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Bernardi S, Palermo A, Grasso RF, Fabris B, Stacul F, Cesareo R. Current Status and Challenges of US-Guided Radiofrequency Ablation of Thyroid Nodules in the Long Term: A Systematic Review. Cancers (Basel) 2021; 13:2746. [PMID: 34205994 PMCID: PMC8199252 DOI: 10.3390/cancers13112746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/22/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND US-guided minimally-invasive techniques, such as radiofrequency ablation (RFA) have emerged as an alternative treatment for benign and malignant thyroid nodules. This systematic review aims to provide an overview on the long-term outcomes of US-guided RFA in patients with benign and malignant thyroid nodules. METHODS We systematically searched PubMed/MEDLINE, EMBASE, and Scopus to identify articles reporting the outcomes of thyroid RFA after a follow-up of at least 3 years. RESULTS A total of 20 studies met the inclusion criteria and were included in the review. In patients with benign thyroid nodules, RFA significantly reduced nodule volume and this was generally maintained for the following 5 years. However, a small but not negligible proportion of nodules regrew and some of them required further treatments over time. In patients with malignant nodules, RFA has been used not only to treat differentiated thyroid cancer (DTC) neck recurrences, but also to treat papillary thyroid microcarcinoma (PTMC). In most patients with PTMC, RFA led to complete disappearance of the tumor. When it was compared to surgery, RFA was not inferior in terms of oncologic efficacy but it had a lower complication rate. However, RFA did not allow for final pathology, disease staging and accurate risk stratification. CONCLUSIONS US-guided RFA significantly reduces benign thyroid nodules and destroys most PTMC, and this is generally maintained for at least 5 years after the initial treatment. Further studies addressing the risk of regrowths in patients with benign thyroid nodules, as well as the risk of recurrence in patients with PTMC are needed.
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Affiliation(s)
- Stella Bernardi
- Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy;
- U.C.O. Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, 34149 Trieste, Italy
| | - Andrea Palermo
- Unità di Endocrinologia e Diabete, Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
| | - Rosario Francesco Grasso
- U.O.S. Radiologia Interventistica, Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
| | - Bruno Fabris
- Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy;
- U.C.O. Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, 34149 Trieste, Italy
| | - Fulvio Stacul
- S.C. Radiologia, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Maggiore Hospital, 34125 Trieste, Italy;
| | - Roberto Cesareo
- U.O.S. Malattie Metaboliche, Ospedale Santa Maria Goretti, 04100 Latina, Italy;
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Ha SM, Shin JY, Baek JH, Song DE, Chung SR, Choi YJ, Lee JH. Does Radiofrequency Ablation Induce Neoplastic Changes in Benign Thyroid Nodules: A Preliminary Study. Endocrinol Metab (Seoul) 2019; 34:169-178. [PMID: 31099203 PMCID: PMC6599903 DOI: 10.3803/enm.2019.34.2.169] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/15/2019] [Accepted: 04/03/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To evaluate the clinical feasibility of radiofrequency ablation (RFA) of benign thyroid nodules along with cytomorphological alteration, and any malignant transformation through biopsy. METHODS The data were retrospectively collected between April 2008 and June 2013 and core needle biopsy (CNB) was performed on 16 benign thyroid nodules previously treated using RFA. The parameters of the patients were compared, between the time of enrollment and the last follow-up examination, using linear mixed model statistical analysis. RESULTS No atypical cells or neoplastic transformation were detected in the undertreated peripheral portion of treated benign nodules on the CNB specimen. RFA altered neither the thyroid capsule nor the thyroid tissue adjacent to the treated area. On histopathological examinations, we observed 81.2% acellular hyalinization, which was the most common finding. After a mean follow-up period of over 5 years, the mean volume of thyroid nodule had decreased to 6.4±4.2 mL, with a reduction rate of 81.3%±5.8% (P<0.0001). CONCLUSION RFA is a technically feasible treatment method for benign thyroid nodules, with no carcinogenic effect or tissue damage of the normal thyroid tissue adjacent to the RFA-treated zone.
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Affiliation(s)
- Su Min Ha
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicinee, Seoul, Korea
| | - Jun Young Shin
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sae Rom Chung
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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3
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Nixon IJ, Angelos P, Shaha AR, Rinaldo A, Williams MD, Ferlito A. Image-guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications. Head Neck 2018; 40:2103-2115. [PMID: 29684251 DOI: 10.1002/hed.25181] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/03/2018] [Accepted: 02/20/2018] [Indexed: 01/03/2023] Open
Abstract
Image-guided ablation of thyroid disease is increasingly being commonly reported. Techniques including ethanol injection and thermal ablation using radio-frequency, laser, and microwave devices have been described. Minimally invasive approaches to the management of benign cystic, solid, and functional thyroid nodules as well as both primary and recurrent thyroid malignancy have been reported. The purpose of this article is to review the current evidence relating to image-guided ablation of thyroid disease with a focus on clinical outcomes and complication rates for patients treated with this minimally invasive approach.
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Affiliation(s)
- Iain J Nixon
- Ear, Nose, and Throat Department, NHS Lothian, Edinburgh, UK
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Ethics, The University of Chicago Medicine, Chicago, Illinois
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Michelle D Williams
- Department of Pathology, Division of Pathology/Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alfio Ferlito
- Coordinator of The International Head and Neck Scientific Group
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4
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Barile A, Quarchioni S, Bruno F, Ierardi AM, Arrigoni F, Giordano AV, Carducci S, Varrassi M, Carrafiello G, Caranci F, Splendiani A, Di Cesare E, Masciocchi C. Interventional radiology of the thyroid gland: critical review and state of the art. Gland Surg 2018; 7:132-146. [PMID: 29770309 DOI: 10.21037/gs.2017.11.17] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thyroid nodules are a common incidental finding during a routinely ultrasound (US) exam unrelated to the thyroid gland in the healthy adult population with a prevalence of 20-76%. As treated before with surgery, in the last years new minimally invasive techniques have been developed as an alternative to surgery. The aim of this review, based on newly revised guidelines, is to provide some information regarding the basic principles, indications, materials, techniques, and results of mini-invasive procedures or treatments for thyroid nodules. We performed a narrative review including both newest and representative papers and guidelines based on the different procedures of ablation techniques developed in the last years for the diagnosis and the treatment of thyroid nodules. All examined papers referred very good results in term of volume nodule reduction, improvement in related symptoms and cosmetic problems, with a very low rate of complications and side effects for all the minimally invasive technique analyzed. Obviously, some differents between technique based on different kind of thyroid nodules and different indication were found. In conclusion, many thyroid nodules nowadays could be treated thanks to the advent of new mini-invasive technique that are less expensive and present a lower risk of major complications and side effects compared to surgery.
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Affiliation(s)
- Antonio Barile
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Simone Quarchioni
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | | | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Aldo Victor Giordano
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Sergio Carducci
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Marco Varrassi
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Giampaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Ferdinando Caranci
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
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Papini E, Gugliemi R, Pacella CM. Laser, radiofrequency, and ethanol ablation for the management of thyroid nodules. Curr Opin Endocrinol Diabetes Obes 2016; 23:400-6. [PMID: 27504993 DOI: 10.1097/med.0000000000000282] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The majority of benign thyroid nodules are nearly asymptomatic, remain stable in size, and do not require treatment. However, a minority of patients with growing nodules may complain of local symptoms or have cosmetic concerns, and thus seek surgical consultation. RECENT FINDINGS The timely use of ultrasound-guided minimally invasive procedures can change the natural history of benign enlarging thyroid nodules. The procedures produce persistent shrinkage of thyroid nodules and are associated with improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first-line treatment for relapsing thyroid cysts. In solid nonfunctioning nodules, laser and radiofrequency ablation produces a more than 50% reduction in nodular volume that remains persistent over several years. For hyperfunctioning nodules, thermal ablation techniques are not appropriate unless radioactive iodine is contraindicated or not accessible. SUMMARY MITs are best suited for the management of medium or large-sized nodules that are sonographically well visualized. Conversely, large nodules or nodular goiters that extend into the chest are difficult to treat. MITs are performed in outpatient clinics, are less expensive, and have a lower risk of complications, compared to surgery, and usually do not induce thyroid dysfunction. However, malignancy should be ruled out with a dedicated ultrasound neck assessment and repeat fine needle aspiration of the lesion before treatment.
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Affiliation(s)
- Enrico Papini
- aDepartment of Endocrinology and Metabolism bDepartment of Diagnostic Imaging, Regina Apostolorum Hospital, Via San Francesco, Albano, Rome, Italy
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Dobrinja C, Bernardi S, Fabris B, Eramo R, Makovac P, Bazzocchi G, Piscopello L, Barro E, de Manzini N, Bonazza D, Pinamonti M, Zanconati F, Stacul F. Surgical and Pathological Changes after Radiofrequency Ablation of Thyroid Nodules. Int J Endocrinol 2015; 2015:576576. [PMID: 26265914 PMCID: PMC4523654 DOI: 10.1155/2015/576576] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/14/2015] [Accepted: 07/01/2015] [Indexed: 01/22/2023] Open
Abstract
Background. Radiofrequency ablation (RFA) has been recently advocated as an effective technique for the treatment of symptomatic benign thyroid nodules. It is not known to what extent it may affect any subsequent thyroid surgery and/or histological diagnosis. Materials and Methods. RFA was performed on 64 symptomatic Thy2 nodules (benign nodules) and 6 symptomatic Thy3 nodules (follicular lesions/follicular neoplasms). Two Thy3 nodules regrew after the procedure, and these patients accepted to undergo a total thyroidectomy. Here we present how RFA has affected the operation and the final pathological features of the surgically removed nodules. Results and Conclusions. RFA is effective for the treatment of Thy2 nodules, but it should not be recommended as first-line therapy for the treatment of Thy3 nodules (irrespective of their mutational status), as it delays surgery in case of malignancy. Moreover, it is unknown whether RFA might promote residual tumor progression or neoplastic progression of Thy3 lesions. Nevertheless, here we show for the first time that one session of RFA does not affect subsequent thyroid surgery and/or histological diagnosis.
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Affiliation(s)
- Chiara Dobrinja
- UCO Chirurgia Generale, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Stella Bernardi
- SS Endocrinologia (UCO Medicina Clinica), Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- *Stella Bernardi:
| | - Bruno Fabris
- SS Endocrinologia (UCO Medicina Clinica), Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Rita Eramo
- UCO Chirurgia Generale, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Petra Makovac
- UCO Chirurgia Generale, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Gabriele Bazzocchi
- SC Radiologia, Maggiore Hospital, Piazza dell'Ospitale, 34100 Trieste, Italy
| | - Lanfranco Piscopello
- SS Endocrinologia (III Medica), Maggiore Hospital, Piazza dell'Ospitale, 34100 Trieste, Italy
| | - Enrica Barro
- SS Endocrinologia (UCO Medicina Clinica), Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Nicolò de Manzini
- UCO Chirurgia Generale, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Deborah Bonazza
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- UCO Anatomia e Istologia Patologica, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Maurizio Pinamonti
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- UCO Anatomia e Istologia Patologica, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Fabrizio Zanconati
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
- UCO Anatomia e Istologia Patologica, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy
| | - Fulvio Stacul
- SC Radiologia, Maggiore Hospital, Piazza dell'Ospitale, 34100 Trieste, Italy
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Papini E, Pacella CM, Hegedus L. Diagnosis of endocrine disease: thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications. Eur J Endocrinol 2014; 170:R133-46. [PMID: 24459238 DOI: 10.1530/eje-13-0917] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In patients with thyroid nodules, ultrasound (US) imaging represents an indispensable tool for assessment of the risk of malignancy. Over approximately four decades, innovative technology and successive improvements have facilitated its entry into the routine management and greatly improved its predictive value. When US features cannot reliably rule out thyroid cancer, US guidance allows a correct and safe sampling also of small or deeply located thyroid lesions. Obtained in this way, cytological or microhistological specimens may reliably define the nature of most thyroid nodules, and the information from histochemical or molecular markers shows promise in the classification of the remaining indeterminate cases. While a prompt surgical treatment can be offered in the minority of suspicious or definitely malignant cases, most individuals warrant only a follow-up. However, at initial evaluation, or over the years, a fraction of these benign lesions may grow and/or become symptomatic. Such cases may benefit from US-guided minimally invasive procedures as an alternative to surgery. Image-guided percutaneous treatments most often achieve relief of neck complaints, are inexpensive, and can be performed on an outpatient basis. The risk of major complications, after adequate training, is very low. Importantly, thyroid function is preserved. Currently, percutaneous ethanol injection for cystic lesions and thermal ablation, with laser or radiofrequency, for solid nodules are increasingly used and disseminated beyond the initial core facilities. In centres with expertise and high patient volume, their use should be considered as first-line treatment alternatives to surgery for selected patients with benign enlarging or symptomatic thyroid lesions.
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8
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Schrut GCA, Miasaki FY, Paz-Filho G, Cavalcanti TCS, Graf H, de Carvalho GA. Changes associated with percutaneous ethanol injection in the treatment of thyroid nodules. Endocr Pathol 2011; 22:79-85. [PMID: 21494802 DOI: 10.1007/s12022-011-9156-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Percutaneous ethanol injection (PEI) is an alternative therapy for thyroid nodules (TN). However, some concern is raised on its carcinogenic effects. To evaluate the cytological and clinical changes caused by PEI in patients with benign TN. Thirty-nine patients with TN (23.1% hyperfunctioning) were submitted to a median of three PEI sessions. After a median of 17 months, patients were reassessed. A new ultrasound-guided fine needle biopsy (US-FNB) was performed, and the smears were analyzed after May-Grünwald-Giemsa staining. The diagnostic findings and the cellular characteristics were compared before and after treatment. There was an increase in the proportion of nondiagnostic/unsatisfactory results (from 2.5% to 18.9%). No malignant cases were observed. The proportion of moderate/intense macrophage infiltration decreased from 60% to 15%. Before treatment, 23.1% patients had hyperthyroidism, which was completely or partially resolved in 66.7%. By ultrasound, the percentage of homogeneous nodules decreased from 64.0% to 38.4% (p=0.0235), and the mean nodule volume decreased from 13.4 ± 12.2 to 5.3 ± 5.1 cm(3). We demonstrate that PEI increases the proportion of nondiagnostic/unsatisfactory results from US-FNB. Therefore, cytological findings after PEI must be evaluated with caution. Our results also suggest that PEI is an efficacious and safe therapeutic option, with no carcinogenic effects observed on cytological evaluations. Safety and efficacy must be evaluated in larger studies with longer follow-up periods.
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Affiliation(s)
- Gianna Carla Alberti Schrut
- SEMPR-Service of Endocrinology and Metabolism, Federal University of Parana, Rua Agostinho Leão Junior, 285, Curitiba, Brazil
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Vergès B, Buffier P, Baillot-Rudoni S, Brindisi MC, Bouillet B, Petit JM. Non-ultrasound-guided ethanol sclerotherapy for the treatment of thyroid cysts. ANNALES D'ENDOCRINOLOGIE 2011; 72:203-7. [DOI: 10.1016/j.ando.2011.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 04/18/2011] [Accepted: 04/18/2011] [Indexed: 11/28/2022]
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10
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Song DE, Kim YM, Gong G. Cytomorphological changes after ultrasound-guided percutaneous ethanol injection in benign thyroid nodules. Cytopathology 2009; 20:183-7. [DOI: 10.1111/j.1365-2303.2008.00556.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zieleźnik W, Kawczyk-Krupka A, Barlik MP, Cebula W, Sieroń A. Modified percutaneous ethanol injection in the treatment of viscous cystic thyroid nodules. Thyroid 2005; 15:683-6. [PMID: 16053384 DOI: 10.1089/thy.2005.15.683] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Here we describe a prospective 2-year evaluation of the efficiency of a new procedure of percutaneous ethanol injection (PEI) treatment of viscous thyroid cystic nodules (VTCN). Three patients with VCTN were selected from a group of 22 patients with solitary thyroid cystic nodules. A modified two-stage ethanol injection procedure was planned for these patients. Stage 1 was performed through the injection of a small dose of ethanol into the nodule. The viscosity of the content was reduced within 2 weeks after the injection. In the second stage the nodule was decompressed and an established dose of sterile 95% ethanol was injected. Patients were followed up for 2 years. In all cases a reduction in nodule volume was found. In the following 18 months further reduction was observed, with an average of 91.7%. The effect was stable throughout the follow-up period. No complications were observed. Therefore, our new two-stage PEI procedure appears all efficient alternative approach for the treatment of VCTNs even if further investigations on a larger series are required.
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Affiliation(s)
- Witold Zieleźnik
- Center for Laser Diagnostics and Therapy Chair and Clinic of Internal Diseases and Physical Medicine, Silesian Medical University, Bytom, Poland.
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12
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Spiezia S, Vitale G, Di Somma C, Pio Assanti A, Ciccarelli A, Lombardi G, Colao A. Ultrasound-guided laser thermal ablation in the treatment of autonomous hyperfunctioning thyroid nodules and compressive nontoxic nodular goiter. Thyroid 2003; 13:941-7. [PMID: 14611703 DOI: 10.1089/105072503322511346] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Percutaneous laser thermal ablation (LTA) has been applied in several tumors. In this study we evaluated the safety and long-term efficacy of LTA in the treatment of benign thyroid nodules. DESIGN AND PATIENTS Seven patients with autonomous hyperfunctioning thyroid nodule (group A) and five patients with compressive nodular goiter (group B) were treated with LTA. Up to three needles were positioned centrally in the thyroid nodule and laser fiber was placed in the lumen of the needle. Laser illumination was performed reaching a maximal energy deposition of 1800 J per fiber. MEASUREMENTS Thyroid nodule volume, endocrinologic, and clinical evaluation were performed at baseline, 3, and 12 months after the treatment. Scintigraphy was performed at diagnosis and 12 months after the first session in group A. RESULTS In group A, mean thyroid volume decreased from 3.15 +/- 1.26 mL to 0.83 +/- 0.49 mL (p < 0.001) after 12 months. The treatment induced disappearance of clinical signs and symptoms related to hyperthyroidism; normalization of free triiodothyronine (FT(3)), free thyroxine (FT(4)), and thyrotropin (TSH) serum levels and recovery of extranodular uptake at scintiscan. In group B, mean thyroid volume decreased from 11.14 +/- 4.99 mL to 3.73 +/- 1.47 mL (p < 0.01) after 12 months. Pressure symptoms in the neck, difficulty in swallowing and tracheal displacement improved in all patients. The treatment was well tolerated in both groups of patients. CONCLUSIONS LTA appears to be a valid and safe alternative approach in the treatment of benign thyroid nodules.
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Affiliation(s)
- Stefano Spiezia
- Department of Surgery, Ultrasound Guided & Neck Pathologies Surgery Unit, S. Maria del Popolo degli Incurabili Hospital ASL NA1, Naples, Italy.
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Abstract
PEI therapy has been applied clinically as a new treatment strategy for cystic lesions and autonomous functioning nodules of the thyroid. Some additional indications currently under consideration include cold benign tumors and inoperable advanced cancer of the thyroid, and postoperative recurrence of Graves' disease. At our institution, we have treated 2323 patients with thyroid disease by PEI therapy from 1999 to 2001. PEI is usually administered under ultrasound guidance in cases of cystic lesions, and under color-Doppler guidance in cases of solid lesions of the thyroid, with the goal of attenuating tumor blood flow. In consequence, of the total 2323 cases who received PEI therapy at our hospital, 1989 (85.6%) were classified as showing an effective response (ER) or partial response (PR). There were no major complications, such as recurrent laryngeal nerve palsy, uncontrollable pain, bleeding, or thyrotoxicosis. Our results also emphasize the importance of the use of color-Doppler guidance for control of the injection volume of ethanol to the minimum required for completely attenuating the tumor vascularity.
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Affiliation(s)
- Nobuhiro Fukunari
- Surgical Branch of Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo 150-8308, Japan.
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14
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Larijani B, Pajouhi M, Ghanaati H, Bastanhagh MH, Abbasvandi F, Firooznia K, Shirzad M, Amini MR, Sarai M, Abbasvandi N, Baradar-Jalili R. Treatment of hyperfunctioning thyroid nodules by percutaneous ethanol injection. BMC Endocr Disord 2002; 2:3. [PMID: 12470301 PMCID: PMC140013 DOI: 10.1186/1472-6823-2-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2002] [Accepted: 12/06/2002] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND: Autonomous thyroid nodules can be treated by a variety of methods. We assessed the efficacy of percutaneous ethanol injection in treating autonomous thyroid nodules. METHODS: 35 patients diagnosed by technetium-99 scanning with hyperfunctioning nodules and suppressed sensitive TSH (sTSH) were given sterile ethanol injections under ultrasound guidance. 29 patients had clinical and biochemical hyperthyroidism. The other 6 had sub-clinical hyperthyroidism with suppressed sTSH levels (<0.24 &mgr;IU/ml) and normal thyroid hormone levels. Ethanol injections were performed once every 1-4 weeks. Ethanol injections were stopped when serum T3, T4 and sTSH levels had returned to normal, or else injections could no longer be performed because significant side effects. Patients were followed up at 3, 6 and, in 15 patients, 24 months after the last injection. RESULTS: Average pre-treatment nodule volume [18.2 PlusMinus; 12.7 ml] decreased to 5.7 PlusMinus; 4.6 ml at 6 months follow-up [P < 0.001]. All patients had normal thyroid hormone levels at 3 and 6 months follow-up [P < 0.001 relative to baseline]. sTSH levels increased from 0.09 PlusMinus; 0.02 &mgr;IU/ml to 0.65 PlusMinus; 0.8 &mgr;IU/ml at the end of therapy [P < 0.05]. Only 3 patients had persistent sTSH suppression at 6 months post-therapy. T4 and sTSH did not change significantly between 6 months and 2 years [P > 0.05]. Ethanol injections were well tolerated by the patients, with only 2 cases of transient dysphonia. CONCLUSION: Our findings indicate that ethanol injection is an alternative to surgery or radioactive iodine in the treatment of autonomous thyroid nodules.
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Affiliation(s)
- Bagher Larijani
- Endocrinology & Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Pajouhi
- Endocrinology & Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghanaati
- Medical Imaging Centre, Imam Khomeini University Hospital, Tehran, Iran
| | | | - Fereshteh Abbasvandi
- Endocrinology & Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Firooznia
- Medical Imaging Centre, Imam Khomeini University Hospital, Tehran, Iran
| | - Mahmood Shirzad
- Endocrinology & Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Amini
- Endocrinology & Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sarai
- Endocrinology & Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasreen Abbasvandi
- Endocrinology & Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Baradar-Jalili
- Endocrinology & Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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