring in 50-60% of healthy patients. Currently, there are no effective conservative treatment options for nodular goiter, and surgery can have limitations and potential complications. The purpose of this study was to evaluate the efficacy, tolerability, and long-term results of using sclerotherapy and laser-induced interstitial thermotherapy (LITT) to treat benign thyroid nodules. A retrospective analysis was conducted on 456 patients with benign nodular goiter who received LITT. The volume of the nodular goiter was measured at 1, 3, 6, and 12 months post-treatment, and a repeated fine needle aspiration (FNA) with the cytological examination was performed to verify the structure of the nodular goiter in the long term. The results showed that LITT was an effective method for treating nodular mass (nodules), as evidenced by a decrease in the volume of NG by 51-85% after 6-12 months. FNA results 2-3 years after LITT showed no thyrocytes, only connective tissue, indicating the efficacy of LITT for benign thyroid nodules. LITT is highly effective in most cases, often resulting in the disappearance or significant decrease in nodular formations.
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Affiliation(s)
- Michael Ivanovich Sheremet
- Department of Surgery No.1, Bukovinian State Medical University, West Vascular Center, Chernivtsi, Ukraine.,West Vascular Center, Chernivtsi, Ukraine
| | - Oleksandr Volodimirovich Lazaruk
- West Vascular Center, Chernivtsi, Ukraine.,Department of Pathologic Anatomy, Bukovinian State Medical University, Chernivtsi, Ukraine
| | | | | | | | | | - Oksana Yuriivna Olinik
- Department of Internal Medicine, Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Tetyana Yuriivna Lazaruk
- West Vascular Center, Chernivtsi, Ukraine.,Department of Internal Medicine, Bukovinian State Medical University, Chernivtsi, Ukraine
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26
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Chen MH, Lin WC, Luo SD, Chiang PL, Chen YS, Chen WC, Lin AN, Wang CK, Baek JH, Chen HL. Residual, regrowth, and new growth of radiofrequency ablation for benign thyroid nodules of different volumes: two-year follow-up results. Int J Hyperthermia 2022; 39:1172-1178. [PMID: 36096486 DOI: 10.1080/02656736.2022.2112305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Radiofrequency ablation (RFA) is recognized as an effective technique for the treatment of benign thyroid nodules (BTNs), although the long-term results are limited. This study aimed to evaluate the residual vital volume increase, regrowth, and new growth over a 2-year period after RFA among different nodule volume groups. SUBJECTS AND METHODS This retrospective study evaluated 135 patients with 153 BTNs who underwent ultrasound guided RFA. The BTNs were categorized into small (<10 mL), medium (10-30 mL), and large (>30 mL) according to the initial volume of BTNs prior to ablation. The volume changes of each nodule were analyzed at 1, 3, 6, 12 and 24 months after RFA. New growth was defined as the growth in volume not found in the early follow-up on ultrasonography. RESULTS The initial ablation ratio of all BTNs was 99.67%. The mean volume reduction ratio (VRR) of BTNs was 85.53% after 2-year follow-up. The small nodule group showed a lower VRR compared to the other two groups at the 1-month follow-up, and there was no difference of VRR at the subsequent follow-ups. The incidence of residual vital volume increase was 4.58%. The overall incidence of regrowth was 3.92% and the mean timing of regrowth was 16.71 months. New growth occurred in 18.95% of patients. No further treatment was required in the majority of cases. CONCLUSION RFA achieved a clinically relevant volume reduction in different sizes of single BTNs which persisted for at least 2 years, thereby preventing the need for retreatment.
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Affiliation(s)
- Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Sheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jung-Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hsiu-Ling Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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27
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Yang Q, Geng C, Chen R, Pang C, Han R, Lyu L, Zhang Y. DMU-Net: Dual-route mirroring U-Net with mutual learning for malignant thyroid nodule segmentation. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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28
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Kim HJ, Baek JH, Cho W, Sim JS. Long-term follow-up of the radiofrequency ablation of benign thyroid nodules: the value of additional treatment. Ultrasonography 2022; 41:661-669. [PMID: 36039675 PMCID: PMC9532194 DOI: 10.14366/usg.21231] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/03/2022] [Indexed: 11/03/2022] Open
Abstract
PURPOSE This study aimed to evaluate the efficacy of additional radiofrequency ablation (RFA) treatment for benign thyroid nodules. METHODS Electronic medical records at a single institution from September 2008 to August 2016 were searched, and consecutive patients treated with RFA due to benign thyroid nodules with cosmetic or symptomatic problems were enrolled. All patients were followed up for at least 30 months. The nodules were divided into three groups: group 1 included nodules that met the criteria for additional treatment and underwent additional treatment, group 2 included nodules that met the criteria but did not undergo additional treatment, and group 3 included nodules that did not meet the criteria. The ablation results were compared among the three groups in terms of the initial ablation ratio (IAR) and volume reduction ratio (VRR). RESULTS Ninety nodules from 88 patients were included in the study. At the last follow-up, group 1 showed a significantly smaller nodule volume and larger VRR (2.5 mL and 84.6%, respectively) than group 2 (8.1 mL and 39.8%, respectively, P<0.001), but did not present a significant difference from group 3 (0.9 mL, P=0.347, and 92.8%, P=0.238). The IAR was significantly higher in group 3 (94.5%) than in the other two groups (group 1, 81.1%; group 2, 82.8%; P<0.001). CONCLUSION Multiple treatment sessions achieve greater VRR. Therefore, additional treatment could be considered for patients who meet the corresponding criteria.
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Affiliation(s)
- Hyun Jin Kim
- Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woojin Cho
- Department of Otolaryngology-Head and Neck Surgery, Withsim Clinic, Seongnam, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
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29
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Offi C, Antonelli G, Brancaccio U, Gaudiello M, Misso C, Nunziata A, Tammaro P, Spiezia S. Laser Ablation Technique in Plummer's Adenoma: Equipment and Details of Technique. VideoEndocrinology 2022. [DOI: 10.1089/ve.2022.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chiara Offi
- Department of Endocrine and Ultrasound-Guided Surgery, “Ospedale del Mare,” Naples, Italy
| | - Giovanni Antonelli
- Department of Endocrine and Ultrasound-Guided Surgery, “Ospedale del Mare,” Naples, Italy
| | - Umberto Brancaccio
- Department of Endocrine and Ultrasound-Guided Surgery, “Ospedale del Mare,” Naples, Italy
| | - Maria Gaudiello
- Department of Endocrine and Ultrasound-Guided Surgery, “Ospedale del Mare,” Naples, Italy
| | - Claudia Misso
- Department of Endocrine and Ultrasound-Guided Surgery, “Ospedale del Mare,” Naples, Italy
| | - Anna Nunziata
- Department of Endocrine and Ultrasound-Guided Surgery, “Ospedale del Mare,” Naples, Italy
| | - Pasquale Tammaro
- Department of Endocrine and Ultrasound-Guided Surgery, “Ospedale del Mare,” Naples, Italy
| | - Stefano Spiezia
- Department of Endocrine and Ultrasound-Guided Surgery, “Ospedale del Mare,” Naples, Italy
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30
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Baldwin CK, Natter MB, Patel KN, Hodak SP. Minimally Invasive Techniques for the Management of Thyroid Nodules. Endocrinol Metab Clin North Am 2022; 51:323-349. [PMID: 35662444 DOI: 10.1016/j.ecl.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Image-guided interventional techniques have emerged as promising treatments for thyroid disease. Percutaneous ethanol ablation, radiofrequency ablation, laser ablation, high intensity focused ultrasound, and microwave ablation have shown efficacy in treating benign thyroid disease. There is increasing evidence that these techniques may effectively treat papillary thyroid microcarcinomas, recurrent and metastatic disease, follicular neoplasms, and parathyroid lesions. They are performed in an outpatient setting, well-tolerated, with negligible risk for thyroid hormone supplementation, making them a popular alternative to surgical resection. In this comprehensive review, we discuss the devices, techniques, advantages, and disadvantages of each intervention, and summarize the published outcomes.
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Affiliation(s)
- Chelsey K Baldwin
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA.
| | - Michael B Natter
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA
| | - Kepal N Patel
- Otolaryngology and Biochemistry, Division of Endocrine Surgery, Department of Surgery, Division of Endocrine Surgery, New York University School of Medicine, 530 1st Avenue, Floor 12, NY 10016, USA
| | - Steven P Hodak
- Department of Medicine, Diabetes and Endocrinology Section, New York University School of Medicine, 222 East, 41st Street, Floor 23, NY 10016, USA
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31
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Fung MMH, Lang BHH. Using Intra-Operative Laryngeal Ultrasonography as a Real-Time Tool in Assessing Vocal Cord Function During Radiofrequency Ablation of the Thyroid Gland. World J Surg 2022; 46:2206-2211. [PMID: 35595868 DOI: 10.1007/s00268-022-06596-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inadvertent injury of the recurrent laryngeal nerve can occur during radiofrequency ablation (RFA) of thyroid nodules. Methods to avoid permanent injury have not been described. Laryngeal ultrasonography (LUSG) can assess the function of vocal cords (VCs) in real time. The present study aimed to evaluate the feasibility and accuracy of LUSG in assessing real-time VC function during RFA of benign thyroid nodules. METHODS Consecutive patients undergoing RFA for benign thyroid nodules under local anesthesia were included. Spontaneous VC movements were checked with intra-operative LUSG (iLUSG) following each transverse ablation plane. In case of reduced VC movement, the ablation was stopped immediately. Post-ablation VC function was rechecked by LUSG on day-0 and flexible laryngoscopy (FL) on day-7. A concordance with day-0 LUSG or day-7 FL was a "true positive" or "true negative" depending on the presence or absence of VC palsy (VCP). Accuracy was calculated as the sum of all true positives and negatives divided by total nerves-at-risk. RESULTS Of 65 eligible patients, 56 (86.2%) were females. Twelve (18.5%) patients had bilateral lobe RFA, while 53 (81.5%) had unilateral RFA. The total number of nerves-at-risk was 77. Three unilateral VCPs (3.9%) were initially detected on iLUSG and confirmed by day-0 LUSG. All recovered fully within one week. The overall accuracy of iLUSG was 100%. CONCLUSION iLUSG is a highly accurate method that permits real-time feedback on the function of the VCs during RFA procedure. Real-time detection of VCP may prevent permanent injury. Methodological routine use of iLUSG is recommended during thyroid RFA.
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Affiliation(s)
- Matrix Man Him Fung
- Division of Endocrine Surgery, Department of Surgery, the University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, SAR, China
| | - Brian Hung Hin Lang
- Division of Endocrine Surgery, Department of Surgery, the University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, SAR, China.
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32
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Li L, Qiu X. Safety and Efficacy of Ultrasound-Guided Radiofrequency Ablation for Benign Nonfunctional Thyroid Nodules in Children: A Retrospective Study of 62 Patients with Over Four Years of Follow-Up. Thyroid 2022; 32:525-535. [PMID: 34915754 DOI: 10.1089/thy.2021.0454] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Image-guided radiofrequency ablation (RFA) for benign nonfunctional thyroid nodules in adults has been shown to be effective and safe, but few trials address the use of RFA in children. Therefore, this study was designed to assess the efficacy and safety of RFA application to benign nonfunctional thyroid nodules in children. Methods: A retrospective study of RFA for 70 benign nonfunctional thyroid nodules in 62 children with four-year follow-up was conducted. Volume reduction ratio (VRR), technique efficacy, regrowth rate, symptom score, and cosmetic score were calculated to evaluate the efficacy. Complications and side effects were recorded. Logistic regression analysis was performed to identify risk factors, and subgroup analyses were performed. Results: Patients were followed up for at least four years (59.1 ± 10.5 months, range 48-85 months). After RFA treatment, the VRR and technique efficacy rates were highest at the first year* (77.5% and 91.4%, respectively) but decreased by four years (55.1% and 81.4%, respectively). The symptom score decreased from 4.0 ± 2.1* to 0.8 ± 1.6 (Z = -6.82, p < 0.001), and the cosmetic score decreased from 3.3 ± 0.7 to 1.3 ± 0.9 (Z = -7.0, p < 0.001).* The nodule regrowth rate was 22.9%, of which 56.3% of cases represented loss of efficacy. In the cases of loss of efficacy, 66.7% had greater volume than their initial presentation. Patients who received a second RFA treatment due to loss of efficacy lost efficacy again. Bilateral nodules, low vascularity, and low cystic components were independent risk factors correlating with technique efficacy. Bilateral nodules correlated with low VRR, low efficacy rate, and high regrowth rate. Nodules with a higher proportion of cystic components had higher VRR. The overall complication rate was 4.8%. Conclusions: RFA was effective in reducing the volume of benign nonfunctional thyroid nodules in children, providing significant symptomatic relief with a good safety profile during short- and long-term follow-up. RFA is a good minimally invasive treatment modality for selected pediatric patients, and it may not be appropriate for the treatment of bilateral thyroid nodules in children.
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Affiliation(s)
- Liwen Li
- Department of Thyroid surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, PR China
| | - Xinguang Qiu
- Department of Thyroid surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, PR China
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33
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Li Y, He H, Li W, Zhao J, Ge N, Zhang Y, Luo Y. Efficacy and safety of radiofrequency ablation for calcified benign thyroid nodules: results of over 5 years' follow-up. BMC Med Imaging 2022; 22:75. [PMID: 35459125 PMCID: PMC9027040 DOI: 10.1186/s12880-022-00795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of radiofrequency ablation (RFA) for treating calcified benign thyroid nodules (CBTNs). Methods Fifty-two patients with 52 CBTNs who underwent RFA in our hospital were included in this retrospective study. According to the size of calcifications, CBTNs were divided into two groups: the punctate echogenic foci (PEF) group and macrocalcification group. Moreover, the macrocalcification group was further subdivided into two groups, the strong group and the weak group, based on their morphologic characteristics. After the RFA procedure, routine ultrasound (US) and clinical evaluation were performed at 1, 3, 6 and 12 months postoperatively and every 12 months thereafter. Results The mean follow-up time was 68.98 ± 7.68 months (60–87 months), and the 5-year mean volume reduction rate (VRR) after RFA was 92.95%, with a complication rate of 0.6% (3/52). The mean initial volume of the macrocalcification group was significantly larger than that of the PEF group (9.94 ± 24.60 ml vs. 0.23 ± 0.22 ml, respectively; P = 0.011). Thus, their VRRs were not comparable between the two groups. However, baseline characteristics did not show statistically significant differences between the strong and weak macrocalcification subgroups. The VRRs of the strong subgroup were significantly lower than those of the weak subgroup at the 3-year, 4-year, and 5-year follow-ups. Conclusion RFA was effective and safe for treating CBTNs. Strong macrocalcification was related to the VRR of CBTNs after the RFA procedure.
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Affiliation(s)
- Yi Li
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China.,Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Hongying He
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wen Li
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China.,Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jiahang Zhao
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China.,Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Naiqiao Ge
- Department of Ultrasound, Medical School of Chinese PLA, Beijing, China.,Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Yukun Luo
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
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Stan MN, Papaleontiou M, Schmitz JJ, Castro MR. Nonsurgical Management of Thyroid Nodules: The Role of Ablative Therapies. J Clin Endocrinol Metab 2022; 107:1417-1430. [PMID: 34953163 PMCID: PMC9016471 DOI: 10.1210/clinem/dgab917] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 12/02/2022]
Abstract
CONTEXT After a thorough evaluation most thyroid nodules are deemed of no clinical consequence and can be observed. However, when they are compressive, toxic, or involved by papillary thyroid carcinoma surgery or radioactive iodine (RAI) (if toxic) are the treatments of choice. Both interventions can lead to hypothyroidism and other adverse outcomes (eg, scar, dysphonia, logistical limitation with RAI). Active surveillance might be used for papillary thyroid microcarcinoma (PTMC) initially, but anxiety leads many cases to surgery later. Several ablative therapies have thus evolved over the last few years aimed at treating these nodules while avoiding described risks. CASES We present 4 cases of thyroid lesions causing concern (compressive symptoms, thyrotoxicosis, anxiety with active surveillance of PTMC). The common denominator is patients' attempt to preserve thyroid function, bringing into focus percutaneous ethanol injection (PEI) and thermal ablation techniques (radiofrequency ablation [RFA] being the most common). We discuss the evidence supporting these approaches and compare them with standard therapy, where evidence exists. We discuss additional considerations for the utilization of these therapies, their side-effects, and conclude with a simplified description of how these procedures are performed. CONCLUSION Thermal ablation, particularly RFA, is becoming an attractive option for managing a subgroup of solid thyroid nodules, while PEI has a role in managing thyroid cysts and a select group of PTMC. Their role in the algorithm of thyroid nodule management is still being refined and technical expertise will be essential to reproduce the reported results into everyday practice.
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Affiliation(s)
- Marius N Stan
- Correspondence: Marius N. Stan, Division of Endocrinology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Jasim S, Patel KN, Randolph G, Adams S, Cesareo R, Condon E, Henrichsen T, Itani M, Papaleontiou M, Rangel L, Schmitz J, Stan MN. American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions. Endocr Pract 2022; 28:433-448. [PMID: 35396078 DOI: 10.1016/j.eprac.2022.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE The objective of this disease state clinical review is to provide clinicians with a summary of the nonsurgical, minimally invasive approaches to managing thyroid nodules/malignancy, including their indications, efficacy, side effects, and outcomes. METHODS A literature search was conducted using PubMed and appropriate key words. Relevant publications on minimally invasive thyroid techniques were used to create this clinical review. RESULTS Minimally invasive thyroid techniques are effective and safe when performed by experienced centers. To date, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Both ultrasound-guided laser and radiofrequency ablation can be safely used for symptomatic solid nodules, both toxic and nontoxic. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. Despite limited data, encouraging results suggest that minimally invasive techniques can also be used in small-size primary and locally recurrent thyroid cancer. CONCLUSION Surgery and radioiodine treatment remain the conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective alternatives when used appropriately and by trained professionals to treat symptomatic or enlarging thyroid masses.
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Affiliation(s)
- Sina Jasim
- Division of Endocrinology, Metabolism and Lipid Research, School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
| | | | - Gregory Randolph
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Adams
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, Florida
| | - Roberto Cesareo
- Unit of Metabolic Diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leonardo Rangel
- Head and Neck Surgery Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - John Schmitz
- Mayo Clinic Department of Radiology, Rochester, Minnesota
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
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Mauri G, Bernardi S, Palermo A, Cesareo R. Minimally-invasive treatments for benign thyroid nodules: recommendations for information to patients and referring physicians by the Italian Minimally-Invasive Treatments of the Thyroid group. Endocrine 2022; 76:1-8. [PMID: 35290617 PMCID: PMC8986658 DOI: 10.1007/s12020-022-03005-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/30/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE In this paper, the members of the Italian Working Group on Minimally-Invasive Treatments of the Thyroid (MITT group) aim to summarize the most relevant information that could be of help to referring physicians and that should be provided to patients when considering the use of MITT for the treatment of benign thyroid nodules. METHODS An interdisciplinary board of physicians with specific expertise in the management of thyroid nodules was appointed by the Italian MITT Group. A systematic literature search was performed, and an evidence-based approach was used, including also the knowledge and the practical experience of the panelists to develop the paper. RESULTS The paper provides a list of questions that are frequently asked by patients to operators performing MITT, each with a brief and detailed answer and more relevant literature references to be consulted. CONCLUSIONS This paper summarizes the most relevant information to be provided to patients and general practitioners/referring physicians about the use of MITT for the treatment of benign thyroid nodules.
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Affiliation(s)
- Giovanni Mauri
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milano, Italy.
- Divisione di Radiologia interventistica, Istituto Europeo di Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy.
| | - Stella Bernardi
- Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
- UCO Medicina Clinica, Azienda Sanitaria Universitaria Integrata Trieste (ASUGI), Trieste, Italy
| | - Andrea Palermo
- Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Roberto Cesareo
- UOS Malattie Metaboliche, Ospedale Santa Maria Goretti, Latina, Italy
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Dong YJ, Liu ZH, Zhou JQ, Zhan WW. Efficacy of Lauromacrogol Injection for Ablation of Benign Predominantly Cystic Thyroid Nodules and Related Factors: A Prospective Study. Korean J Radiol 2022; 23:479-487. [PMID: 35345062 PMCID: PMC8961015 DOI: 10.3348/kjr.2020.1205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/03/2022] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To prospectively evaluate the efficacy of lauromacrogol injection for ablation (LIA) of benign predominantly cystic thyroid nodules and its related factors. MATERIALS AND METHODS A total of 142 benign predominantly cystic thyroid nodules (median volume, 12.5 mL; range, 0.4-156 mL) in 137 patients (male:female sex ratio, 36:101; mean age ± standard deviation [SD], 49 ± 13 years) were treated with LIA after being confirmed as benign via cytology. The volume reduction rate (VRR) of the nodules and cosmetic score were evaluated during follow-up at 1, 3, and 6 months after treatment and every 6 months thereafter. A VRR of ≥ 50% at the 12-month follow-up was considered to indicate effective treatment. The associations between the clinical factors and nodular ultrasound features, including the initial nodule volume, proportion of solid components, vascularity grade and ineffective treatment (VRR of < 50% at the 12-month follow-up), and regrowth were analyzed. RESULTS All patients completed follow-up for at least 12 months. The average ± SD follow-up period was 32 ± 11 months (range, 12-54 months). The effective treatment rate was 73.2% (104/142), while the regrowth rate was 12.0% (17/142) at the last follow-up. Grade 2-3 intranodular vascularity in the solid components of the nodules was the only independent factor associated with ineffective treatment, with an odds ratio (reference category, grade 0-1) of 3.054 (95% confidence interval, 1.148-8.127) (p = 0.025). CONCLUSION LIA is an effective treatment for predominantly cystic thyroid nodules. Grade 2-3 intranodular vascularity in the solid components of nodules is the only independent risk factor for ineffective LIA.
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Affiliation(s)
- Yi Jie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhen Hua Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian Qiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Wei Wei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Safety and Efficacy of Single-Session Radiofrequency Ablation Treatment for Benign Non-toxic Multinodular Goiter. World J Surg 2022; 46:1704-1710. [PMID: 35313358 DOI: 10.1007/s00268-022-06527-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is an effective treatment for benign thyroid nodules. However, it remains unclear if ablating multiple nodules in single-session offers comparable safety and efficacy to ablating single nodule. Our study compared early complication rate and 6-month nodule shrinkage between multiple-nodules ablation and single-nodule ablation by RFA. METHODS Among the 174 eligible patients undergoing RFA of one or more benign thyroid nodules, 85 (48.8%) had single-nodule ablation (group I) while 89 (51.1%) had two or three nodules ablation (group II). The 6-month nodule shrinkage of each nodule (by volume reduction ratio) (VRR) was calculated by (Baseline volume - volume at 6-month)/(Baseline volume)*100 and compared between two groups. To determine independent predictors for VRR, a multivariate analysis was done by logistic regression analysis. RESULTS Patients in group II reported significantly higher pain scores during and 2-h after treatment than group I (42.31 vs. 29.66, p = 0.029 and 38.21 vs. 26.18, p = 0.037, respectively). Two vocal cord paresis occurred in each group. 3- and 6-month VRR of the largest nodule were comparable between two groups (67.39% vs. 63.89%, p = 0.248 and 77.29% vs. 73.38%, p = 0.182). Similar 3- and 6-month VRR were observed for 2 and 3 largest nodules in group II. In multivariate analysis, total energy given per nodule volume (OR = 1.007, 95% CI = 1.001-1.012, p = 0.036) was the only independent predictor for 6-month VRR. CONCLUSION In the presence of multinodular goiter, ablating two or more nodules by RFA within one session appears to offer a comparable level of safety and efficacy to ablating single nodule.
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Treatment of Cystic Thyroid Nodules. Tech Vasc Interv Radiol 2022; 25:100822. [DOI: 10.1016/j.tvir.2022.100822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pierannunzio D, Fedeli U, Francisci S, Paoli AD, Toffolutti F, Serraino D, Zoppini G, Borsatti E, Di Felice E, Falcini F, Ferretti S, Giorgi Rossi P, Gobitti C, Guzzinati S, Mattioli V, Mazzoleni G, Piffer S, Vaccarella S, Vicentini M, Zorzi M, Franceschi S, Elisei R, Dal Maso L. Thyroidectomies in Italy: A Population-Based National Analysis from 2001 to 2018. Thyroid 2022; 32:263-272. [PMID: 35018816 DOI: 10.1089/thy.2021.0531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: The incidence of thyroid disease is generally increasing, and it is subject to major geographic variability, between and within countries. Moreover, the incidence rates and the proportion of overdiagnosis for thyroid cancer in Italy are among the highest worldwide. This study aimed to estimate population-based frequency and trends of thyroidectomies in Italy by type of surgical procedure (total/partial), indication (tumors/other conditions), sex, age, and geographical region. Materials and Methods: Age-standardized rates (ASRs) of thyroidectomies were estimated from 2001 to 2018 using the national hospital discharges database. Results: In Italy, ASRs of thyroidectomies were nearly 100 per 100,000 women in 2002-2004 and decreased to 71 per 100,000 women in 2018. No corresponding variation was shown in men (ASR 27 per 100,000 men) in the overall period. A more than twofold difference between Italian regions emerged in both sexes. The proportion of total thyroidectomies (on the sum of total and partial thyroidectomies) in the examined period increased from 78% to 86% in women and from 72% to 81% in men. Thyroidectomies for goiter and nonmalignant conditions decreased consistently throughout the period (from 81 per 100,000 women in 2002 to 49 in 2018 and from 22 to 16 per 100,000 men), while thyroidectomies for tumors increased until 2013-2014 up to 24 per 100,000 women (9 per 100,000 men) and remained essentially stable thereafter. Conclusions: The decrease in thyroidectomies for nonmalignant diseases since early 2000s in Italy may derive from the decrease of goiter prevalence, possibly as a consequence of the reduction of iodine deficiency and the adoption of conservative treatments. In a context of overdiagnosis of thyroid cancer, recent trends have suggested a decline in the diagnostic pressure with a decrease in geographic difference. Our results showed the need and also the possibility to implement more conservative surgical approaches to thyroid diseases, as recommended by international guidelines.
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Affiliation(s)
- Daniela Pierannunzio
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Padua, Italy
| | - Silvia Francisci
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giacomo Zoppini
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Eugenio Borsatti
- Nuclear Medicine Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Enza Di Felice
- Authority for Healthcare and Welfare, Emilia Romagna Regional Health Service, Bologna, Italy
- Controllo Gestione, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
- Azienda Usl della Romagna, Forlì, Italy
| | - Stefano Ferretti
- Ferrara Cancer Registry, University of Ferrara, Azienda USL Ferrara, Ferrara, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Gobitti
- Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | | | - Veronica Mattioli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Silvano Piffer
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento, Italy
| | - Salvatore Vaccarella
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Massimo Vicentini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Manuel Zorzi
- Epidemiological Department, Azienda Zero, Padua, Italy
| | - Silvia Franceschi
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Rossella Elisei
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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The Treatment of Thyroid Cancer with Radiofrequency Ablation. Tech Vasc Interv Radiol 2022; 25:100825. [DOI: 10.1016/j.tvir.2022.100825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bo XW, Lu F, Yu SY, Yue WW, Li XL, Hu M, Wu LL, Lv ZY, Sun LP, Xu HX. Comparison of efficacy, safety, and patient satisfaction between thermal ablation, conventional/open thyroidectomy, and endoscopic thyroidectomy for symptomatic benign thyroid nodules. Int J Hyperthermia 2022; 39:379-389. [PMID: 35188057 DOI: 10.1080/02656736.2022.2040608] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Xiao-Wan Bo
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng Lu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Song-Yuan Yu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Man Hu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Li-Li Wu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhu-Ying Lv
- Department of Diagnostic Ultrasound, Hangzhou Cancer Hospital, Hangzhou, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Cao J, Fan P, Wang F, Shi S, Liu L, Yan Z, Dong Y, Wang W. Application of contrast-enhanced ultrasound in minimally invasive ablation of benign thyroid nodules. J Interv Med 2022; 5:32-36. [PMID: 35586282 PMCID: PMC8947980 DOI: 10.1016/j.jimed.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to investigate the application value of contrast-enhanced ultrasound (CEUS) before and after minimally invasive ablation procedures for benign thyroid nodule(s) (BTN). Methods This prospective study included patients with BTNs scheduled to undergo ultrasound-guided minimally invasive ablation treatment. CEUS was performed before and after ablation (at 1 day, and 1, 6, and 12 months after ablation). Changes in microvascular perfusion and the volume of BTNs were noted and assessed. Results Sixty-two patients (62 BTNs), who underwent ablation procedures between June 2016 and August 2020, were included. All lesions were confirmed by biopsy, and histopathological results were obtained before ablation treatment. On preoperative CEUS, the lesions exhibited hyperenhancement (53.23%) or iso-enhancement (46.77%) during the arterial phase, and all lesions exhibited iso-enhancement in the venous and late phases. One day after ablation, none of the BTNs exhibited obvious enhancement on CEUS. One (1.61%) lesion was re-treated due to a nodule-like enhancement area detected by CEUS at the 6-month follow-up. The mean nodular volume reduction rate (VRR) at 1, 6, and 12 months follow-up demonstrated no significant difference between the two ablation groups (microwave ablation versus radiofrequency ablation). Twelve months after ablation, the mean (±SD) VRR of all BTNs was 60.3 ± 10.3%. Conclusion CEUS helped guide treatment decisions for BTNs before ablation treatment. Moreover, it could also be used to accurately and noninvasively evaluate treatment efficacy.
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Affiliation(s)
- Jiaying Cao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peili Fan
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Feihang Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuainan Shi
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Corresponding author. Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Zhiping Yan
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- Corresponding author. Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Gambelunghe G, Ristagno S, Stefanetti E, Avenia N, De Feo P. Ultrasound-guided laser ablation of very large benign thyroid nodules: 4-year, retrospective follow-up in 24 patients. Int J Hyperthermia 2022; 39:217-221. [DOI: 10.1080/02656736.2022.2025923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Serenella Ristagno
- Department of Oncology, Section of Endocrine Surgery, Taormina Hospital, Italy
| | | | - Nicola Avenia
- Department of Endocrine Surgery, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
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Multicenter Study of Benign Thyroid Nodules with Radiofrequency Ablation: Results of 762 Cases over 4 Years in Taiwan. J Pers Med 2022; 12:jpm12010063. [PMID: 35055378 PMCID: PMC8782025 DOI: 10.3390/jpm12010063] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness and safety of radiofrequency ablation (RFA) treatment for benign thyroid nodules (BTNs) in five medical centers in Taiwan. METHODS From April 2016 to July 2020, 762 patients underwent ultrasound guided RFA treatment of 826 benign thyroid nodules at five medical centers in Taiwan. The RFA procedure was performed by radiologists, otolaryngologists, or surgeons. Patients were grouped into three subgroups according to the initial volume of BTNs. The volume reduction ratio (VRR) of each nodule, and complications were analyzed at 1, 3, and 6 months after RFA treatment and the three groups compared. RESULTS The large nodular group showed greater VRR compared to the other two groups at first 1-month follow-up. At 6-months follow-up, there was no significant difference of VRR among the three groups. Goiters with difference in size can attain a successful VRR (>50%) although different specialists demonstrated variable VRR after 6-months follow-up. A total of 40 (4.8%) complications were reported. All patients recovered spontaneously without surgery intervention. CONCLUSIONS The reliability and safety of RFA for benign thyroid nodules had been established. RFA has gradually become an alternative to surgery in the treatment of benign thyroid nodules in Taiwan.
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Zhu Y, Jiao Z, Zhu L, Xie F, Song Q, Yan L, Luo Y, Zhang M. A New Perspective for Predicting the Therapeutic Success of RFA in Solid BTNs: Quantitative Initial RFA Ratio by Contrast-Enhanced Ultrasound. Front Endocrinol (Lausanne) 2022; 13:904459. [PMID: 35774147 PMCID: PMC9237222 DOI: 10.3389/fendo.2022.904459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The short-term therapeutic success of radiofrequency ablation (RFA) in solid benign thyroid nodules is of great concern. The aim of this study was to investigate a new method, initial radiofrequency ablative ratio (IRAR) using contrast-enhanced ultrasound (CEUS), for predicting therapeutic success of RFA in solid benign thyroid nodules (BTNs) immediately and effectively after RFA. METHODS A total of 813 nodules in 776 patients with benign thyroid nodules were treated with RFA from January 2014 to August 2018, among which 120 patients (M:F=41:79) with 120 solid BTNs (small: ≤10ml, n=57; medium: 10-30ml, n=42; large: >30ml, n=21) were enrolled in our study according to the inclusion criteria. The IRAR was defined as the ablative volume ratio immediately after RFA displayed by CEUS. The therapeutic success was evaluated at the 6-month follow-up. The relationship between the IRAR and volume reduction ratio (VRR) at 6-month was analyzed. The marginal regrowth of solid BTNs was also examined by CEUS at the 6 and 12 months of follow-up. RESULTS In medium and large nodules, the IRAR was significantly and positively correlated with VRR (r= 0.69, P < 0.001) at 6 months after RFA. There was a tendency to achieve therapeutic success (50% VRR: 55/63, 87.3%) when the IRAR exceeded 75%, and marginal regrowth was also relatively slow within 12 months after a single session treatment. No significant correlation between IRAR and VRR of small nodules was found. In conclusion, IRAR is significantly and positively correlated with VRR, which may indicate therapeutic success when it exceeds 75%. CONCLUSIONS CEUS can be used to accurately quantify the IRAR, which is positively correlated with the VRR. Moreover, the IRAR may be used as a parameter to predict the short-term therapeutic success of RFA in solid BTNs.
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Affiliation(s)
- Yaqiong Zhu
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Ziyu Jiao
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lianhua Zhu
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Fang Xie
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Qing Song
- Departments of Ultrasound, The Seventh Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Yukun Luo, ; Mingbo Zhang,
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Yukun Luo, ; Mingbo Zhang,
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Li YR, Chou WY, Chan WK, Cheng KL, Sun JH, Liu FH, Chen ST, Liou MJ. Successful Applications of Food-Assisted and -Simulated Training Model of Thyroid Radiofrequency Ablation. Front Endocrinol (Lausanne) 2022; 13:809835. [PMID: 35432189 PMCID: PMC9009177 DOI: 10.3389/fendo.2022.809835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) for benign thyroid nodules is one kind of scarless treatment for symptomatic or cosmetic benign thyroid nodules. However, how to train RFA-naive physicians to become qualified operators for thyroid RFA is an important issue. Our study aimed to introduce a successful training model of thyroid RFA. MATERIALS AND METHODS We used a food-assisted and -simulated training model of thyroid RFA. Chicken hearts were simulated into thyroid nodules, three-layer pork meats were simulated into peri-thyroid structure, and gel bottles were simulated into trachea, respectively. Successful training ablations were defined as chicken hearts that were fully cooked. After repeating training ablations of chicken hearts at least 100 times with the nearly 100% success rates for three young trainees, they served as the first assistant for the real procedures of thyroid RFA and then were qualified to perform thyroid RFA on real patients under the supervision of one experienced interventional radiologist. RESULTS 23 real patients who received RFA and follow-up at least 6 months after treatment were included in Linkou Chang Gung Memorial Hospital from January 1, 2020 to October 1, 2021. Three young endocrinologists performed thyroid RFA independently. The outcomes were volume reduction rate (VRR), major complications and minor complications. The median VRR at 12 months was 82.00%, two major complications were transient hoarseness, and three minor complications were wound pain. All complications were completely recovered within three days. CONCLUSIONS For young and RFA-native physicians without any basic skills of echo-guided intervention, this food-assisted and -simulated training model of thyroid RFA was useful for medical training and education.
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Affiliation(s)
- Yan-Rong Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Yu Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wai-Kin Chan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kai-Lun Cheng
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Jui-Hung Sun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Feng-Hsuan Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Miaw-Jene Liou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Miaw-Jene Liou,
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48
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Squarcia M, Mora M, Aranda G, Carrero E, Martínez D, Jerez R, Valero R, Berenguer J, Halperin I, Hanzu FA. Long-Term Follow-Up of Single-Fiber Multiple Low-Intensity Energy Laser Ablation Technique of Benign Thyroid Nodules. Front Oncol 2021; 11:584265. [PMID: 34950572 PMCID: PMC8691264 DOI: 10.3389/fonc.2021.584265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Aim The 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. Methods Prospective 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. Results On 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. Conclusions LA 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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Affiliation(s)
- Mattia Squarcia
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain.,Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mireia Mora
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Gloria Aranda
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Enrique Carrero
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Daniel Martínez
- Department of Pathology and Anatomy, Hospital Clinic, Barcelona, Spain
| | - Ramona Jerez
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Ricard Valero
- Department of Anesthesia and Critical Care Hospital Clinic, Barcelona, Spain
| | - Joan Berenguer
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain
| | - Irene Halperin
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Felicia A Hanzu
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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49
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Orloff LA, Noel JE, Stack BC, Russell MD, Angelos P, Baek JH, Brumund KT, Chiang FY, Cunnane MB, Davies L, Frasoldati A, Feng AY, Hegedüs L, Iwata AJ, Kandil E, Kuo J, Lombardi C, Lupo M, Maia AL, McIver B, Na DG, Novizio R, Papini E, Patel KN, Rangel L, Russell JO, Shin J, Shindo M, Shonka DC, Karcioglu AS, Sinclair C, Singer M, Spiezia S, Steck JH, Steward D, Tae K, Tolley N, Valcavi R, Tufano RP, Tuttle RM, Volpi E, Wu CW, Abdelhamid Ahmed AH, Randolph GW. Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association. Head Neck 2021; 44:633-660. [PMID: 34939714 DOI: 10.1002/hed.26960] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The use of ultrasound-guided ablation procedures to treat both benign and malignant thyroid conditions is gaining increasing interest. This document has been developed as an international interdisciplinary evidence-based statement with a primary focus on radiofrequency ablation and is intended to serve as a manual for best practice application of ablation technologies. METHODS A comprehensive literature review was conducted to guide statement development and generation of best practice recommendations. Modified Delphi method was applied to assess whether statements met consensus among the entire author panel. RESULTS A review of the current state of ultrasound-guided ablation procedures for the treatment of benign and malignant thyroid conditions is presented. Eighteen best practice recommendations in topic areas of preprocedural evaluation, technique, postprocedural management, efficacy, potential complications, and implementation are provided. CONCLUSIONS As ultrasound-guided ablation procedures are increasingly utilized in benign and malignant thyroid disease, evidence-based and thoughtful application of best practices is warranted.
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Affiliation(s)
- Lisa A Orloff
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Julia E Noel
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Brendan C Stack
- Department of Otolaryngology - Head & Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Marika D Russell
- Department of Otolaryngology - Head & Neck Surgery, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Jung Hwan Baek
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kevin T Brumund
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA
| | - Feng-Yu Chiang
- Department of Otolaryngology - Head and Neck Surgery, E-Da Hospital, School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Mary Beth Cunnane
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Louise Davies
- The Section of Otolaryngology, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Andrea Frasoldati
- Department of Endocrinology and Metabolism, Arcispedale Santa Maria Nuova IRCCS-ASL, Reggio Emilia, Italy
| | - Anne Y Feng
- Department of Otolaryngology - Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Ayaka J Iwata
- Department of Otolaryngology - Head & Neck Surgery, Kaiser Permanente, Santa Clara, California, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jennifer Kuo
- Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Celestino Lombardi
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mark Lupo
- Thyroid & Endocrine Center of Florida, Sarasota, Florida, USA
| | - Ana Luiza Maia
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center, Research Institute, Tampa, Florida, USA
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | | | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Kepal N Patel
- Department of Surgery, New York University, New York, New York, USA
| | - Leonardo Rangel
- Division of Otorhinolaryngology - Head and Neck Surgery, State University of Rio de Janeiro, Rio de Janiero, Brazil
| | - Jonathon O Russell
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Shin
- Department of Otolaryngology - Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maisie Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - David C Shonka
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Amanda S Karcioglu
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA.,Clinician Educator, Pritzker School of Medicine, Chicago, Illinois, USA
| | - Catherine Sinclair
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai West Hospital, New York, New York, USA
| | - Michael Singer
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Stefano Spiezia
- Endocrine Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Jose Higino Steck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Campinas, Campinas, Brazil
| | - David Steward
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kyung Tae
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Neil Tolley
- Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK
| | | | - Ralph P Tufano
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Michael Tuttle
- Endocrine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erivelto Volpi
- Oncology Center, Oswaldo Cruz German Hospital, Sao Paulo, Brazil
| | - Che Wei Wu
- Department of Otolaryngology - Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Amr H Abdelhamid Ahmed
- Department of Otolaryngology - Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology - Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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50
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Liu LH, Yang BB, Liu Y, Wang JL, Wang DD, Ding HY, Wang SR. Factors related to the absorption rate of benign thyroid nodules after image-guided microwave ablation: a 3-year follow-up. Int J Hyperthermia 2021; 39:8-14. [PMID: 34936851 DOI: 10.1080/02656736.2021.1995632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To assess the absorption rate and factors related to the development of benign thyroid nodules (BTNs) following image-guided microwave ablation (MWA). MATERIALS AND METHODS This retrospective study reviewed nodule efficacy in patients who underwent MWA of BTNs between January 2016 and January 2018. The endpoint was a third-year follow-up. Nodules were categorized into those showing complete absorption (volumes with less than 100% volume reduction ratio (VRR) and those showing partial absorption (100% VRR)). Univariable and multivariable regression analyses were carried out to identify variables that were associated with nodule absorption rates. RESULTS A total of 173 BTNs (median volume= 4.23 ml; 25-75 percentiles= 2.27-9.00 ml) from 173 patients were evaluated. 49.7% (86/173) of patients had nodules that became completely absorbed. The mean VRRs of all BTNs were 18.0%, 78.7%, 89.0%, 94.5%, and 97.1% at the 1-, 6-,12-, 24- and 36- month follow-ups. At the 3-year follow-up time point, nodule characteristics related to nodule VRR included nodule volume (adjusted odds ratio [AOR], 1.1 [95% CI: 1.0, 1.2]; p = 0.03) and nodule margin (AOR, 5.3 [95% CI: 1.8, 16.0]; p < 0.01). Treatment-related characteristics included energy per ml in nodular volume (AOR, 1.0 [95% CI: 1.0, 1.0]; p < 0.01) and blockage of peripheral flow (AOR, 3.3 [95% CI: 1.3 8.3]; p = 0.01). CONCLUSIONS US-guided image-guided MWA results in satisfactory long-term outcomes for the patients with BTNs. Factors related to nodule absorption rate were the volume and margin of the nodule, energy per ml in nodular volume and blockage of peripheral flow.
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Affiliation(s)
- Li-Hong Liu
- Department of Ultrasound, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Bei-Bei Yang
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Ying Liu
- Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China
| | - Jin-Ling Wang
- Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China
| | - Dan-Dan Wang
- Department of Ultrasound, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hong-Yu Ding
- Department of Ultrasound, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan, China
| | - Shu-Rong Wang
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China.,Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China
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