Conspicuousness and recurrence related factors of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules

Xia, Baoying; Yu, Boyang; Wang, Xiaofei; Ma, Yu; Liu, Feng; Gong, Yanping; Zou, Xinyu; Lei, Jianyong; Su, Anping; Wei, Tao; Zhu, Junfei; Lu, Qiang; Li, Zhihui

doi:10.1186/s12893-021-01312-1

Cited by 14 publications

(12 citation statements)

References 38 publications

(47 reference statements)

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“…Previous evidence has supported the negative correlation between the therapeutic efficacy of ablation and initial volume of nodules (22,23). Therefore, we further evaluated the effect of nodule volume on the efficacy of EA and MWA.…”

Section: Discussionmentioning

confidence: 93%

The influence of nodule size on clinical efficacy of ethanol ablation and microwave ablation on cystic or predominantly cystic thyroid nodules

Zhang

Chu

Liu

et al. 2022

Endocrine Connections

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Objective: To compare the efficacy and safety of ethanol ablation (EA) and microwave ablation (MWA) in the treatment of cystic or predominantly cystic thyroid nodules. Methods: Patients with cystic or predominantly cystic thyroid nodules intervened with EA or MWA were retrospectively enrolled and divided into EA group (n=30) and MWA group (n=31). The volume and volume reduction rate (VRR) of thyroid nodules before ablation, and at 3 months and 12 months after ablation were compared between the two groups. The effective rate (ER) and incidence of adverse events in both groups were recorded. Results: The median VRR and ER at 3 months after ablation were significantly higher in EA group than in MWA group (81.30% vs. 75.76%, P=0.011; 76.67% [23/30] vs. 51.61% [16/31], P=0.040), while no significant difference was detected at 12 months (93.39% vs. 88.78%, P=0.141; 86.67% [26/30] vs. 87.10% [27/31], P=0.960). The median VRR of small nodules in EA group was significantly higher than that in MWA group (81.30% vs. 71.18%, P=0.006; 93.40% vs. 83.14%, P=0.032). There was no significant difference of median VRR of medium nodules at final follow-up between MWA and EA group (93.01% vs. 89.68%, P=0.482). Serious adverse events were not reported in both groups. Conclusion: EA and MWA are both effective and safe in the treatment of cystic or predominantly cystic thyroid nodules. EA is more cost-effective and effective than MWA for small nodules, but it requires more cycles of treatment and may pose a higher risk of postoperative pain compared with MWA.

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Section: Discussionmentioning

confidence: 93%

The influence of nodule size on clinical efficacy of ethanol ablation and microwave ablation on cystic or predominantly cystic thyroid nodules

Zhang

Chu

Liu

et al. 2022

Endocrine Connections

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“…7 Xia et al report contradictory data with a higher energy to volume ratio in the recurrence group (p<0,05) in his retrospective case series. 15 The energy deployment in our patients with recurrence might have been underestimated: Cysts are recorded with the volume prior to evacuation, which takes part at the beginning of the procedure. Once evacuated, the target volume has become smaller requiring a respectively smaller amount of energy for sufficient treatment of the remaining wall.…”

Section: Discussionmentioning

confidence: 96%

“…Wang et al found 16 recurrencies in their series of 94 patients representing a recurrence rate of 17 %, 7 resembling our own results of 19 % on a per-patient basis. In a more recently published paper, Xia et al found a recurrence rate of only 2,3 % using the same definition for recurrence as Wang et al 15 Under the term "recurrence", we summarized all unsatisfying outcomes of our patients, including regrowth of the treated nodule during ultrasound follow-up, recurrent symptoms and failure of reducing the nodule volume > 50 % within 6 months. This liberal definition led to a comparably large part of patients experiencing recurrence.…”

Section: Discussionmentioning

confidence: 99%

Microwave ablation of thyroid nodules: effects on recurrence and outcome

Eisele¹

2022

EMIJ

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Background: Microwave ablation developed into an accepted treatment for benign thyroid nodules. Definition and risk factors for recurrence are under discussion. We assumed recurrence in case of a second procedure for the same reason or if clinical symptoms reappear after initial relief, and analyzed our prospectively collected data for risk factors and outcome. Methods: Indications included benign thyroid nodules (n=24), cystic nodules (n=9), autonomous functioning nodules (n=9), recurrent cancer (n=3) and Basedow’s disease (n=2). For microwave ablation, a CE certified generator was used. All procedures were conducted under ultrasound control and with general anesthesia or mild sedation. Followup included ultrasound, laboratory parameters and a standardized questionnaire. Results: A total of 47 patients were enrolled into the study. Among them were 19 cases with risk factors for recurrence which were defined as nodule size exceeding 4 cm with or without cystic appearance. Recurrence occurred in 9 cases leading to conventional hemithyreoidectomy (n=1), reablation (n=5) or sclerotherapy (n=1). The association of recurrence with the presence of a risk factor was statistically significant (p<0,001, Chi square test). In case of recurrence, statistically significant less energy was deployed in comparison to successful MCT (0,39 +/- 0,31 kJ/mL vs. 1,57 +/- 2,37 kJ/mL, p< 0,005, t-test). Conclusion: Recurrence is a common problem following microwave ablation of thyroid nodules. Nodules > 4 cm and cystic disease seem to predispose for treatment failure. Further studies are required to define recurrence and the best indications for microwave ablation of thyroid nodules.

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“…Most published studies exploring MWA for BTN have used fixed time points for follow up, commonly recording changes in volume and VRR at 1, 3, 6, and 12 months after ablation ( 23 , 27 , 28 ). However, in actual clinical practice, follow-up times are influenced by poor patient compliance and insufficient knowledge of the disease.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided microwave ablation for benign thyroid nodules results in earlier and faster nodule shrinkage in patients with Hashimoto's thyroiditis than in those with normal thyroid function

Chen

Liu²,

Jin³

et al. 2023

Front. Surg.

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ObjectivesGiven that the histological features of the thyroid parenchyma in patients with Hashimoto's thyroiditis (HT) differ from those of the normal thyroid gland, HT may affect the effectiveness of ultrasound-guided microwave ablation (MWA) for benign thyroid nodules (BTNs). The present study aimed to compare the effectiveness of MWA for the treatment of BTNs in patients with both BTNs and HT and those with BTNs and normal thyroid function, based on changes in the volume reduction ratio (VRR) of the BTNs.MethodsPatients who had achieved a VRR ≥50% after MWA for BTN (July 2020–June 2021), followed up for 12 months, and their data were retrospectively analyzed.ResultsA total of 213 nodules were identified in 185 patients, including 167 in the “BTN” group and 46 in the “BTN + HT” group. A comparison of the fitting curves for VRR–follow-up time revealed that the VRR increased with time after MWA, although the relationship was nonlinear. Piece-wise linear regression model analysis of the threshold effect of VRR and follow-up time in the two groups indicated that the inflection point of the “BTN” group occurred at 2.1 months: VRR increased fastest within 2.1 months of MWA (rate of change: 32.9% per month; P < 0.001), following which the rate of change was slower and maintained at 1.0% per month (P = 0.006). In the “BTN + HT” group, the inflection point occurred 1.5 months after MWA, with the most significant increase occurring in this period (rate of change: 41.5% per month; P < 0.001), followed by a rate of 2.8% per month (P < 0.001) after 1.5 months.ConclusionsThe relationship between VRR and follow-up time for ultrasound-guided MWA for BTN is nonlinear and exhibits a threshold effect. The current results indicated that the VRR in both groups increased before and after the inflection point, although the rate of change was greater before than after the inflection point. The inflection point occurs earlier in patients with BTN + HT than in those with BTN yet normal thyroid function, and this difference may be related to the “oven effect” involved in the development of HT.

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Conspicuousness and recurrence related factors of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules

Cited by 14 publications

References 38 publications

The influence of nodule size on clinical efficacy of ethanol ablation and microwave ablation on cystic or predominantly cystic thyroid nodules

The influence of nodule size on clinical efficacy of ethanol ablation and microwave ablation on cystic or predominantly cystic thyroid nodules

Microwave ablation of thyroid nodules: effects on recurrence and outcome

Ultrasound-guided microwave ablation for benign thyroid nodules results in earlier and faster nodule shrinkage in patients with Hashimoto's thyroiditis than in those with normal thyroid function

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