1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Kallas ON, Nezami N, Singer AD, Wong P, Kokabi N, Bercu ZL, Umpierrez M, Tran A, Reimer NB, Oskouei SV, Gonzalez FM. Cooled Radiofrequency Ablation for Chronic Joint Pain Secondary to Hip and Shoulder Osteoarthritis. Radiographics 2022; 42:594-608. [PMID: 35148246 DOI: 10.1148/rg.210074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) of the shoulder and hip is a leading cause of physical disability and mental distress. Traditional nonsurgical management alone is often unable to completely address the associated chronic joint pain. Moreover, a large number of patients are not eligible for joint replacement surgery owing to comorbidities or cost. Radiofrequency ablation (RFA) of articular sensory nerve fibers can disrupt the transmission of nociceptive signals by neurolysis, thereby providing long-term pain relief. A subtype of RFA, cooled RFA (CRFA), utilizes internally cooled electrodes to generate larger ablative zones compared with standard RFA techniques. Given the complex variable innervation of large joints such as the glenohumeral and hip joints, a larger ablative treatment zone, such as that provided by CRFA, is desired to capture a greater number of afferent nociceptive fibers. The suprascapular, axillary, and lateral pectoral nerve articular sensory branches are targeted during CRFA of the glenohumeral joint. The obturator and femoral nerve articular sensory branches are targeted during CRFA of the hip. CRFA is a promising tool in the interventionalist's arsenal for management of OA-related pain and symptoms, particularly in patients who cannot undergo, have long wait times until, or have persistent pain following joint replacement surgery. An invited commentary by Tomasian is available online. ©RSNA, 2022.
Collapse
Affiliation(s)
- Omar N Kallas
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Nariman Nezami
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Adam D Singer
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Philip Wong
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Nima Kokabi
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Zachary L Bercu
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Monica Umpierrez
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Andrew Tran
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Nickolas B Reimer
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Shervin V Oskouei
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Felix M Gonzalez
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| |
Collapse
|
5
|
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: 1] [Impact Index Per Article: 0.5] [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
| |
Collapse
|
6
|
Fei Y, Qiu Y, Huang D, Xing Z, Li Z, Su A, Zhu J. Effects of energy-based ablation on thyroid function in treating benign thyroid nodules: a systematic review and meta-analysis. Int J Hyperthermia 2021; 37:1090-1102. [PMID: 32981370 DOI: 10.1080/02656736.2020.1806362] [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: 02/08/2023] Open
Abstract
BACKGROUND Whether thyroid function would be affected by ablation remains controversial. This systematic review and meta-analysis aimed to investigate the effects of energy-based ablation on thyroid function in treating benign thyroid nodules. METHODS EMBASE, PubMed, Cochrane Library, and Web of Science databases were searched. The mean difference (MD) or standard MD (SMD) was applied to assess changes in thyroid function, thyroglobulin (Tg), and antibodies after ablation. RevMan version 5.3 was used for data synthesis. RESULTS Forty-two studies involving 6380 patients were eligible. The pooled results revealed significant decrease of 1-day thyroid-stimulating hormone (95% CI, -0.67 to -0.14), significant increase of 1-day, 1-week, and 1-month free thyroxine (95% CI, 1.57 to 5.28; 95% CI, 0.61 to 2.42; 95% CI, -0.76 to -0.15), 1-day and 1-week Tg level (95% CI, 0.40 to 0.81; 95% CI, 0.21 to 1.29), 6-month anti-thyroglobulin antibodies (95% CI, 0.02 to 0.26), 1- and 3-month thyroperoxidase antibody (95% CI, 0.02 to 0.22; 95% CI, 0.17 to 0.43), and 1-day, 1-, and 3-month thyrotrophin receptor antibody (95% CI, 0.10 to 0.43; 95% CI, 0.00 to 0.30; 95% CI, 0.13 to 0.36) after ablation. No statistically significant differences were found in these six indicators in the longer term. The results of subgroup analysis were similar to the pooled results. No significant publication bias was found. CONCLUSIONS Energy-based ablation was more likely to have negative effects on thyroid function and antibodies and led to transient increase in Tg level in the short term. However, most of the patients would not develop any thyroid dysfunction in the long-term follow-up.
Collapse
Affiliation(s)
- Yuan Fei
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Yuxuan Qiu
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.,Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhichao Xing
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhe Li
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Anping Su
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Jingqiang Zhu
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| |
Collapse
|
7
|
Ha EJ, Baek JH, Che Y, Chou YH, Fukunari N, Kim JH, Lin WC, My LT, Na DG, Hwee Quek LH, Wu MH, Yamakado K, Zhou J. Radiofrequency Ablation of Benign Thyroid Nodules: Recommendations from the Asian Conference on Tumor Ablation Task Force - Secondary Publication. J Med Ultrasound 2021; 29:77-83. [PMID: 34377636 PMCID: PMC8330684 DOI: 10.4103/jmu.jmu_178_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/05/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022] Open
Abstract
Radiofrequency ablation (RFA) is a thermal ablation technique widely used for the management of benign thyroid nodules. To date, five academic societies in various countries have reported clinical practice guidelines, opinion statements, or recommendations regarding the use of thyroid RFA. However, despite some similarities, there are also differences among the guidelines, and a consensus is required regarding safe and effective treatment in Asian countries. Therefore, a task force was organized by the guideline committee of the Asian Conference on Tumor Ablation with the goal of devising recommendations for the clinical use of thyroid RFA. The recommendations in this article are based on a comprehensive analysis of the current literature and the consensus opinion of the task force members.
Collapse
Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ying Che
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yi-Hong Chou
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Department of Radiology, Taipei Veterans General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan.,Department of Radiology, Yee Zen General Hospital, Taoyuan, Taiwan
| | - Nobuhiro Fukunari
- Department of Surgery, Showa University School of Medicine, Northern Yokohama Hospital, Yokohama, Japan
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Le Thi My
- Department of Radiology, Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea
| | | | - Ming-Hsun Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| |
Collapse
|
8
|
Muhammad H, Santhanam P, Russell JO. Radiofrequency ablation and thyroid nodules: updated systematic review. Endocrine 2021; 72:619-632. [PMID: 33449296 DOI: 10.1007/s12020-020-02598-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE In the thyroid gland, radiofrequency ablation (RFA) is being applied to both benign nodules and cancers internationally, while interest is also growing in the West. Benign thyroid nodules (BTNs) may be candidates for intervention when symptoms develop. For differentiated thyroid cancers (DTC), surgery is currently the first-line treatment. However, for candidates with high surgical risk or those who refuse to undergo repeated surgery, newer techniques such as RFA are an option. Surgery is associated with complications including hypothyroidism, voice change, hypocalcemia, and a scar. RFA has been used in Asian and European institutions as an alternative to surgery, but is relatively new in North America. Although RFA is not associated with significant complications, few randomized control trials have assessed its efficacy. The studies to date suggest a low rate of severe complications and a small need for thyroid hormone replacement following RFA. Further large-scale studies focusing on a Western population are needed. The aim of this review is to evaluate the evidence with respect to the current studies and data about the safety and efficacy of radiofrequency ablation for the management of BTNs and DTC. METHODS We systematically searched the PubMed/MEDLINE, EMBASE, Clinical Queries, and Web of Science databases, for articles published up to April 30th, 2020. RESULTS Total of 75 studies that met the inclusion criteria were included in the review. Thirty-five studies focused on RFA use for solid nodules, 12 studies on predominantly cystic nodules, 10 for autonomously functioning thyroid nodules, and 18 studied were published on differentiated thyroid cancer. CONCLUSIONS RFA seems to be an effective and safe alternative to surgery in high-risk surgical patients with thyroid cancers and for selected BTNs. Additional trials with longer follow-up in North American patients are needed to validate its full role in the armamentarium of thyroid ologists.
Collapse
Affiliation(s)
- Haris Muhammad
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, 21204, USA
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| |
Collapse
|
9
|
Yan L, Zhang M, Xie F, Ma J, Xiao J, Luo Y. Efficacy and safety of radiofrequency ablation for benign thyroid nodules in patients with previous thyroid lobectomy. BMC Med Imaging 2021; 21:47. [PMID: 33706713 PMCID: PMC7948381 DOI: 10.1186/s12880-021-00577-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Radiofrequency ablation (RFA) is recommended for the treatment of benign thyroid nodules. However, data on the clinical role of RFA for benign thyroid nodules in patients with history of thyroid lobectomy are insufficient. The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign thyroid nodules in patients who had previously undergoing thyroid lobectomy. Methods From May 2015 to October 2018, a total of 20 patients (19 females, 1 male, mean age 49.50 ± 14.26 years, range 22–74 years) with 20 benign thyroid nodules (mean volume 15.04 ± 21.17 ml, range 0.40–69.67 ml) who had undergone previous thyroid lobectomy were included in this retrospective study. Patients were followed up at 3, 6, 12 months after RFA and every 12 months thereafter by ultrasound, clinical evaluation and thyroid function. Volume, volume reduction rate (VRR), symptom score and cosmetic score were evaluated. Results During the mean follow-up time of 21.24 ± 16.41 months, the mean nodule volume decreased significantly from 15.04 ± 21.17 ml to 1.29 ± 1.17 ml (P = 0.018) with a mean VRR of 85.41 ± 12.17%. Therapeutic success was achieved in a single session for all thyroid nodules. The symptom score (P = 0.001) and cosmetic score (P = 0.001) were both significantly reduced at the last follow-up. The levels of free triiodothyronine (fT3), free thyroxine (fT4) and thyroid stimulating hormone were not significantly different at the last follow-up from those prior to treatment (all P > 0.05). No life-threatening complications or sequelae occurred after RFA. Conclusions As a minimally invasive modality, RFA was a safe, effective, and thyroid function-preserving option for patients with symptomatic benign thyroid nodules after a previous lobectomy.
Collapse
Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Fang Xie
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Jun Ma
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China.
| |
Collapse
|
10
|
Sharma RK, Kuo JH. Complications of RFA for Thyroid Nodules: Prevention and Management. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
11
|
Muhammad H, Santhanam P, Russell JO, Kuo JH. RFA and benign thyroid nodules: Review of the current literature. Laryngoscope Investig Otolaryngol 2021; 6:155-165. [PMID: 33614945 PMCID: PMC7883624 DOI: 10.1002/lio2.517] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022] Open
Abstract
Benign thyroid nodules (BTNs) are commonly found in the general population. They are usually asymptomatic and their incidence has increased as a result of wide-spread use of ultrasound. Benign nodules are typically monitored clinically until they increase in size, resulting in compressive symptoms warranting surgery. However, although surgery is generally well-tolerated and of low-risk, it is associated with a small risk for several complications including hypothyroidism, nerve injury, hematoma, injury to other structures and wound infection. Recently, newer image-guided ablation techniques including radiofrequency ablation (RFA) have been introduced. RFA has a similar safety profile when compared to surgery and has shown promising results in challenging surgical candidates. Though several studies have been published in Asian and European countries on the efficacy of RFA, limited data is available on the North American population. The aim of the study is to review the current literature establishing the clinical outcomes and safety of RFA for benign nodules. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Haris Muhammad
- Department of Internal MedicineGreater Baltimore Medical CenterTowsonMarylandUSA
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes, & Metabolism, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jonathon O. Russell
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jennifer H. Kuo
- Department of Surgery, Section of Endocrine SurgeryColumbia University Medical CenterNew YorkNew YorkUSA
| |
Collapse
|
12
|
Sim JS, Baek JH. Long-Term Outcomes of Thermal Ablation for Benign Thyroid Nodules: The Issue of Regrowth. Int J Endocrinol 2021; 2021:9922509. [PMID: 34335748 PMCID: PMC8321738 DOI: 10.1155/2021/9922509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/20/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Thermal ablation (TA) for benign thyroid nodules (BTNs) is widely accepted as an effective and safe alternative to surgery. However, studies on the long-term outcomes of TA have reported problems with nodule regrowth and symptom recurrence, which have raised the need for adequate control of regrowth. Therefore, a more complete TA with a longer-lasting treatment effect may be required. In this study, we review and discuss long-term outcomes and regrowth of BTNs following TA and evaluate factors affecting the long-term outcomes. We also discuss the management of regrowth based on long-term outcomes.
Collapse
Affiliation(s)
- Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam 13590, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| |
Collapse
|
13
|
Ha EJ, Baek JH, Che Y, Chou YH, Fukunari N, Kim JH, Lin WC, My LT, Na DG, Quek LHH, Wu MH, Yamakado K, Zhou J. Radiofrequency ablation of benign thyroid nodules: recommendations from the Asian Conference on Tumor Ablation Task Force. Ultrasonography 2020; 40:75-82. [PMID: 33142404 PMCID: PMC7758103 DOI: 10.14366/usg.20112] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022] Open
Abstract
Radiofrequency ablation (RFA) is a thermal ablation technique widely used for the management of benign thyroid nodules. To date, five academic societies in various countries have reported clinical practice guidelines, opinion statements, or recommendations regarding the use of thyroid RFA. However, despite some similarities, there are also differences among the guidelines, and a consensus is required regarding safe and effective treatment in Asian countries. Therefore, a task force was organized by the guideline committee of the Asian Conference on Tumor Ablation with the goal of devising recommendations for the clinical use of thyroid RFA. The recommendations in this article are based on a comprehensive analysis of the current literature and the consensus opinion of the task force members.
Collapse
Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yi-Hong Chou
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Department of Radiology, Taipei Veterans General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan.,Department of Radiology, Yee Zen General Hospital, Taoyuan, Taiwan
| | - Nobuhiro Fukunari
- Department of Surgery, Showa University School of Medicine, Northern Yokohama Hospital, Yokohama, Japan
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Le Thi My
- Department of Radiology, Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea
| | | | - Ming-Hsun Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| |
Collapse
|
14
|
Lee M, Baek JH, Suh CH, Chung SR, Choi YJ, Lee JH, Ha EJ, Na DG. Clinical practice guidelines for radiofrequency ablation of benign thyroid nodules: a systematic review. Ultrasonography 2020; 40:256-264. [PMID: 32660208 PMCID: PMC7994735 DOI: 10.14366/usg.20015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose Thermal ablation is a novel treatment alternative for benign thyroid nodules, and one of the most promising thermal ablation techniques is radiofrequency ablation (RFA). Considering the increasing use of thyroid RFA, some scientific societies have proposed clinical practice guidelines. We systemically reviewed and compared these guidelines for thyroid RFA to identify a standard treatment strategy that represents the positions of most societies. Methods We searched the MEDLINE and EMBASE databases for studies with human participants that were published in English between January 1, 2000 and August 2, 2019. Studies containing clinical practice guidelines for the RFA of benign thyroid nodules were included. We extracted data regarding indications, pre- and post-procedural evaluations, treatment techniques, and the need to obtain informed consent. Results Of the 83 studies found, four studies were included, and one study was added after searching the bibliographies of those articles. The five included studies were guidelines developed by the Korean Society of Thyroid Radiology, a group of experts from Italian scientific societies, the Italian Working Group on Minimally Invasive Treatments of the Thyroid, the United Kingdom’s National Institute for Health and Clinical Excellence, and a group of four professional Austrian thyroid associations. Indications, pre- and post-procedural evaluations, and techniques were similar across studies; however, differences in each of these categories were found. Conclusion While the reviewed guidelines are similar with regard to major categories, international guidelines for the RFA of benign thyroid nodules should be established in the future.
Collapse
Affiliation(s)
- Minkyoung Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea.,Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea
| |
Collapse
|
15
|
Vuong NL, Dinh LQ, Bang HT, Thuy TTM, Bac NH, Vy TT. Radiofrequency Ablation for Benign Thyroid Nodules: 1-Year Follow-Up in 184 Patients. World J Surg 2019; 43:2447-2453. [PMID: 31165252 DOI: 10.1007/s00268-019-05044-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benign thyroid nodules are common, and must be treated when symptomatic. Non-surgical minimally invasive modalities, including radiofrequency ablation (RFA), have been widely used with good results. The factors related to the efficacy of RFA are still debated. This study was to evaluate the safety, efficacy and related factors of RFA in the treatment of benign thyroid nodules. METHODS A retrospective single-center study was conducted on 251 benign thyroid nodules in 184 patients treated with RFA. The procedure was performed under ultrasound (US) guidance using the trans-isthmic approach and the moving-shot technique. Clinical and US examinations were performed at 1, 3, 6, 12 months, and then at 6 month intervals. Study outcomes were volume reduction ratio (VRR) and complications. RESULTS There were 153 women and 31 men included in the study. The mean age was 43.9 years. The median initial largest diameter and volume of nodules were 30 mm and 6.18 ml. The median length of follow-up was 12 months. Two minor complications were found. The mean VRR was 66.8; 74.3; and 81% after 3, 6, and 12 months, respectively. Initial solidity was a factor related to the efficacy: cystic nodules had higher VRR compared to solid ones. CONCLUSIONS RFA is safe, effective and can be used as a routine treatment for benign thyroid nodules. More prospective multicenter studies with long-term follow-up are required to improve the safety and efficacy of RFA.
Collapse
Affiliation(s)
- Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Quang Dinh
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ho Tat Bang
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Thi Mai Thuy
- Department of Medical Imaging, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Bac
- University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Thanh Vy
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
| |
Collapse
|
16
|
Guo LH, Wang D, Li XL, Liu BJ, Chen S, Li DD, Xu HX. Stiffness distribution in the ablated zone after radiofrequency ablation for liver: An ex-vivo study with a tissue elastometer. Clin Hemorheol Microcirc 2019; 72:151-160. [PMID: 30689559 DOI: 10.3233/ch-180404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Nanjing Medical University, Shanghai, China
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Shigao Chen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Dan-Dan Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Nanjing Medical University, Shanghai, China
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
17
|
Dobnig H, Amrein K. Value of monopolar and bipolar radiofrequency ablation for the treatment of benign thyroid nodules. Best Pract Res Clin Endocrinol Metab 2019; 33:101283. [PMID: 31278063 DOI: 10.1016/j.beem.2019.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Only a few thyroid nodules are perceived as functional or optically disturbing. If there is a need for action, surgical intervention is the long-term standard by which thermoablative procedures (radiofrequency-, laser-, microwave ablation, high intensity focused ultrasound) must be measured against in terms of safety, effectiveness and patient satisfaction. Prior to intervention assessment of the dignity of the nodule by ultrasound-guided fine needle aspiration is essential for cold and warm nodules, as is the confirmation of an inconspicuous cervical lymph node status. The short-term treatment results of these newer interventions in terms of nodule volume reduction and symptomatic improvement are promising and the general complication rate of the procedures is low. Since functional thyroid parenchyma is preserved, maintaining normal thyroid status is the rule. The procedure is usually performed on an outpatient basis, under local anesthesia and monitoring. The subsequent convalescence is usually very short. Most studies are available on monopolar radiofrequency ablation. Several professional societies have defined indications for radiofrequency ablation (RFA), but these need to be further refined based on practical experience and literature. An acceptable long-term recurrence rate still has to be proven for practically all thermoablative methods, for monopolar RFA limited long-term data are encouraging so far. The recurrence rate as well as patient satisfaction will provide the basis for a meaningful overall cost-benefit analysis in the future.
Collapse
Affiliation(s)
- Harald Dobnig
- Thyroid Endocrinology Osteoporosis Institute Dobnig, Graz, Austria; Thyroid Practice for Radiofrequency Ablation, Vienna, Austria.
| | - Karin Amrein
- Thyroid Endocrinology Osteoporosis Institute Dobnig, Graz, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Austria
| |
Collapse
|
18
|
Sim JS, Baek JH. Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth. Endocrinol Metab (Seoul) 2019; 34:117-123. [PMID: 31257739 PMCID: PMC6599899 DOI: 10.3803/enm.2019.34.2.117] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 11/11/2022] Open
Abstract
Thermal ablation (TA) procedures, such as radiofrequency ablation and laser ablation, are used for the treatment of benign thyroid nodules. Short-term studies (<2 years) have demonstrated that TA is an effective and safe procedure to improve cosmetic or symptomatic problems. However, studies including a longer follow-up period show that treated thyroid nodules can increase in size after 2 to 3 years. Several studies suggest that this results from regrowth at the undertreated nodule margins. Here, we review current data on regrowth after TA and describe factors related to it and possible approaches to prevent it.
Collapse
Affiliation(s)
- Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
19
|
Choi Y, Jung SL, Bae JS, Lee SH, Jung CK, Jang J, Shin NY, Choi HS, Ahn KJ, Kim BS. Comparison of efficacy and complications between radiofrequency ablation and repeat surgery in the treatment of locally recurrent thyroid cancers: a single-center propensity score matching study. Int J Hyperthermia 2019; 36:359-367. [DOI: 10.1080/02656736.2019.1571248] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Yangsean Choi
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Ja-Sung Bae
- Department of Thyroid Surgery, The Catholic University of Korea College of Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
| | - So-Hee Lee
- Department of Thyroid Surgery, The Catholic University of Korea College of Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Chan-Kwon Jung
- Department of Pathology, The Catholic University of Korea College of Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Jinhee Jang
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Na-Young Shin
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Hyun Seok Choi
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Kook-Jin Ahn
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Bum-Soo Kim
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul St. Mary’s Hospital, Seoul, Korea
| |
Collapse
|
20
|
Radiofrequency ablation of thyroid nodules: “Good Clinical Practice Recommendations” for Austria. Wien Med Wochenschr 2019; 170:6-14. [DOI: 10.1007/s10354-019-0682-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/06/2019] [Indexed: 12/15/2022]
|
21
|
Radiofrequenzablation von Schilddrüsenknoten: Good Clinical Practice Empfehlungen. AUSTRIAN JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM 2018. [DOI: 10.1007/s41969-018-0043-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
22
|
Kim JH, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, Choi YJ, Chung SR, Ha EJ, Hahn SY, Jung SL, Kim DS, Kim SJ, Kim YK, Lee CY, Lee JH, Lee KH, Lee YH, Park JS, Park H, Shin JH, Suh CH, Sung JY, Sim JS, Youn I, Choi M, Na DG. 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology. Korean J Radiol 2018; 19:632-655. [PMID: 29962870 PMCID: PMC6005940 DOI: 10.3348/kjr.2018.19.4.632] [Citation(s) in RCA: 340] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023] Open
Abstract
Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology (KSThR) developed recommendations for the optimal use of radiofrequency ablation for thyroid tumors in 2012. As new meaningful evidences have accumulated, KSThR decided to revise the guidelines. The revised guideline is based on a comprehensive analysis of the current literature and expert consensus.
Collapse
Affiliation(s)
- Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea
| | - Hye Shin Ahn
- Department of Radiology and Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea
| | - Seon Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan 48101, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul 03181, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul 06351, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Dae Sik Kim
- Department of Radiolgy, Incheon Medical Center, Incheon 22532, Korea.,Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea
| | - Soo Jin Kim
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea.,Department of Radiology, New Korea Hospital, Kimpo 10086, Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kwang Hwi Lee
- Department of Radiology, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, UAE
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul 04763, Korea
| | - Hyesun Park
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul 06351, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jin Yong Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam 13590, Korea
| | - Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul 03181, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul 04554, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea.,Department of Radiology, GangNeung Asan Hospital, Gangneung 25440, Korea
| | | |
Collapse
|
23
|
Korkusuz Y, Mader A, Gröner D, Ahmad S, Mader OM, Grünwald F, Happel C. Comparison of Mono- and Bipolar Radiofrequency Ablation in Benign Thyroid Disease. World J Surg 2018; 41:2530-2537. [PMID: 28474275 DOI: 10.1007/s00268-017-4039-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Radiofrequency ablation (RFA) is an approved minimal invasive method for the treatment of benign thyroid nodules. Several experimental, mainly ex vivo animal studies have compared the effectiveness of different RFA procedures in liver tissue. The aim of this retrospective clinical study was to evaluate the difference between monopolar and bipolar RFA in thyroid tissue considering thyroid volume reduction, patient discomfort and ultrasound evaluation. METHODS Eighteen patients with symptomatic complex benign thyroid nodules were treated in a single RFA session. Nine patients were treated with monopolar RFA, and nine other patients were treated with bipolar RFA. All patients underwent assessments before therapy and at 3-month follow-up (3MFU) including a complete hormone status (T3, T4, TSH, TG, TPOAb, TgAb, TRAb) and several ultrasound (US) evaluations using B-mode and color-coded Doppler imaging. The US evaluations contained measurement of volume, US Doppler, US echogenicity and US elastography. Additionally, applied energy (kJ), power output (W), number of shots (N) and total treatment time (s) were recorded in every case. RESULTS Monopolar RFA resulted in a significant (p < 0.05) average thyroid volume reduction of Ø 18 ± 77 ml (25.1 ± 103%) and a nodule volume reduction of Ø 10.6 ± 22 ml (60.3 ± 62%). Bipolar RFA resulted in a significant (p < 0.05) average thyroid volume reduction of Ø 21.2 ± 54 ml (43.2 ± 84%) and a nodule volume reduction of Ø 13.8 ± 33 ml (70.8 ± 46%). Both groups showed equal results concerning volume reduction (p > 0.05). Monopolar RFA did not lead to any significant changes concerning the US scores, whereas bipolar RFA led to a significant (p < 0.05) reduction in US Doppler and nodular blood flow. No significant difference between both groups could be found concerning applied energy, treatment time, power output and number of shots (p > 0.05). CONCLUSION Bipolar RFA did not show any disadvantages in comparison with monopolar RFA in the treatment of benign thyroid nodules. It shows better performance in terms of volume reduction and is superior when it comes to feasibility and patient discomfort. The recent study confirms the good ex vivo results for bipolar RFA.
Collapse
Affiliation(s)
- Yücel Korkusuz
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Alexander Mader
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany. .,Department of Nuclear Medicine, German Center for Thermoablation of Thyroid Nodules, University Medical Center Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Daniel Gröner
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Shadi Ahmad
- Department of General and Visceral Surgery, Agaplesion Elisabethenstift, Darmstadt, Germany
| | - Oscar Maximilian Mader
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Wang JF, Wu T, Hu KP, Xu W, Zheng BW, Tong G, Yao ZC, Liu B, Ren J. Complications Following Radiofrequency Ablation of Benign Thyroid Nodules: A Systematic Review. Chin Med J (Engl) 2018; 130:1361-1370. [PMID: 28524837 PMCID: PMC5455047 DOI: 10.4103/0366-6999.206347] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: This systematic review examined whether radiofrequency ablation (RFA) is a safe treatment modality for benign thyroid nodules (BTNs). Data Sources: PubMed, Embase, and the Cochrane Library database were searched for articles that (a) targeted human beings and (b) had a study population with BTNs that were confirmed by fine-needle aspiration cytology and/or core needle biopsy. Study Selection: Thirty-two studies relating to 3409 patients were included in this systematic review. Results: Based on literatures, no deaths were associated with the procedure, serious complications were rare, and RFA appears to be a safe and well-tolerated treatment modality. However, a broad spectrum of complications offers insights into some undesirable complications, such as track needle seeding and Horner syndrome. Conclusions: RFA appears to be a safe and well-tolerated treatment modality for BTNs. More research is needed to characterize the complications of RFA for thyroid nodules.
Collapse
Affiliation(s)
- Jin-Fen Wang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Tao Wu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Kun-Peng Hu
- Department of General Surgery, Linnan Hospital, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510530, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, Endocrinology Unit, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Bo-Wen Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Ge Tong
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Zhi-Cheng Yao
- Department of General Surgery, Linnan Hospital, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510530, China
| | - Bo Liu
- Department of General Surgery, Linnan Hospital, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510530, China
| | - Jie Ren
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| |
Collapse
|
26
|
Yoon RG, Baek JH, Chung SR, Choi YJ, Lee JH. Ex vivo comparison between thyroid-dedicated bipolar and monopolar radiofrequency electrodes. Int J Hyperthermia 2018; 34:624-630. [DOI: 10.1080/02656736.2018.1437283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Ra Gyoung Yoon
- Department of Radiology, University of Eulji College of Medicine, Eulji Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sae Rom Chung
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
27
|
Yan J, Qiu T, Lu J, Wu Y, Yang Y. Microwave ablation induces a lower systemic stress response in patients than open surgery for treatment of benign thyroid nodules. Int J Hyperthermia 2018; 34:606-610. [PMID: 29366346 DOI: 10.1080/02656736.2018.1427286] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE In this study, we compared the systemic stress response induced by microwave ablation with that induced by conventional open surgery for treatment of benign thyroid nodules. METHODS A total of 108 patients with benign thyroid nodules were randomly assigned to receive ultrasound-guided thyroid microwave ablation (microwave group, n = 57) and conventional open thyroid surgery (open group, n = 51). Body temperature, white blood cell (WBC) counts, visual analogue scale (VAS) scores for pain, and serum levels of high sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6) and cortisol were measured at 24 h before operation and at 8 h, 24 h and 48 h after operation. RESULTS No significant between-group differences were observed with respect to preoperative body temperature, VAS scores, WBC counts, serum hs-CRP, IL-6 and cortisol levels. Patients in the open group exhibited higher body temperature at 24 h after operation and higher WBC counts at both 24 h and 48 h after operation, as compared to those in the microwave group. As compared with microwave ablation, open surgery was associated with significantly higher VAS scores, and significantly higher serum levels of hs-CRP, IL-6 and cortisol at all postoperative time-points (8 h, 24 h and 48 h). CONCLUSION Microwave ablation induces a lower systemic stress response than open surgery for treatment of benign thyroid nodules.
Collapse
Affiliation(s)
- Jing Yan
- a Department of General Surgery , Panzhihua Central Hospital , Panzhihua , China
| | - Tihong Qiu
- a Department of General Surgery , Panzhihua Central Hospital , Panzhihua , China
| | - Jing Lu
- a Department of General Surgery , Panzhihua Central Hospital , Panzhihua , China
| | - Yanjun Wu
- a Department of General Surgery , Panzhihua Central Hospital , Panzhihua , China
| | - Yinghong Yang
- a Department of General Surgery , Panzhihua Central Hospital , Panzhihua , China
| |
Collapse
|
28
|
Radzina M, Cantisani V, Rauda M, Nielsen MB, Ewertsen C, D'Ambrosio F, Prieditis P, Sorrenti S. Update on the role of ultrasound guided radiofrequency ablation for thyroid nodule treatment. Int J Surg 2018; 41 Suppl 1:S82-S93. [PMID: 28506420 DOI: 10.1016/j.ijsu.2017.02.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 12/19/2022]
Abstract
Thyroid nodules can be frequently detected in general population, most of them are benign, however malignant cases are rising in the past decades. Ultrasound (US) is the most common imaging modality to assess thyroid nodular lesions, plan patient work-up and guide minimally invasive treatment. The present review paper has been researched to evaluate the current status of radiofrequency ablation (RFA) treatment in order to evaluate indications, techniques, complications, limitations and outcome assessment in benign solid, partially cystic nodules and recurrent malignant nodules. RFA comparison with other ablation techniques has been provided as well. US guided Radiofrequency ablation has been proved to be effective and safe in cases of benign thyroid nodules and a promising treatment method alternative to surgery for patients with recurrent papillary thyroid cancer. It's major role lies in significant reduction of thyroid nodule mean volume and improvement of the patient symptoms. However, future multicenter studies are warranted to better clarify the multi-parametric patient selection criteria and evaluate RFA technique efficacy, advantages and limitations in the variety of thyroid nodular disease.
Collapse
Affiliation(s)
- Maija Radzina
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Pilsonu Street 13, LV - 1002, Riga, Latvia.
| | - Vito Cantisani
- Department of Radiological Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Viale Regina Elena 324, Italy.
| | - Madara Rauda
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Pilsonu Street 13, LV - 1002, Riga, Latvia.
| | | | - Caroline Ewertsen
- Department of Radiology, University of Copenhagen, Copenhagen, Denmark.
| | - Ferdinando D'Ambrosio
- Department of Radiological Sciences, Policlinico Umberto I, Univ. Sapienza, Roma, 00185, Viale Regina Elena 324, Italy.
| | - Peteris Prieditis
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Pilsonu Street 13, LV - 1002, Riga, Latvia.
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Policlinico Umberto I, University Sapienza, Roma, 00185, Viale Regina Elena 324, Italy.
| |
Collapse
|
29
|
Dietrich CF, Müller T, Bojunga J, Dong Y, Mauri G, Radzina M, Dighe M, Cui XW, Grünwald F, Schuler A, Ignee A, Korkusuz H. Statement and Recommendations on Interventional Ultrasound as a Thyroid Diagnostic and Treatment Procedure. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:14-36. [PMID: 29126752 DOI: 10.1016/j.ultrasmedbio.2017.08.1889] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
The recently published guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on interventional ultrasound (INVUS)-guided procedures summarize the intended interdisciplinary and multiprofessional approach. Herewith, we report on recommendations for interventional procedures for diagnosis and treatment of the thyroid gland.
Collapse
Affiliation(s)
- Christoph F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany; Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Thomas Müller
- Medizinische Klinik I, Klinikum am Steinenberg, Reutlingen, Germany
| | - Jörg Bojunga
- 1st Medical Department, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Maija Radzina
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Riga, Latvia
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Frank Grünwald
- Department of Nuclear Medicine, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany; German Center for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas Schuler
- Zentrum für Innere Medizin, Alb Fils Kliniken, Helfenstein Klinik, Germany
| | - Andre Ignee
- Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Huedayi Korkusuz
- Department of Nuclear Medicine, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany; German Center for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| |
Collapse
|
30
|
Mader A, Mader OM, Gröner D, Korkusuz Y, Ahmad S, Grünwald F, Kranert WT, Happel C. Minimally invasive local ablative therapies in combination with radioiodine therapy in benign thyroid disease: preparation, feasibility and efficiency - preliminary results. Int J Hyperthermia 2017; 33:895-904. [PMID: 28540810 DOI: 10.1080/02656736.2017.1320813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Initial studies of combinations of radioiodine therapy (RIT) and local ablative procedures for the treatment of thyroid nodules have shown promising results. The goal of this study was to evaluate the effectiveness of RIT combined with radiofrequency ablation (RFA) in patients with goitres and to determine which ablative procedure is the most suitable for a combined therapy. METHODS Thirty patients with goitres were divided into two subgroups. A test group of 15 patients received combined therapy (RIT + RFA) and a control group of 15 patients received RIT mono therapy. All patients underwent assessments including ultrasound, laboratory evaluation (T3, T4, TSH, TG, TPOAb, TgAbTRAb) and scintigraphic imaging with Tc-99m-Pertechnetate. The 3-month volume reduction was used to evaluate therapy effectiveness. RESULTS Combined therapy (subgroup 1) resulted in a significant (p < 0.05) thyroid volume reduction (22.3 ± 54 ml/32.2 ± 58.2%) with better performance (p > 0.05) than the control group (20.2 ± 32.2 ml/29.6 ± 42.1%). All patients became euthyroid after treatment. No major discomfort or complications occurred. A review of the literature investigating combinations of other local ablative procedures with RIT was performed to determine the most promising combination. CONCLUSIONS The present study confirms the positive experiences with the combined therapy of RIT and local ablative procedures shown in the current literature and approves this approach for the treatment of goitres with RFA + RIT. These findings, when confirmed by further studies, should expand the indication of combined therapy as a minimally invasive alternative to surgery.
Collapse
Affiliation(s)
- Alexander Mader
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Oscar Maximilian Mader
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Daniel Gröner
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Yücel Korkusuz
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Shadi Ahmad
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Frank Grünwald
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - W Tilman Kranert
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Christian Happel
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| |
Collapse
|
31
|
Zhao CK, Xu HX, Lu F, Sun LP, He YP, Guo LH, Li XL, Bo XW, Yue WW. Factors associated with initial incomplete ablation for benign thyroid nodules after radiofrequency ablation: First results of CEUS evaluation. Clin Hemorheol Microcirc 2017; 65:393-405. [PMID: 27983547 DOI: 10.3233/ch-16208] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Feng Lu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| |
Collapse
|
32
|
Yue WW, Wang SR, Lu F, Sun LP, Guo LH, Zhang YL, Li XL, Xu HX. Radiofrequency ablation vs. microwave ablation for patients with benign thyroid nodules: a propensity score matching study. Endocrine 2017; 55:485-495. [PMID: 27905049 DOI: 10.1007/s12020-016-1173-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/05/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare the efficacy and the safety of radiofrequency ablation and microwave ablation for treatment of benign thyroid nodules using a propensity score matching study design. METHODS Two hundred and sixty patients with benign thyroid nodules were studied retrospectively, including 102 patients treated with radiofrequency ablation and 158 treated with microwave ablation. To reduce confounding bias due to retrospective assignment, propensity score matching was performed to balance the preablation data of the two groups. After matching, a total of 102 patient pairs (1:1) were created. The volume reduction ratio, therapeutic success rate, symptom and cosmetic score, and major complication were compared between the two groups at 1, 3, 6, and 12 months after treatment. RESULTS Between the well-matched groups, no significant differences were found in all nodule volume-related end points at 6 months (volume reduction ratio: 79.4 vs. 77.2 %, P = 0.108; symptom score: 2.1 vs. 1.9, P = 0.456; cosmetic score: 2.1 vs. 2.3, P = 0.119; therapeutic success rate: 99 vs. 97 %, P = 0.621) and 12 months (volume reduction ratio: 83.6 vs. 81.6 %, P = 0.144; symptom score: 1.5 vs. 1.5, P = 0.869; cosmetic score: 1.6 vs. 1.7, P = 0.409; therapeutic success rate: 100 vs. 100 %, P > 0.99) after treatment. No major complications occurred in either group (P > 0.99). CONCLUSIONS With well-matched groups and consistent procedure design, our results demonstrated that the volume reduction ratio, therapeutic success rate, symptom and cosmetic score, and complications related to treatment for the two techniques are equivalent. Radiofrequency ablation and microwave ablation are both effective and safe methods in treating benign thyroid nodules.
Collapse
Affiliation(s)
- Wen-Wen Yue
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Yantai, Shandong, 264100, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Yantai, Shandong, 264100, China.
| | - Feng Lu
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Yong-Lin Zhang
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Yantai, Shandong, 264100, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China.
| |
Collapse
|
33
|
Wu W, Gong X, Zhou Q, Chen X, Chen X. Ultrasound-Guided Percutaneous Microwave Ablation for Solid Benign Thyroid Nodules: Comparison of MWA versus Control Group. Int J Endocrinol 2017; 2017:9724090. [PMID: 29333159 PMCID: PMC5733153 DOI: 10.1155/2017/9724090] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/29/2017] [Accepted: 09/05/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The aim of this research is to investigate the feasibility of percutaneous ultrasound-guided microwave ablation (MWA) for benign solid thyroid nodules. METHODS Ultrasound-guided percutaneous microwave ablation was performed for 90 benign solid thyroid nodules in 75 patients. The volume changes of the nodules were evaluated before and after microwave ablation, and the cosmetic grading and clinical symptoms were assessed as well. RESULTS The volume of all the 90 benign thyroid nodules obviously decreased after microwave ablation at 3-, 6-, 9-, and 12-month follow-ups (p < 0.01), while that of the control group increased at the follow-up of 12 months (p < 0.01). The volume reduction rate (VRR) at 3-, 6-, 9-, and 12-month follow-ups was 55.98%, 69.31%, 76.65%, and 84.67% in the MWA group, respectively. The cosmetic problems and clinical symptoms were also improved in the MWA group. All the patients are well tolerated to the procedure. Hoarseness occurred in 2 cases (2.7%) and Horner syndrome in 1 case (1.3%), and 1 patient (1.3%) developed slight burn on cervical skin. CONCLUSIONS Ultrasound-guided percutaneous microwave ablation is a practical method for treating benign solid thyroid nodules, and the complications were acceptable. The trial is registered with clinicaltrials.gov with the registration number NCT03057925.
Collapse
Affiliation(s)
- Wenjun Wu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Xiaohua Gong
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Qi Zhou
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Xiong Chen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Xiaojun Chen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| |
Collapse
|
34
|
Yue WW, Wang SR, Li XL, Xu HX, Lu F, Sun LP, Guo LH, He YP, Wang D, Yin ZQ. Quality of Life and Cost-Effectiveness of Radiofrequency Ablation versus Open Surgery for Benign Thyroid Nodules: a retrospective cohort study. Sci Rep 2016; 6:37838. [PMID: 27883069 PMCID: PMC5121639 DOI: 10.1038/srep37838] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/02/2016] [Indexed: 12/02/2022] Open
Abstract
This study is to compare the health-related quality of life (HRQoL) and cost-effectiveness of radiofrequency ablation (RFA) and open thyroidectomy (OT) for benign thyroid nodules (BTNs) treatment. HRQoL and utility were assessed for 404 BTN patients immediately before treatments (RFA:OT = 137:267) and at 6-month visit. A cost-effectiveness analysis was performed from societal perspective in the China context. Resource use (hospitalization, sick leaves) was collected. We used the net monetary benefit approach and computed cost-effectiveness acceptability curves for RFA and OT. Sensitivity analyses of costs of RFA were performed. At 6-month visit, patients treated with RFA had significantly better HRQoL than patients treated with OT on general health (68.5 versus 66.7, P = 0.029), vitality (71.3 versus 67.5, P < 0.001) and mental health (80.9 versus 79.3, P = 0.038). RFA was more effective than OT in terms of quality-adjusted life-years (QALYs; 0.01QALY/patient) but more expensive (US$823/patient). The probability that RFA would be cost effective at a US$50,000/QALY threshold was 15.5% in China, and it would be increased to 88.4% when price of the RFA device was lowered by 30%. RFA exhibited a significant improvement of HRQoL relative to OT, but is unlikely to be cost effective at its current price in short time.
Collapse
Affiliation(s)
- Wen-Wen Yue
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | | | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Feng Lu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Zhi-Qiang Yin
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China.,Center of Diagnosis and Treatment for Thyroid Diseases, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| |
Collapse
|