Context Radiofrequency ablation (RFA) of benign thyroid nodules has been gaining consensus. However, no solid information on its long-term efficacy is available. Objective To analyze the long-term results of single-session RFA. Design Retrospective longitudinal observational study. Setting Primary care center. Patients or Other Participants Adult outpatients who underwent a single-session RFA and posttreatment follow-up of least 3 years. Intervention Ultrasound-guided RFA was performed after local anesthesia by “moving-shot” technique. RFA was performed with a median power of 55W and a median time of 14 minutes with an internally cooled 18-gauge electrode with an active 10-mm tip. Main Outcome Measures Objective (trend of nodule volume) and subjective (compressive and cosmetic concerns) response to RFA were evaluated. Continuous variables were analyzed by the Wilcoxon and ANOVA test and their correlations by using the Spearman test. Categorical variables were compared by Pearson χ2 test. Results Two hundred and fifteen patients were included. An early significant reduction of nodule volume was found at 1 year, lasting up to 5 years. A 67% nodule shrinkage was observed at the end of the observation period. The best response was recorded in nodules below 10 mL (79% reduction early and 81% at 5 years). Patients’ symptoms were significantly reduced. Conclusions This study, by demonstrating a durable shrinkage of benign thyroid nodules treated by RFA with an improvement of subjective symptoms, establishes the reliability of RFA as alternative to surgery in the management of thyroid nodules, thus representing a remarkable novelty for clinical practice.

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This study supports the National Cancer Institute consensus showing a different risk of malignancy for "follicular lesions of undetermined significance” compared with "follicular neoplasms" and "Hurthle cells neoplasms," which are more suspect for malignancy. This subclassification could improve clinical management of thyroid nodules, helping to better select patients for surgery or follow up.

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