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

Safety and efficacy analysis of ultrasound-guided microwave ablation for pediatric recurrent aggressive fibromatosis

BACKGROUND

The treatment of aggressive fibromatosis (AF) poses a challenge for physicians due to propensity for local recurrence and aggressive nature, with traditional surgical excision often resulting in recurrence. Ultrasound-guided ablation, offering minimal trauma and reusability, has emerged as a novel therapeutic option for invasive fibromas. We report our experience of microwave ablation (MWA) as a local and analgesic treatment for inoperable or recurring AF.

METHODS

This study includes 8 patients who underwent percutaneous MWA of 10 AF between November 2021 and November 2023. All patients underwent pain assessment using a visual analog scale (VAS) and preoperative imaging. Patients received clinical and radiological follow-up at 6 months post-procedure, with pain-rating and adverse events being recorded. A long-term follow-up was achieved until 1 November 2024.

RESULTS

In this study, the 10 tumors in 8 patients have a preoperative size ranging from 1.84 to 477.96 ml, with a mean of 71.90 ± 147.55 ml. Postoperatively, at 6 months, the lesion sizes ranged from 0 to 174.99 ml, with a mean of 24.97 ± 53.78 ml (P < 0.05). The mean volume reduction ratio (VRR) was 55.86% (range 15.48-100%), with an overall treatment effectiveness rate of 80% (8 out of 10). Long-term follow-up revealed 2 cases meeting complete response (CR) criteria, 4 cases achieving partial response (PR), and 2 cases meeting stable disease (SD) criteria. The average pre-treatment VAS score among the 8 patients was 6.38 (range 5-9), which decreased to 3.0 (range 0-6) after 1 month of treatment, demonstrating a significant average pain reduction of 3.38 (p < 0.05). The study reported an adverse reaction incidence of 12.5% (1/8) due to neural heat damage from ablation, with symptom improvement following supportive care.

CONCLUSION

MWA is an effective therapeutic option for the local treatment and for the analgesic management of AF.

Safety and efficacy of microwave ablation for symptomatic benign thyroid nodules in children

OBJECTIVE

To evaluate the efficacy and safety of microwave ablation (MWA) for the treatment of symptomatic benign thyroid nodules in children.

METHODS

A retrospective study of MWA for the treatment of 34 symptomatic benign thyroid nodules in 25 children was conducted. Volume reduction ratio (VRR), technique efficacy, symptom score, cosmetic score, and thyroid function were used to evaluate the efficacy of the technique. The associated complications and side effects were recorded.

RESULTS

The participants were followed for at least 6 months (median 12 months, range 6-48 months). After MWA treatment, the volumes of the targeted nodules decreased gradually (median volume 5.86 mL before MWA and 0.34 mL at the final follow-up assessment), the VRR achieved was up to 85.03% at the final follow-up assessment, and the technical efficacy at this time was 91.2%. The subjective and objective nodule-related symptoms were also ameliorated. The circulating hormone concentrations reflecting thyroid function remained within their normal ranges in all the participants after one month of follow-up. The procedure had no major complications.

CONCLUSIONS

MWA seems to be an effective and safe technique for the treatment of symptomatic benign thyroid nodules in pediatric patients.

CLINICAL RELEVANCE STATEMENT

Microwave ablation is a safe and effective method to treat symptomatic benign thyroid nodules in pediatric patients. This treatment may be selected if the patient or parents are not suitable or refuse to undergo surgery.

KEY POINTS

• Microwave ablation is effective in reducing the volume of benign thyroid nodules and ameliorating nodule-related symptoms in pediatric patients. • Microwave ablation is a safe method in children, with low complications. • Microwave ablation does not affect the circulating thyroid hormone concentrations of children.

The safety and efficacy of radiofrequency ablation in benign pediatric thyroid disease in the US: An initial case series

Objective

To evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign nonfunctional thyroid nodules or functional lingual thyroid gland in a pediatric population.

Methods

Four pediatric patients (four female; mean age 13.50 ± 4.04, range 8-17 years) with either benign thyroid nodules or mildly obstructive lingual thyroid glands were treated with RFA from 2020 to 2021 were evaluated. The inclusion criteria for RFA therapy were (i) age < 18 years; (ii) benign cytopathological results on ultrasound guided fine needle aspiration; (iii) pressure or pain symptoms caused by the thyroid nodules; (iv) dysphagia or obstruction caused by the lingual thyroid tissue; (v) follow up for >6 months with otolaryngology or endocrinology.

Results

Two patients had benign non-functioning thyroid nodules and two had mildly obstructive functioning lingual thyroid glands. Mean follow up was 10.75 ± 4.79 months. Each patient underwent one RFA session with no complications. For the patients with thyroid nodules, there was >74% reduction in nodule size at last follow up with improvement in neck swelling and pain. For the patients with lingual thyroid glands, both did not have any other functional thyroid gland identified. Both had visible decrease in size of the gland as visualized transorally with improvement in dysphagia and obstructive symptoms when lying flat.

Conclusion

RFA is a safe and effective option for managing benign thyroid nodules and lingual thyroid glands in a pediatric patient population.

Level of evidence

4.

Differences in the management of thyroid nodules in children and adolescents as compared to adults

PURPOSE OF REVIEW

To describe recent advances in the diagnosis and management of thyroid nodules in both children and adults, highlighting differences between the two groups.

RECENT FINDINGS

Thyroid nodules are less common in children than adults but the risk of malignancy is higher. Screening recommendations for patients with certain genetic syndromes or specific risk factors for thyroid nodules and cancer continue to evolve ultrasound is the most appropriate imaging modality for evaluating thyroid nodules in all patients, but radiographic risk stratification systems validated in adults have not been extensively studied in children. Criteria for proceeding to fine needle aspiration (FNA) biopsy differ some between children and adults, with nodule size being less of a consideration in young patients. Molecular testing continues to improve the diagnostic capabilities of FNA for all age groups, but options for pediatric thyroid nodules are currently limited. In children, only oncogene panels are validated and their exact utility, along with miRNA classifiers, is an evolving area of study. For adults, data support selection of a specific molecular test based on ultrasound characteristics and pretest probability of malignancy. Multiple series have shown that fusion mutations are more common in pediatric thyroid nodules, while point mutations are seen more often in adult thyroid nodules. Molecular data help guide management recommendations regarding the need for surgery when FNA is indeterminate, but clinical use is still being refined. Radiofrequency ablation is a nonoperative approach that has gained significant traction for the treatment of symptomatic benign nodules in adults, but data are currently extremely limited in children.

SUMMARY

There are difference in the diagnosis and treatment of thyroid nodules in adults and children, the nuances of which are important for clinical management.

Accuracy of Ultrasound Diagnosis of Benign and Malignant Thyroid Nodules: A Systematic Review and Meta-Analysis

Background

Distinguishing between benign and malignant thyroid nodules remains difficult. Ultrasound has been established as a non-invasive and relatively simple imaging technique for thyroid nodules. This study aimed to assess the diagnostic accuracy of conventional ultrasound and ultrasound elastography for the differentiation between benign and malignant thyroid nodules by meta-analyzing published studies.

Methods

Literature was retrieved from the PubMed and Embase databases from inception to May 31, 2022. The literature was screened using inclusion and exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS2) scale was used to assess the quality of the included literature. Publication bias of the included studies was assessed by Deek's funnel plot. Heterogeneity tests were performed using Cochrane Q statistic and I2 statistic.

Results

Finally, 9 articles were included. The meta-analysis showed that the combined sensitivity and specificity of ultrasound for the diagnosis of thyroid nodules were 0.88 [95% CI (0.83-0.91)] and 0.86 [95% CI (0.79-0.90)], respectively. The area under the curve (AUC) of the summary receiver operating characteristic curve (SROC) was 0.92 [95% CI (0.90-0.94)]. There was no significant publication bias in this study. Discussion. Existing evidence shows that ultrasound has a certain accuracy in diagnosing benign and malignant thyroid nodules, providing a scientific basis for thyroid assessment and diagnosis.

Systematic review and meta-analysis: diagnostic value of different ultrasound for benign and malignant thyroid nodules

BACKGROUND

Conventional ultrasound and contrast-enhanced ultrasound (CEUS) are commonly used in the diagnosis of benign and malignant thyroid nodules. However, the value of the two methods in the diagnosis of benign and malignant thyroid nodules remains controversial.

METHODS

PubMed, Medline, EBSCO, Science Direct, Cochrane Library, China National Knowledge Infrastructure (CNKI) database and manual journal retrieval were searched from January 2000 to January 2022, to include research on conventional ultrasound or CEUS in the diagnosis of benign and malignant thyroid nodule related clinical studies. Meta-analysis was conducted using RevMan5.3 and Stata Corp to analyze the sensitivity and specificity of conventional ultrasound and CEUS in the diagnosis of benign and malignant thyroid nodules with 95% confidence interval (CI) as indicators. Heterogeneity of the results was evaluated by Q test and I2 in RevMan5.3. Deek's method was used to evaluate publication bias.

RESULTS

A total of 1,378 nodules were included in 11 literatures, including 535 malignant thyroid nodules and 843 benign thyroid nodules. Heterogeneity tests conducted for CEUS diagnostic sensitivity of the 6 included literatures indicated that there was no heterogeneity among the study groups [Q=2.05, degree of freedom (df) =5.00, I2=0.00%, P=0.84]. The combined sensitivity was 0.87, with 95% confidence interval (CI): 0.82 to 0.90. Heterogeneity tests on the diagnostic specificity of CEUS of the six included literatures suggested that there was heterogeneity among the different study groups (Q=14.27, df =5.00, I2=64.96%, P=0.01). The combined specificity was 0.84 (95% CI: 0.78 to 0.89). Heterogeneity tests performed on the sensitivity of five conventional ultrasound diagnosis articles revealed that there was heterogeneity among different study groups (Q=13.62, df =4.00, I2=70.64%, P=0.01). The combined sensitivity was 0.86 (95% CI: 0.78 to 0.92). Heterogeneity tests on the specificity of conventional ultrasound diagnosis in five included literatures indicated that there was heterogeneity among different study groups (Q=16.94, df =4.00, I2=76.39%, P=0.00). The combined specificity was 0.84 (95% CI: 0.75 to 0.90). There was no bias in the included literature.

DISCUSSION

The sensitivity of CEUS in the diagnosis of benign and malignant thyroid nodules was slightly higher than that of conventional ultrasound, which provides a reference for the clinical diagnosis of benign and malignant thyroid nodules.