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Chan WK, Sun JH, Liou MJ, Hsu CJ, Lu YL, Chou WY, Li YR, Liu FH. Novel and Advanced Ultrasound Techniques for Thyroid Thermal Ablation. Endocrinol Metab (Seoul) 2024; 39:40-46. [PMID: 38347707 PMCID: PMC10901668 DOI: 10.3803/enm.2024.1917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 03/01/2024] Open
Abstract
Thyroid radiofrequency ablation and microwave ablation are widely adopted minimally invasive treatments for diverse thyroid conditions worldwide. Fundamental skills such as the trans-isthmic approach and the moving shot technique are crucial for performing thyroid ablation, and advanced techniques, including hydrodissection and vascular ablation, improve safety and efficacy and reduce complications. Given the learning curve associated with ultrasound-guided therapeutic procedures, operators need training and experience. While training models exist, limited attention has been given to ultrasound maneuvers in ablation needle manipulation. This article introduces two essential maneuvers, the zigzag moving technique and the alienate maneuver, while also reviewing the latest ultrasound techniques in thyroid ablation, contributing valuable insights into this evolving field.
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Affiliation(s)
- Wai-Kin Chan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jui-Hung Sun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Miaw-Jene Liou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chia-Jung Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Ling Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Yu Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yan-Rong Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Feng-Hsuan Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
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Aliberti C, Impellizzeri H, Inama M, Moretto G, Vitali A, Balduzzi A, Toaiari M, Francia G, Casaril A. Microwave ablation for large benign thyroid nodules: a proposal for a new approach: "the fluid-motion technique". Updates Surg 2024; 76:239-244. [PMID: 37899391 DOI: 10.1007/s13304-023-01663-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Most thyroid nodules are benign, and treatment is primarily indicated for patients with symptoms or cosmetic concerns related to nodular volume. Recently, there has been growing interest in nonsurgical and minimally invasive techniques for the treatment of symptomatic benign thyroid nodules, including microwave ablation (MWA). AIMS This study aims to evaluate the effectiveness, efficacy, and safety of ultrasound-guided uncooled MWA in the treatment of benign symptomatic thyroid nodules, using a new ablation technique called the "fluid-motion technique." MATERIALS AND METHODS From April 2021 to February 2023, a total of 150 patients with benign thyroid nodules were treated using MWA at the Endocrine Surgery Unit of Pederzoli Hospital, Peschiera del Garda (Italy), with 102 of them being followed-up for at least 6 months. RESULTS Before treatment, the mean major diameter was 38.4 ± 10.0 mm, and the mean volume was 13.6 ± 10.5 mL. At 1 month, the mean volume was 6.8 ± 6.2 mL, and at 3 months, it was 4.6 ± 4.1 mL. The mean Volume Reduction Rate (VRR) at 3 months was 61.1 ± 22.0%. Of the nodules, 17 (17%), 65 (66%), and 20 (19%) had volumes ≤ 10, 10.1-20, and ≥ 20.1 mL, respectively. For these nodules, the mean VRR at 3 and 6 months was 55.3 ± 16%, 63.4 ± 24.8%, 72 ± 26.9% and 68.0 ± 11.2%, 73.5 ± 18.3%, and 81.6 ± 15.8%, respectively. CONCLUSION Our study shows that ultrasound-guided MWA is an effective and safe minimally invasive treatment for benign thyroid nodules. The goal is to achieve a VRR that can reduce symptoms and improve cosmetic appearance.
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Affiliation(s)
- C Aliberti
- Interventional Radiology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - H Impellizzeri
- EndocrineSurgery Unit, Pederzoli Hospital, Peschiera del Garda, Italy.
| | - M Inama
- Minimal Invasive Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - G Moretto
- Minimal Invasive Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - A Vitali
- Minimal Invasive Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - A Balduzzi
- Minimal Invasive Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - M Toaiari
- Endocrinology Service, Pederzoli Hospital, Peschiera del Garda, Italy
| | - G Francia
- Endocrinology Service, Pederzoli Hospital, Peschiera del Garda, Italy
| | - A Casaril
- EndocrineSurgery Unit, Pederzoli Hospital, Peschiera del Garda, Italy
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Cerit MN, Yücel C, Cerit ET, Yalçın MM, Şendur HN, Oktar SÖ. Comparison of the Efficiency of Radiofrequency and Microwave Ablation Methods in the Treatment of Benign Thyroid Nodules. Acad Radiol 2023; 30:2172-2180. [PMID: 37357048 DOI: 10.1016/j.acra.2023.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/27/2023]
Abstract
RATIONALE AND OBJECTIVES To compare the efficacy of two thermal ablation techniques (radiofrequency vs microwave ablation) in the treatment of benign thyroid nodules. MATERIALS AND METHODS A total of 80 patients with 80 nodules underwent thermal ablation of thyroid nodules with either radiofrequency ablation (RFA) (23 females and 14 males; mean age 41 ± 9years) or microwave ablation (MWA) (28 females and 15 males; mean age 45 ± 11years). Ultrasound assessments were made at the 1st, 3rd, 6th, and 12th months after the ablation procedure. RESULTS The mean initial volume of the nodules (RFA: 15.6 mL [min 2.5-max 74]; MWA: 40 mL [min 2-max 205]) was statistically significantly different (P < .001). The following were the volume reduction rates of nodules at 1, 3, 6, and 12months, respectively: after RFA: 46.8 ± 13.5%, 62.9 ± 13.6%, 71.6 ± 11.9%, and 77.9 ± 10.3%. After MWA: 38.7 ± 12.5%, 54 ± 15.3%, 59.6 ± 12.5%, and 65 ± 11.3%. For all months, volume reduction rates in the RFA group were significantly higher than those in the MWA group (P < .05). One patient treated by RFA reported an abscess formation and another patient treated by RFA had a self-limiting hematoma, who recovered without any further treatment. Also, in the MWA group, one patient had abscess formation and another patient had transient recurrent nerve paralysis, who recovered with appropriate treatment. CONCLUSION Both methods are effective in treating benign thyroid nodules; however, RFA provides a better volume reduction.
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Affiliation(s)
- Mahi N Cerit
- Department of Radiology, Gazi University Faculty of Medicine, Beşevler, 06500 Ankara, Turkey (M.N.C., C.Y., H.N.S., S.Ö.O.).
| | - Cem Yücel
- Department of Radiology, Gazi University Faculty of Medicine, Beşevler, 06500 Ankara, Turkey (M.N.C., C.Y., H.N.S., S.Ö.O.); Private Radiology Clinic, Gazi University Faculty of Medicine, Ankara, Turkey (C.Y.)
| | - Ethem T Cerit
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey (E.T.C., M.M.Y.)
| | - Mehmet M Yalçın
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey (E.T.C., M.M.Y.)
| | - Halit N Şendur
- Department of Radiology, Gazi University Faculty of Medicine, Beşevler, 06500 Ankara, Turkey (M.N.C., C.Y., H.N.S., S.Ö.O.)
| | - Suna Ö Oktar
- Department of Radiology, Gazi University Faculty of Medicine, Beşevler, 06500 Ankara, Turkey (M.N.C., C.Y., H.N.S., S.Ö.O.)
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Hu C, Liang S, Liu H, Yang J, Kang H, Guan S, Yan R, Xu E. Prediction of ablation zone disappearance after microwave ablation for the patients with papillary thyroid microcarcinoma using nomograph. Front Endocrinol (Lausanne) 2023; 14:1145958. [PMID: 37600691 PMCID: PMC10433776 DOI: 10.3389/fendo.2023.1145958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives To construct a prognostic nomogram to predict the ablation zone disappearance for patients with papillary thyroid microcarcinoma (PTMC) after microwave ablation (MWA). Materials and methods From April 2020 to April 2022, patients with PTMC who underwent MWA treatment were collected retrospectively. Ultrasound (US) or contrast-enhanced ultrasound (CEUS) was performed at 1 day, 1, 3, 6, 12, 18 and 24 months after MWA to observe the curative effect after ablation. The volume, volume reduction rate (VRR) and complete disappearance rate of the ablation zone at each time point were calculated. Univariate and multivariate logistic regression analysis were used to determine the prognostic factors associated with the disappearance of the ablation zone after MWA, and the nomogram was established and validated. Results 72 patients with PTMCs underwent MWA were enrolled into this study. After MWA, no tumor progression (residual, recurrence or lymph node metastasis) and major postoperative complications occurred. The ablation zone in 28 (38.89%) patients did not completely disappear after MWA in the follow-up period. Three variables, including age (odds ratio [OR]: 1.216), calcification type (OR: 12.283), initial maximum diameter (OR: 2.051) were found to be independent prognostic factors predicting ablation zone status after MWA by multivariate analysis. The above variables and outcomes were visualized by nomogram (C-index=0.847). Conclusions MWA was a safe and effective treatment for PTMC. Older patients with macrocalcification and larger size PTMCs were more unlikely to obtain complete disappearance of ablation zones. Incomplete disappearance of ablation zone was not related to recurrence.
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Affiliation(s)
- Cai Hu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Shuang Liang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Huahui Liu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Jing Yang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Haiyu Kang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Sainan Guan
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Ronghua Yan
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzen, China
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
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Fu Y, Huang Y, Liu Y, Song Y. Analysis of risk factors for intra-cystic hemorrhage in microwave ablation of partially cystic thyroid nodules. Front Endocrinol (Lausanne) 2023; 14:1171669. [PMID: 37522119 PMCID: PMC10374254 DOI: 10.3389/fendo.2023.1171669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
Objective The aim of this study is to identify risk factors of intra-cystic hemorrhage in microwave ablation of mixed solid and cystic microwave ablation s, and to design a preoperative nomogram to predict the risk value of intraoperative bleeding with the goal of individualizing the surgical approach toward different types of cystic and solid thyroid nodules. Methods A total of 241 patients with cystic-solid thyroid nodules who underwent ultrasound-guided percutaneous microwave ablation were retrospectively divided into a bleeding group and a non-bleeding group to compare the diameter, cystic proportion, cystic fluid nature, color Doppler flow imaging, Contrast-enhanced ultrasound (CEUS) findings, and operative methods. Based on univariate and multivariate analysis, the important risk factors of nodular intracapsular hemorrhage in the ablation procedure were projected to a nomogram for predicting the possibility of intraoperative hemorrhage in the thyroid cystic solid nodules. Results Intra-cystic hemorrhage was developed in 37 cases during the ablation of mixed thyroid nodules with a total incidence of 15% (37/241). Significant differences were found statistically between the two groups on the diameter of the lesions, CEUS findings, the cystic fluid ratio, and operative methods (P = 0.000, P = 0.001, P = 0.024, P = 0.002). The possibility of intraoperative nodular intracapsular hemorrhage was predicted by the model based on the risk factors with the accuracy of 81% and prediction consistency index (C-index) of 0.78. Conclusion A new and efficient prediction model was developed based on the identified risk factors for intracapsular hemorrhage during microwave ablation of mixed thyroid nodules, which will aid in the development of targeted surgical planning for different types of cystic thyroid nodules, thus reducing the risk of hemorrhage during ablation.
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Affiliation(s)
- Yao Fu
- Department of Ultrasonography, the Second Hospital of Dalian Medical University, Dalian, China
| | - Yuhui Huang
- Department of Ultrasonography, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yongtai Liu
- Department of Acute Abdomen Surgery, the Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yu Song
- Department of Ultrasonography, the Second Hospital of Dalian Medical University, Dalian, China
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Bellynda M, Kamil MR, Yarso KY. Radiofrequency ablation for benign thyroid nodule treatment: New solution in our center. Int J Surg Case Rep 2022; 97:107418. [PMID: 35933949 PMCID: PMC9403209 DOI: 10.1016/j.ijscr.2022.107418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/25/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Thyroid nodules are one of the most common thyroid disorders and are estimated at 4-7 % in the general population. Although it is estimated that 95 % of thyroid nodules are benign and only 4.0-6.5 % malignant, a combined assessment of clinical data, ultrasound imaging, and FNAB is needed to estimate the risk of malignancy. Several minimally invasive nonsurgical modalities have been developed to treat thyroid nodules, including ethanol ablation (EA), laser ablation (LA), microwave ablation (MWA), and radiofrequency ablation (RFA). Since 2006, this method had been used to treat thyroid nodules and reported to have good efficacy and safety for treating benign thyroid nodules and recurrent thyroid cancer. This paper aims to provide the efficacy and safety of the RFA procedure in benign thyroid lesions. CASE PRESENTATIONS Here we report 34 cases of patients with thyroid nodules who underwent RFA procedures. After the procedure, patients were followed up in the first, third, sixth, and twelfth months. The ratio of decreasing volume in the first, third, sixth, and twelfth months was as follows 81.6 %; 76.89 %; 63.48 %, 60.11 %. CLINICAL DISCUSSION Factors that are thought to predict RFA response include small volume nodule (<12 ml), the presence of a fluid component and well-defined margins, the absence of vascularization, and nonfunctioning status. However, RFA has several limitations, including the procedure that is highly operator dependent to maximize its efficacy, the possibility of persistent lesions, and the lack of a final histological diagnosis that does not completely exclude aggressive histological variants. CONCLUSION The RFA procedure has minimal side effects, is highly effective, and is short in procedure time.
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Affiliation(s)
| | | | - Kristanto Yuli Yarso
- Surgical Oncology Division, Surgery Department, Sebelas Maret University, Indonesia,Corresponding author at: dr. Muwardi street no 4, Surakarta.
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Orloff LA, Noel JE, Stack BC, Russell MD, Angelos P, Baek JH, Brumund KT, Chiang FY, Cunnane MB, Davies L, Frasoldati A, Feng AY, Hegedüs L, Iwata AJ, Kandil E, Kuo J, Lombardi C, Lupo M, Maia AL, McIver B, Na DG, Novizio R, Papini E, Patel KN, Rangel L, Russell JO, Shin J, Shindo M, Shonka DC, Karcioglu AS, Sinclair C, Singer M, Spiezia S, Steck JH, Steward D, Tae K, Tolley N, Valcavi R, Tufano RP, Tuttle RM, Volpi E, Wu CW, Abdelhamid Ahmed AH, Randolph GW. Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association. Head Neck 2021; 44:633-660. [PMID: 34939714 DOI: 10.1002/hed.26960] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The use of ultrasound-guided ablation procedures to treat both benign and malignant thyroid conditions is gaining increasing interest. This document has been developed as an international interdisciplinary evidence-based statement with a primary focus on radiofrequency ablation and is intended to serve as a manual for best practice application of ablation technologies. METHODS A comprehensive literature review was conducted to guide statement development and generation of best practice recommendations. Modified Delphi method was applied to assess whether statements met consensus among the entire author panel. RESULTS A review of the current state of ultrasound-guided ablation procedures for the treatment of benign and malignant thyroid conditions is presented. Eighteen best practice recommendations in topic areas of preprocedural evaluation, technique, postprocedural management, efficacy, potential complications, and implementation are provided. CONCLUSIONS As ultrasound-guided ablation procedures are increasingly utilized in benign and malignant thyroid disease, evidence-based and thoughtful application of best practices is warranted.
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Affiliation(s)
- Lisa A Orloff
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Julia E Noel
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Brendan C Stack
- Department of Otolaryngology - Head & Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Marika D Russell
- Department of Otolaryngology - Head & Neck Surgery, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Jung Hwan Baek
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kevin T Brumund
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA
| | - Feng-Yu Chiang
- Department of Otolaryngology - Head and Neck Surgery, E-Da Hospital, School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Mary Beth Cunnane
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Louise Davies
- The Section of Otolaryngology, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Andrea Frasoldati
- Department of Endocrinology and Metabolism, Arcispedale Santa Maria Nuova IRCCS-ASL, Reggio Emilia, Italy
| | - Anne Y Feng
- Department of Otolaryngology - Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Ayaka J Iwata
- Department of Otolaryngology - Head & Neck Surgery, Kaiser Permanente, Santa Clara, California, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jennifer Kuo
- Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Celestino Lombardi
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mark Lupo
- Thyroid & Endocrine Center of Florida, Sarasota, Florida, USA
| | - Ana Luiza Maia
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center, Research Institute, Tampa, Florida, USA
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | | | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Kepal N Patel
- Department of Surgery, New York University, New York, New York, USA
| | - Leonardo Rangel
- Division of Otorhinolaryngology - Head and Neck Surgery, State University of Rio de Janeiro, Rio de Janiero, Brazil
| | - Jonathon O Russell
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Shin
- Department of Otolaryngology - Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maisie Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - David C Shonka
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Amanda S Karcioglu
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA.,Clinician Educator, Pritzker School of Medicine, Chicago, Illinois, USA
| | - Catherine Sinclair
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai West Hospital, New York, New York, USA
| | - Michael Singer
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Stefano Spiezia
- Endocrine Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Jose Higino Steck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Campinas, Campinas, Brazil
| | - David Steward
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kyung Tae
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Neil Tolley
- Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK
| | | | - Ralph P Tufano
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Michael Tuttle
- Endocrine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erivelto Volpi
- Oncology Center, Oswaldo Cruz German Hospital, Sao Paulo, Brazil
| | - Che Wei Wu
- Department of Otolaryngology - Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Amr H Abdelhamid Ahmed
- Department of Otolaryngology - Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology - Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Agyekum EA, Fu JH, Xu FJ, Ren YZ, Akortia D, Chen Q, Qian XQ, Wang Y, Wang X. Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules. Front Oncol 2021; 11:761005. [PMID: 34868975 PMCID: PMC8637803 DOI: 10.3389/fonc.2021.761005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/28/2021] [Indexed: 12/07/2022] Open
Abstract
Thyroid nodules are commonly encountered in health care practice. They are usually benign in nature, with few cases being malignant, and their detection has increased in the adult population with the help of ultrasonography. Thyroidectomy or surgery is the first-line treatment and traditional method for thyroid nodules; however, thyroidectomy leaves permanent scars and requires long-term use of levothyroxine after surgery, which makes patients more reticent to accept this treatment. Thermal ablation is a minimally-invasive technique that have been employed in the treatment of benign and malignant thyroid nodules nodules, and have been shown to be effective and safe. Several studies, including long-term, retrospective, and prospective studies, have investigated the use of ablation to treat benign thyroid nodules and malignant thyroid nodules, including papillary thyroid carcinoma. Here, we review the recent progress in thermal ablation techniques for treating benign and malignant nodules, including their technicalities, clinical applications, pitfalls and limitations, and factors that could affect treatment outcomes. Special in-depth elaboration on the recent progress of the application of thermal ablation therapy in malignant thyroid nodules.
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Affiliation(s)
- Enock Adjei Agyekum
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China.,School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jian-Hua Fu
- Department of Interventional Radiology, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Fei-Ju Xu
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Yong-Zhen Ren
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Debora Akortia
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Qing Chen
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Xiao-Qin Qian
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Yuguo Wang
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Xian Wang
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
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9
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Wu J, Liu J, Liu L. Comparison Between Radiofrequency Ablation and Microwave Ablation in the Treatment for Benign Thyroid Nodules: a Meta-analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03180-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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10
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Efficacy on radiofrequency ablation according to the types of benign thyroid nodules. Sci Rep 2021; 11:22270. [PMID: 34782643 PMCID: PMC8593160 DOI: 10.1038/s41598-021-01593-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 09/22/2021] [Indexed: 11/14/2022] Open
Abstract
Percutaneous radiofrequency ablation (RFA) has been recommended as minimally invasive treatment for patients with symptomatic benign thyroid nodules (BTNs) because of the large number of clinical applications. This retrospective observational study sought to evaluate the clinical outcomes of RFA for BTNs. From 2014 to 2019, a sample size of 1289 patients treated by RFA were 262 ones with solid nodules and 1027 ones with cystic-solid nodule, respectively. The efficacy including the nodule maximal diameter reduction ratio (MDRR), the volume reduction ratio (VRR) and the cosmetic scores reduction ratio (CSRR). The results of the nodule MDRR and VRR in the cystic-solid nodule group were significantly better than those in the solid nodule group at the 3rd and 6th month, and the CSRR in the two groups showed statistically significant difference at the 3rd month. In a word, RFA is an effective method for symptomatic benign solid or cystic-solid nodules. The achieved MDRR and VRR in the cystic-solid nodule group were significantly better than those in the solid nodule group at the 3rd and 6th month.
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Zhao J, Qian L, Liu Y, Tan X. A long-term retrospective study of ultrasound-guided microwave ablation of thyroid benign solid nodules. Int J Hyperthermia 2021; 38:1566-1570. [PMID: 34727816 DOI: 10.1080/02656736.2021.1994659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To explore the clinical outcomes and safety of ultrasound-guided microwave ablation (MWA) for treating thyroid benign solid nodules during a three-year follow-up. METHODS A total of 53 patients with thyroid benign solid nodules with the largest diameter exceeding 2 cm were treated with US-guided MWA between January 2015 and December 2017. Nodule volume, the cosmetic score, and the symptom scores were evaluated before ablation and 1, 2, and 3 years after the operation. The characteristics of MWA and complications were also evaluated. RESULTS The thyroid nodule volume at each time point after ablation was significantly smaller than that before ablation (p < .05). The Symptom and Cosmetics score were significantly improved (p < .05). Hoarseness was the major complication, with an incidence of 1.89%. The original nodules volume was 7.28 ± 11.42 mL; the isolating fluid was 34.36 ± 13.35 mL; the ablation time was 188.77 ± 89.13s. CONCLUSIONS MMA is an effective and safe approach for reducing nodule volume and symptoms in patients with benign thyroid solid nodules.
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Affiliation(s)
- Junfeng Zhao
- Department of Ultrasound, Capital Medical University Beijing Friendship Hospital, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Capital Medical University Beijing Friendship Hospital, Beijing, China
| | - Yujiang Liu
- Department of Ultrasound, Capital Medical University Beijing Friendship Hospital, Beijing, China
| | - Xiaoqu Tan
- Department of Ultrasound, Capital Medical University Beijing Friendship Hospital, Beijing, China
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Wang X, Niu X, Mu S, Zhang M, Jiang W, Zhai L, Jiang D, Tang W, Zhao C. Analysis and evaluation of the efficacy of ultrasound-guided microwave ablation for papillary thyroid microcarcinoma. Int J Hyperthermia 2021; 38:1476-1485. [PMID: 34645358 DOI: 10.1080/02656736.2021.1988152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The choice of the most appropriate therapeutic approach for a diagnosed papillary thyroid microcarcinoma (PTMC) remains controversial. The present study aimed to evaluate the efficacy of microwave ablation (MWA) for unifocal PTMC with a diameter of ≤0.6 cm. METHODS A total of 63 consecutive patients with PTMC treated with MWA were studied retrospectively. MWA was performed using the hydrodissection technique and multidimensional fixed-needle principle. We analyzed the absorption of the MWA area and evaluated the prognosis over a follow-up period of 24 months. In addition, 83 patients with PTMC who underwent surgery were selected. The operating room characteristics and procedural complications of the two groups were compared. RESULTS In the MWA group, the volume of nodules (p < 0.05) decreased from 0.04 ± 0.03 cm3 to 0.0001 ± 0.0004 cm3 at the 24-month follow-up after MWA, and the volume reduction rate (p < 0.05) was 99.43 ± 1.58%. The incidence of temporary reactive hyperplastic lymphadenectasis was higher and that of other complications was lower in the MWA group than in the surgery group. One percent of the patients in the surgery group had recurrence or metastasis, but none were detected in the MWA group. The loss of thyroid tissue volume (p < 0.001), operating room time (p < 0.001), and the mean length of hospital stay (p < 0.001) were significantly lower in the MWA group than in the surgery group. CONCLUSION Ultrasound-guided MWA is an effective treatment strategy for unifocal PTMC with a diameter of ≤0.6 cm.
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Affiliation(s)
- Xinya Wang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaoyan Niu
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuang Mu
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mingzhu Zhang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wenbin Jiang
- Health Management Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lixue Zhai
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Danni Jiang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wanqing Tang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Cheng Zhao
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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He L, Zhao W, Xia Z, Su A, Li Z, Zhu J. Comparative efficacy of different ultrasound-guided ablation for the treatment of benign thyroid nodules: Systematic review and network meta-analysis of randomized controlled trials. PLoS One 2021; 16:e0243864. [PMID: 33471820 PMCID: PMC7816973 DOI: 10.1371/journal.pone.0243864] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Percutaneous ablation is currently deemed an additionally treatment option for benign thyroid nodules in the world, but possibly different effect among the ablation modalities is not clear. So we aim to evaluate the efficacy and complications of thermal/chemical ablation by network meta-analysis. MATERIALS AND METHODS In the network meta-analysis, PubMed, EMBASE and the Cochrane Library databases were searched from 1980 to 2020. Studies of adults with thyroid benign nodules under percutaneous ablation therapy were included. Percentage mean volume change, symptom score change, cosmetic score change and complications were evaluated by network meta-analysis. RESULTS In the network meta-analysis, Radiofrequency Ablation(RFA) with 2 treatment sessions group was associated with the highest reduction for the mean volume change during 6-month follow-up (MD = 79.09 and 95% CrI:48.23-89.94). There is no significant difference in the incidence of complications. Subgroup analysis showed that 2 sessions of Radiofrequency Ablation (RFA) ranks the highest probability (surface under the cumulative ranking curve (SUCRA) values 77.9) of being the most efficacious treatment for solid or predominantly solid benign nodules. Ethanol ablation (EA) ranked first (SUCRA value 81.1) in the treatment for cyst or predominantly cyst benign nodules. CONCLUSION RFA appears to be superior to other US-guided percutaneous ablation in reducing benign thyroid nodule volume during short- and long-term follow-up. In the subgroup analysis, RFA with 2 treatment sessions showed the most significant effectiveness for solid benign thyroid nodules and EA showed more effectiveness to decrease the volume of cyst benign thyroid nodules.
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Affiliation(s)
- Linye He
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wanjun Zhao
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Zijing Xia
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Anping Su
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Zhihui Li
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jingqiang Zhu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Current Practice of Percutaneous Ablation Technologies for Thyroid Nodules 2020. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00323-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Hu K, Wu J, Dong Y, Yan Z, Lu Z, Liu L. Comparison between ultrasound-guided percutaneous radiofrequency and microwave ablation in benign thyroid nodules. J Cancer Res Ther 2020; 15:1535-1540. [PMID: 31939434 DOI: 10.4103/jcrt.jcrt_322_19] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective The purpose of this study was to compare the efficacy and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of benign thyroid nodules (BTNs). Methods Patients with BTNs were treated in our hospital, including 72 patients treated with RFA and 100 patients treated with MWA from June 2016 to March 2019. The volume reduction rates (VRRs), thyroid function, clinical status, and complications were compared at each postoperative duration to evaluate the efficacy and safety of the two modalities. Results The mean VRRs of the RFA group vs. the MWA group at 1, 3, 6, and 12 months were 22.7±13.4% vs. 24.0±16.1% (P = 0.681), 56.1±19.5% vs. 54.8±22.8% (P = 0.788), 77.9±21.0% vs. 68.7±19.1% (P = 0.038), and 85.4±18.9% vs. 75.8±19.4% (P = 0.029), respectively. There was no significant difference in the VRRs between the two treatments at 1 and 3 months and the RFA group achieved higher VRRs than MWA group at 6 and 12 months. Moreover, the symptom and cosmetic scores decreased significantly in both groups and all patients succeeded in preserving thyroid function. Of the total patients, 2.8% in the RFA group and 4% in the MWA group experienced voice changes after undergoing thyroid ablation, and one patient in the RFA group had intraoperative hemorrhage of about 10 mL. Conclusions RFA and MWA are both effective and safe techniques for treating BTNs. Higher VRRs were observed at the 6- and 12-month follow-ups in the RFA group.
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Affiliation(s)
- Ke Hu
- Department of Endocrinology; Department of Endocrinology, Minhang Brunch, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingjing Wu
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiqiang Lu
- Department of Endocrinology; Department of Endocrinology, Minhang Brunch, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
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The importance of subcapsular anesthesia in the anesthesiological management for thyroid radiofrequency ablation. Med Oncol 2020; 37:22. [DOI: 10.1007/s12032-020-01347-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/20/2020] [Indexed: 12/27/2022]
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Li J, Liu Y, Liu J, Yang P, Hu X, Qian L. A comparative study of short-term efficacy and safety for thyroid micropapillary carcinoma patients after microwave ablation or surgery. Int J Hyperthermia 2020; 36:640-646. [PMID: 31244350 DOI: 10.1080/02656736.2019.1626492] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Although papillary thyroid microcarcinoma (PTMC) has a high incidence and excellent clinical outcome, debate continues as to the therapeutic approach that would be most appropriate after confirming the diagnosis. Methods: We retrospectively analyzed the medical records of 311 patients with T1aN0M0 PTMC between January 2013 and September 2018. In all, 168 underwent microwave ablation (MWA), and 143 underwent surgery. MWA was performed using extensive ablation with hydrodissection. The surgery comprised thyroid lobectomy (TL) with unilateral central lymph node dissection (CND). We examined clinical outcomes during mean follow-up periods of 824 ± 452 days for the TL group and 753 ± 520 days for the MWA group. Results: Postprocedural follow-up revealed that, in the MWA group, the tumors had completely disappeared in 34 patients, and the remainder were reduced to necrotic or carbonized tissue. The incidence of transient hypoparathyroidism was significantly lower in the MWA group than in the TL group (p < .001). In addition, during the follow-up, we found no statistically significant differences between the two groups (TL vs MWA) for PTMC recurrence (1 vs 2 cases), lymph node metastasis (5 vs 5 cases), or disease-free survival [2001 days (5.5 years) vs 1702 days (4.7 years)] (p = .659, p = .795, and p = .974, respectively). Conclusions: If low-risk thyroid carcinoma (i.e., T1N0M0 PTMC) is accurately diagnosed early, MWA could be a minimally invasive alternative to surgery based on our short-term follow-up regarding recurrence and the low rates of complications and disease-free survival.
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Affiliation(s)
- Jianming Li
- a Department of Ultrasound, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Yujiang Liu
- a Department of Ultrasound, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Jibin Liu
- b Department of Radiology , Thomas Jefferson University , Philadelphia , PA , USA
| | - Peipei Yang
- a Department of Ultrasound, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Xiangdong Hu
- a Department of Ultrasound, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Linxue Qian
- a Department of Ultrasound, Beijing Friendship Hospital , Capital Medical University , Beijing , China
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Singh Ospina N, Iñiguez-Ariza NM, Castro MR. Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment. BMJ 2020; 368:l6670. [PMID: 31911452 DOI: 10.1136/bmj.l6670] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient's values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Nicole M Iñiguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - M Regina Castro
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Zheng BW, Wang JF, Ju JX, Wu T, Tong G, Ren J. Efficacy and safety of cooled and uncooled microwave ablation for the treatment of benign thyroid nodules: a systematic review and meta-analysis. Endocrine 2018; 62:307-317. [PMID: 30073455 DOI: 10.1007/s12020-018-1693-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the effectiveness and safety of microwave ablation (MWA), including cooled MWA (cMWA) and uncooled MWA (uMWA), for the treatment of benign thyroid nodules (BTNs). METHODS The databases of MEDLINE, EMBASE and Cochrane library were searched up to 3 Jun, 2018. In this meta-analysis, data of volume reduction rates (VRRs) at the 3-, 6- and 12-month follow-up, and complications are obtained to evaluate the effectiveness and safety of cMWA and uMWA for the treatment of BTNs. RESULTS Nine studies involving 1461 patients with 1845 BTNs were included. The pooled VRR at the 3-month follow-up after MWA therapy reached 54.3% (95% CI: 45.3-63.3%, I2 = 97.6%), 73.5% (95% CI: 66.7-80.3%, I2 = 94.9%) at the 6-month follow-up, and 88.6% (95% CI: 84.9-92.4%, I2 = 92.7%) at the 12-month follow-up. The pooled proportions of overall, major and minor complications were 52.4% (95% CI: 29.8-74.9%; I2 = 99.5%), 4.8% (95% CI: 2.7-7.0%; I2 = 55.9%) and 48.3% (95% CI: 31.2-65.4%; I2 = 99.7%). Both cMWA and uMWA achieved similar pooled VRR at the 3-month follow-up (58.4 vs 45.3%, P = 0.07) and pooled proportion of major complications (4.9 vs 5.0%, P = 0.49), while uMWA had higher pooled proportions of overall and minor complications than cMWA (97.8 vs 29.7%, P < 0.01; 97.8 vs 21.0%, P < 0.01), with more patients suffering pain and skin burn after uMWA (100 vs 5.5%, P < 0.01; 47.2 vs 0.2%, P < 0.01). CONCLUSION MWA is an effective treatment modality for BTNs. When considering the patient's comfort, cMWA would be a more preferable procedure with less complications.
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Affiliation(s)
- Bo-Wen Zheng
- Department of Medical Ultrasonics, Guangdong Province Key Laboratory of Hepatology Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Jin-Fen Wang
- Department of Medical Ultrasonics, Guangdong Province Key Laboratory of Hepatology Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Jin-Xiu Ju
- Department of Medical Ultrasonics, Guangdong Province Key Laboratory of Hepatology Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Tao Wu
- Department of Medical Ultrasonics, Guangdong Province Key Laboratory of Hepatology Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Ge Tong
- Department of Medical Ultrasonics, Guangdong Province Key Laboratory of Hepatology Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Jie Ren
- Department of Medical Ultrasonics, Guangdong Province Key Laboratory of Hepatology Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
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Morelli F, Ierardi AM, Pompili G, Sacrini A, Biondetti P, Angileri SA, Montesano G, Petrillo M, Giacchero R, Dionigi G, Carrafiello G. Cooled tip radiofrequency ablation of benign thyroid nodules: preliminary experience with two different devices. Gland Surg 2018; 7:67-79. [PMID: 29770303 DOI: 10.21037/gs.2017.11.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Thyroid nodules are very common in general population. Even if benign, they may require a treatment in case of symptoms or cosmetic concerns. In the last years, minimally invasive treatments alternative to surgery have been developed, in particular ultrasound (US) guided radiofrequency ablation (RFA). Methods Twenty-four patients (9 males; 15 females; mean age 57.9 years) were treated and divided in two groups (A and B) according to the RFA needle used (18 gauge needle, AMICA; 17 gauge needle, COVIDIEN). Nodules and patients characteristics, together with procedural data were registered pre-treatment and at 1-month follow-up. US visibility of the needle, volume of the nodules, symptoms and cosmetic concerns, complications were registered. Results Visibility of the needle was not significantly different in the two groups (P=0.0787). At 1 month the mean volume of the nodules dropped from 37.1 to 25 mL in group A and from 23.2 to 15.4 mL in group B; shrinkage rate (36.9% and 39.5%, respectively) was not significantly different (P=0.3137). Symptoms decreased from 3.1 to 1.4 in group A and from 4 to 1.6 in group B: no significant differences in reductions were observed (P=0.3305). Cosmetic score decreased from 3.7 to 3.4 in group A and from 3.9 to 3.6 in group B: no significant differences in reductions were observed (P=0.96). Total complication rate (18.2% in group A vs. 23.1% in group B) did not showed significant differences (P=0.5049). Conclusions The two systems used in our study resulted equivalent in terms of US needle visibility, efficacy, symptom/cosmetic relief, safety. More patients and a longer follow-up are necessary to confirm our results.
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Affiliation(s)
| | | | | | - Andrea Sacrini
- Department of Radiology, San Paolo Hospital, Milan, Italy
| | | | | | | | - Mario Petrillo
- Department of Radiology, San Paolo Hospital, Milan, Italy.,Curie Diagnostical Medical Center, Cologno Monzese, Italy
| | | | - Gianlorenzo Dionigi
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
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Li J, Liu Y, Liu J, Qian L. Ultrasound-guided percutaneous microwave ablation versus surgery for papillary thyroid microcarcinoma. Int J Hyperthermia 2018; 34:653-659. [PMID: 29637797 DOI: 10.1080/02656736.2018.1453092] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Papillary thyroid microcarcinoma (PTMC) has high incidence and low disease-specific mortality. However, active surveillance is not accepted by most patients owing to high physical or psychological pressures. The emergence of ablation technologies is supplanting traditional surgery. Our goal was to compare the clinical outcomes of microwave ablation (MWA) and surgery for T1aN0M0 PTMC. METHODS A total of 92 consecutive patients with T1aN0M0 PTMC were studied retrospectively. Forty-six patients had been treated with MWA, and the other 46 had undergone surgery. MWA was performed using extensive ablation extending from the nodule's lower pole to the upper pole. Surgery was performed by total thyroidectomy or thyroid lobectomy. We compared the two groups in terms of mean length of stay, cost, mean blood loss, surgical incision, operating room (OR) time, quality of life (QOL) assessment, complications, and therapeutic efficacy over a follow-up period of 42 months. RESULTS The mean length of stay, cost, mean blood loss, surgical incisions, OR time, and complications in the MWA group were significantly lower than those of the surgery group. The QOL after MWA was higher than it was after surgery. The nodule volume decreased significantly from 53.61 ± 48.43 mm3 to 4.84 ± 6.55 mm3 (p < .001) at the 42-month follow-up, exhibiting a percentage volume reduction of 81.33 ± 36.87%. No recurrence or metastasis occurred in either group during the follow-up period. CONCLUSIONS MWA may be considered a minimally invasive alternative to surgery for solitary T1aN0M0 PTMC with low incidence of complications and good therapeutic effect.
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Affiliation(s)
- Jianming Li
- a Department of Ultrasound , Beijing Friendship Hospital, Capital Medical University , Beijing , China
| | - Yujiang Liu
- a Department of Ultrasound , Beijing Friendship Hospital, Capital Medical University , Beijing , China
| | - Jibin Liu
- b Department of Radiology , Thomas Jefferson University , Philadelphia , PA , USA
| | - Linxue Qian
- a Department of Ultrasound , Beijing Friendship Hospital, Capital Medical University , Beijing , China
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Pesapane F, Patella F, Fumarola EM, Zanchetta E, Floridi C, Carrafiello G, Standaert C. The prostate cancer focal therapy. Gland Surg 2018; 7:89-102. [PMID: 29770305 PMCID: PMC5938267 DOI: 10.21037/gs.2017.11.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022]
Abstract
Despite prostate cancer (PCa) is the leading form of non-cutaneous cancer in men, most patients with PCa die with disease rather than of the disease. Therefore, the risk of overtreatment should be considered by clinicians who have to distinguish between patients with high risk PCa (who would benefit from radical treatment) and patients who may be managed more conservatively, such as through active surveillance or emerging focal therapy (FT). The aim of FT is to eradicate clinically significant disease while protecting key genito-urinary structures and function from injury. While effectiveness studies comparing FT with conventional care options are still lacking, the rationale supporting FT relies on evidence-based advances such as the understanding of the index lesion's central role in the natural history of the PCa and the improvement of multiparametric magnetic resonance imaging (mpMRI) in the detection and risk stratification of PCa. In this literature review, we want to highlight the rationale for FT in PCa management and the current evidence on patient eligibility. Furthermore, we summarize the best imaging modalities to localize the target lesion, describe the current FT techniques in PCa, provide an update on their oncological outcomes and highlight trends for future research.
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Affiliation(s)
- Filippo Pesapane
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Francesca Patella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Enrico Maria Fumarola
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Edoardo Zanchetta
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Chiara Floridi
- Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Chloë Standaert
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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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.
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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
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Wei Y, Qian L, Liu JB, Liu Y. Sonographic measurement of thyroid nodule changes after microwave ablation: relationship between multiple parameters. Int J Hyperthermia 2018; 34:660-668. [PMID: 29303011 DOI: 10.1080/02656736.2017.1418537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ying Wei
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Yujiang Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Korkusuz Y, Gröner D, Raczynski N, Relin O, Kingeter Y, Grünwald F, Happel C. Thermal ablation of thyroid nodules: are radiofrequency ablation, microwave ablation and high intensity focused ultrasound equally safe and effective methods? Eur Radiol 2017; 28:929-935. [PMID: 28894936 DOI: 10.1007/s00330-017-5039-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 06/06/2017] [Accepted: 08/16/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study compares volume reduction of benign thyroid nodules three months after Radiofrequency Ablation (RFA), Microwave Ablation (MWA) or High Intensity Focused Ultrasound (HIFU) to evaluate which of these methods is the most effective and safe alternative to thyroidectomy or radioiodine therapy. MATERIAL AND METHODS Ninety-four patients (39 male, 55 female) with a total of 118 benign, symptomatic thyroid nodules were divided into three subgroups. HIFU was applied to 14 patients with small nodules. The other 80 patients were divided up into two groups of 40 patients each for RFA and MWA in the assumption that both methods are comparable effective. The pre-ablative and post-ablative volume was measured by ultrasound. RESULTS RFA showed a significant volume reduction of nodules of 50 % (p<0.05), MWA of 44 % (p<0.05) and HIFU of 48 % (p<0.05) three months after ablation. None of the examined ablation techniques caused serious or permanent complications. CONCLUSION RFA, MWA and HIFU showed comparable results considering volume reduction. All methods are safe and effective treatments of benign thyroid nodules. KEY POINTS • Thermal Ablation can be used to treat benign thyroid nodules • Thermal Ablation can be an alternative to thyroidectomy or radioiodine therapy • Radiofrequency Ablation, Microwave Ablation, High Intensity Focused Ultrasound are safe and effective.
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Affiliation(s)
- Yücel Korkusuz
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Daniel Gröner
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Natascha Raczynski
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.
| | - Oleg Relin
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany
| | - Yasmina Kingeter
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
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