BackgroundRadiofrequency ablation (RFA) has gained ground as an effective and well-tolerated technique to treat benign thyroid nodules. Most of the available studies have described the short-term outcomes of RFA, whereas there is a limited number of studies evaluating long-term issues, such as regrowth and the likelihood of retreatments. In addition, risk markers of regrowth and retreatment remain to be defined. The initial ablation ratio (IAR) is an index that measures the amount of ablation after RFA, which has been associated with technique efficacy (i.e. volume reduction >50% after 1 year from the procedure). This study aimed at evaluating i) IAR reproducibility and ii) IAR predictive value for RFA 5-year outcomes.Materials and MethodsThis is a retrospective single center study on patients with benign thyroid nodules treated with RFA and followed for 5 years after initial treatment. IAR interobserver reproducibility was evaluated with Bland-Altman method and Lin’s concordance correlation coefficient (ρc). IAR predictive value for RFA 5-year outcomes was evaluated with linear and logistic regression models, as well as with Cox models, while receiver operating characteristic (ROC) analyses were used for cut-offs.ResultsWe selected 78 patients with 82 benign thyroid nodules. The procedure significantly reduced nodule volume and this reduction was generally maintained over time. Technique efficacy was achieved in 92% of patients, while 23% of nodules regrew and 12% of nodules were retreated. Median IAR was 83%. Lin’s concordance and Pearson’s correlation coefficients suggested a good interobserver reproducibility of this index, consistent with the limits of agreement of the Bland-Altman plot. IAR was significantly associated with technique efficacy, 1- and 5-year volume reduction ratio, and with the likelihood of a retreatment, but not with nodule regrowth. ROC analyses showed that IAR cut-off was 49% for technique efficacy and 73% for retreatment.ConclusionsOur results show for the first time that IAR is reproducible and that it predicts the volume reduction and the likelihood of a retreatment after 5 years from RFA.

Objective Mild autonomous cortisol secretion (MACS) has been associated with a higher prevalence of osteoporosis, although most data rely on single-center studies with limited sample size. We aimed to assess the prevalence of fragility fractures and contributing factors in a large cohort of patients with adrenal incidentalomas. Design and Methods Medical records of 1023 patients with adrenal incidentalomas from 1990 to 2019 were reviewed, and 735 patients were selected. Clinically-obtained electronic radiological images closest to first endocrine evaluation, such as lateral views of spine X-rays or CT thoraco-abdominal scans, were reviewed to screen for asymptomatic morphometric vertebral fractures. Clinical fragility fractures, hormonal and DXA indices were also recorded. Results 474 patients had non-functioning (NF) adrenal incidentalomas, 238 had MACS and 23 Adrenal Cushing’s Syndrome (AC). Prevalence of fragility fractures was different (P = 0.018) between groups, respectively 24.1% (NF), 34.0% (MACS) and 30.4% (AC), with significant difference between NF and MACS (P = 0.012). When analyzed separately by sex and menopausal status, this difference remained significant in post-menopausal women (P = 0.011), with a fracture prevalence of 22.2% (NF), 34.6% (MACS). Fracture prevalence was similar in males. Women with MACS aged ≥65 years reported a 48.8% prevalence of fractures, as compared with 29.5% in NF (P < 0.01). In post-menopausal women, fragility fractures were associated with age (OR 1.1, P < 0.001), smoking (OR 1.8, P = 0.048) and 1mg-DST cortisol (OR 3.1, P = 0.029), while in men, only age was associated with fragility fractures. Conclusions A considerable fracture burden was shown in post-menopausal women with adrenal incidentalomas and MACS, with clinical implications for the evaluation and management of bone metabolism.

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View related articlesView Crossmark data Citing articles: 1 View citing articles Institutional review board approvalThis retrospective study is part of a research project whose protocol was approved by the Institutional Review Board on 10/03/2020 (CEUR-2020-Os-039). Disclosure statementNo potential conflict of interest was reported by the author(s).