A randomized controlled trial to evaluate the efficacy of ultrasound-guided laser photocoagulation for treatment of benign thyroid nodules

Gambelunghe, Giovanni; Fatone, Cristina; Ranchelli, A.; Fanelli, Carmine G.; Lucidi, Paola; Cavaliere, Antonio; Avenia, Nicola; D'Ajello, M; Santeusanio, Fausto; Feo, Pierpaolo De

doi:10.1007/bf03347368

Cited by 62 publications

(43 citation statements)

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“…Although the energy deposited per milliliter nodule tissue has varied in the available studies, a statistically significant correlation between energy deposited and nodule volume reduction could not be demonstrated (18,21,22), and only few studies have been able to demonstrate such a correlation (34,35). This suggests that in the individual patient, it is not easy to determine the optimal energy level.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules

Døssing¹,

Bennedbæk²,

Hegedűs³

2011

European Journal of Endocrinology

120

103

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Aim: To evaluate the long-term efficacy of interstitial laser photocoagulation (ILP) in solitary benign thyroid nodules. Design and methods: A total of 78 euthyroid outpatients (45 participating in randomized trials) with a benign solitary solid and scintigraphically cold thyroid nodule causing local discomfort were assigned to ILP. ILP (using one laser fiber) was performed under continuous ultrasound (US) guidance and with an output power of 1.5-3.5 W. Thyroid nodule volume was assessed by US and thyroid function determined by routine assays, before and during follow-up. Pressure symptoms and cosmetic complaints were evaluated on a visual analogue scale (0-10 cm). Of the total patients, six had thyroid surgery 6 months after ILP and three were lost to follow-up. The median follow-up for the remaining 69 patients was 67 months (range 12-114). Results: The overall median nodule volume decreased from 8.2 ml (range 2.0-25.9) to 4.1 ml (range 0.6-33.0; P!0.001) at the final evaluation, corresponding to a median reduction of 51% (range: K194 to 95%). This correlated with a significant decrease in pressure as well as cosmetic complaints. After 12-96 months (median 38 months) of ILP, 21 patients (29%) had thyroid surgery because of an unsatisfactory result. All had benign histology. Thyroid function was unaltered throughout and side effects were restricted to mild local pain. Conclusion: US-guided ILP results in a satisfactory long-term clinical response in the majority of patients with a benign solitary solid cold thyroid nodule. Further large-scale studies should aim at optimizing selection criteria for ILP, preferably in randomized studies.

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Section: Discussionmentioning

confidence: 99%

Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules

Døssing¹,

Bennedbæk²,

Hegedűs³

2011

European Journal of Endocrinology

120

103

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“…The rate of permanent hypothyroidism was low (only three patients) [63,65]. Valcavi et al have found that thyroid pericapsular bleeding developed in almost 2 % of patients, but this disappeared in 3-4 weeks.…”

Section: Complicationsmentioning

confidence: 94%

“…The patient is placed in a supine position with neck hyperextended. The procedure is performed under ultrasound system guidance [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74]. In most studies, a 21-G needle is inserted into the lesion along its longest axis.…”

Section: La Devices and Proceduresmentioning

confidence: 99%

“…Care should be taken to place the needle tip in the deepest part of the nodule, with a distance of at least 15 mm (10 mm according to Gambelunghe et al [60,65]. from the inferior margin of the lesion [59,62,74], and to maintain the same distance between the needle tip and surrounding cervical structures [57,58,61,62,66,69,70,[72][73][74].…”

Section: La Devices and Proceduresmentioning

confidence: 99%

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Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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Benign thyroid nodules are a common disease in the general population. Most often, they are completely asymptomatic and discovered occasionally during routine ultrasound examinations, and do not require any treatment. When thyroid nodules become symptomatic, surgical excision is still considered standard treatment. In the last few years, several experiences in the treatment of benign thyroid nodules through image-guided percutaneous thermal ablation have been reported with encouraging results, so that currently, these treatments are often proposed as first-choice options for patients with symptomatic benign thyroid nodules. In this paper, we discuss the present literature on the topic, focusing on different techniques available for image-guided percutaneous ablation, particularly radiofrequency (RFA), laser (LA), microwave (MWA), and high-intensity-focus ultrasound (HIFU). Little evidence about the efficacy of MWA and HIFU is now available. According to the literature, good results have been obtained with RFA and LA. Regarding RFA, volume reduction after ablative treatment has been found to range from 47 to 84 % at 3-6 months, and from 62 to 93 % at 1 year; LA also seems to be effective in achieving shrinkage of thyroid nodules, with volume reduction from 37 to 81 % at 3-6 months, and from 13 to 82 % at 1-year follow-up. Moreover, applications of advanced image-guidance modality, such as contrast-enhanced ultrasound and virtual navigation with fusion imaging, are discussed.Keywords Laser Á Radiofrequency Á Microwave Á Highintensity focused ultrasound Á Thyroid nodule SOMMARIO I noduli benigni della tiroide sono una evenienza comune nella popolazione generale. Più spesso vengono scoperti occasionalmente durante un esame ecografico fatto per altri motivi, sono asintomatici e non richiedono alcun trattamento. Qualora i noduli diventino sintomatici, l'escissione chirurgica è ancora considerato il trattamento standard. Tuttavia, negli ultimi anni, è cresciuta l'esperienza circa il trattamento di tali noduli tramite ablazione percutanea sotto guida ecografica tanto che, attualmente, questo viene spesso proposto come trattamento di scelta. Lo scopo del nostro lavoro è fare una revisione della letteratura riguardante l'argomento, con un particolare focus sulle differenti tecniche attualmente a disposizione, in particolare radiofrequenza (RFA), laser (LA), microonde (MWA) e high-intensity-focus ultrasound (HIFU). Al momento ci sono ancora poche evidenze sull'efficacia di MWA e HIFU. Secondo quanto riportato in letteratura, buoni risultati sono stati ottenuti con RFA e LA. Riguardo la radiofrequenza, la riduzione volumetrica dopo la procedura ablativa va da 47 a 84 % a 3-6 mesi e da 62 a 93 % a 1 anno; anche il laser sembra essere efficace nel causare la riduzione del nodulo, con percentuali che vanno da 37 a 81 % a 3-6-mesi a da 13 a 82 % a 1 anno di follow-up Abbiamo poi discusso brevemente le

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“…Patients with such tumors are not suitable for surgery, radiotherapy, and chemotherapy. With these three treatments precluded, the possible and available treatments must be local and non-invasive, with image precise monitoring, and real-time confirmation, and these options include laser [1] , cr yotherapy [2] , photodynamicmic therapy [3,4] , radioactive particle [5] and high intensity focused ultrasound (HIFU) [6] . HIFU is a new treatment for solid malignant tumors, which emerged in recent years [7,8] .…”

Section: Introductionmentioning

confidence: 99%

Complications of high intensity focused ultrasound in patients with recurrent and metastatic abdominal tumors

Xu²,

Gu³

et al. 2007

WJG

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AIM:To analyze the local and systemic complications of high intensity focused ultrasound (HIFU) for patients with recurrent and metastatic abdominal tumors. METHODS:From Aug 2001 to Aug 2004, 17 patients with recurrent and metastatic abdominal tumors were enrolled in this study. Real-time sonography was taken, and vital signs, liver and kidney function, skin burns, local reactions, and systemic effects were observed and recored before, during, and after HIFU. CT and MRI were also taken before and after HIFU. RESULTS:All 17 patients had skin burns and pain in the treatment region; the next common complication was neurapraxia of the stomach and intestines to variable degrees. The other local and systemic complications were relatively rare. Severe complications were present in two patients; one developed a superior mesenteric artery infarction resulting in necrosis of the entire small intestines, and the other one suffered from a perforation in terminal ileum due to HIFU treatment. CONCLUSION:Although HIFU is a one of noninvasive treatments for the recurrent and metastatic abdominal tumors, there are still some common and severe complications which need serious consideration.

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A randomized controlled trial to evaluate the efficacy of ultrasound-guided laser photocoagulation for treatment of benign thyroid nodules

Cited by 62 publications

References 9 publications

Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules

Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules

Image-guided thermal ablation of benign thyroid nodules

Complications of high intensity focused ultrasound in patients with recurrent and metastatic abdominal tumors

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