Efficacy and Safety of Radiofrequency Ablation Versus Observation for Nonfunctioning Benign Thyroid Nodules: A Randomized Controlled International Collaborative Trial

Deandrea, Maurilio; Sung, Jin Yong; Limone, Paolo Piero; Mormile, Alberto; Garino, Francesca; Ragazzoni, Federico; Kim, Kyu Sun; Lee, Ducky; Baek, Jung Hwan

doi:10.1089/thy.2015.0133

Cited by 131 publications

(128 citation statements)

References 35 publications

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“…Indeed, as previously reported (20,24), thyroid nodules have been treated by one single RFA using the same radiofrequency outpower in order to better evaluate the efficacy of this technique.…”

Section: Radiofrequency Ablation For Thyroid Nodulesmentioning

confidence: 99%

“…The real impact of RFA of benign thyroid nodules in terms of efficacy is still controversial because most of the published studies are compromised by several bias such as trials not controlled, small thyroid nodule volume or short follow-up period (13)(14)(15)(16)(17)(18)(19)(20). Moreover, a few authors have treated large thyroid nodules and, in these patients, further RFA treatments were needed to obtain a significant volumetric reduction (14,15).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of a single radiofrequency ablation of solid benign non-functioning thyroid nodules

Cesáreo

Palermo

Pasqualini

et al. 2017

Arch. Endocrinol. Metab.

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Objective: The objective of our study is to evaluate the clinical outcomes and safety of radiofrequency thermal ablation (RFA) for benign thyroid nodules (BTNs) over a 1-year follow-up. Subjects and methods: This is a monocentric retrospective study. Forty-eight patients with solid, non-functioning BTNs were treated by RFA using a 17G internally cooled electrode. We categorized thyroid nodules as small (≤ 12 mL), medium (12 to 30 mL), or large (over 30 mL). BTNs volume reduction, thyroid function, cosmetic and compressive score changes and side effect evaluation at 6 and 12 months were evaluated. Results: BTN volume decreased significantly from baseline to 6 (mean percentage decrease of BTN volume was 66.8 ± 13.6%, p < 0.001). At 12 months, the mean percentage reduction of BTN volume compared to six months was 13.7 ± 17.1% (p < 0.001). At 6-month, symptom score had improved significantly (p < 0.001) while it does not change significantly between 6 and 12 months. In particular, symptom score improved significantly in the medium (p < 0.001) and large (p < 0.01) subgroups. Cosmetic score improved significantly between baseline and 6 months (p < 0.001) and between 6 and 12 months (p < 0.01). In all the subgroups, cosmetic score improved significantly between baseline and 6 months, while between 6 and 12 months it improved significantly only in the large group (p < 0.05). RFA was well tolerated. Only one patient experienced permanent right paramedian vocal cord palsy. Conclusions: A single RFA treatment was effective in reducing BTNs volume, in particular small and medium nodules. Cosmetic score improved in all treated BTNs while symptom score only got better in the medium and large BTNs. Arch Endocrinol Metab. 2017;61(2):173-9.

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Section: Radiofrequency Ablation For Thyroid Nodulesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of a single radiofrequency ablation of solid benign non-functioning thyroid nodules

Cesáreo

Palermo

Pasqualini

et al. 2017

Arch. Endocrinol. Metab.

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“…First, most of the thyroid nodules treated by HIFU had been small in size/volume when compared to studies evaluating other thermal ablation techniques [10, 11]. This is because it takes a relatively long time for a small and tight focused region to cover the entire nodule volume (Table 3).…”

Section: Discussionmentioning

confidence: 99%

High intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a systematic review

Lang

2017

J Ther Ultrasound

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BackgroundWith an increasing number of imaging studies being done nowadays, the number of incidentally discovered thyroid nodules is expected to rise. Although many of these nodules are small and benign in nature, some do grow and may cause pressure and/or thyrotoxic symptoms. Surgical resection has traditionally been recommended for symptomatic nodules but is associated with risk of hypothyroidism, bleeding, infection, and nerve damage. High intensity focused ultrasound (HIFU) is one of the non-surgical thermal ablation techniques that may serve as an alternative in the treatment of benign thyroid nodules. The present review is to systematically evaluate the efficacy and safety of HIFU ablation.MethodsWe comprehensively searched all studies that evaluated the use of HIFU ablation as a treatment of benign thyroid nodules from Medline (PubMed) and Cochrane Library electronic databases using specific keywords. All titles identified by the search strategy were independently screened by two authors. Case reports, animal studies, editorials, expert opinions, reviews without original data and studies on pediatric population were excluded. Multiple reports of the same dataset were assessed and the most representative and updated report of a study was included.ResultsFive original studies were found. All treated thyroid nodules were confirmed to be benign cytologically and either appeared solid or predominantly (>70%) solid on ultrasonography. Only one type of commercially available US-guided device with an extracorporeal probe (3 MHz) was used in all the reported treatments. No major complications including recurrent laryngeal nerve injury, skin burn or haematoma were reported in all of the studies. The overall nodule volume reduction after single session of HIFU ablation ranged between 45 and 68%, depending on nodule size and length of follow-up.ConclusionsDespite the few number of studies, our review appeared to suggest that HIFU is a safe and efficacious method of treating symptomatic benign thyroid nodules. However, larger-scale, prospective trials with longer follow-up period are indeed required to confirm this. In terms of the ablation itself, relative to other ablation techniques, there are still much room for improvements in shortening treatment duration and expanding the range of treatable nodules.

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“…Laser/radiofrequency ablation appears to be an effective and safe outpatient treatment for volume reduction of solid cold thyroid nodules [29,30] , offering infrequent side effects, lower cost than surgery, and persistent nodule size reduction, especially for spongiform nodules [31] . Our respondents would equally choose surgery or radiofrequency ablation ( ∼ 46% each) to treat a 70-year-old patient with a 4.0-cm spongiform nodule and compressive symptoms.…”

Section: Management Of Different Cases With a Benign Nodulementioning

confidence: 99%

A 2016 Italian Survey about Guidelines and Clinical Management of Thyroid Nodules

et al. 2016

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Background: While thyroid nodules are frequent in endocrine clinical practice, patients are often asymptomatic and euthyroid, and death is rare in cases of malignancy. Objectives: To evaluate the perception of current international guidelines regarding thyroid nodule management among Italian endocrinologists, and to compare daily clinical practice with suggested recommendations. Methods: Italian Association of Clinical Endocrinologists (AME) members were invited to participate in a Web-based survey. Results: A total of 566 physicians responded. About 50% had read the full text of the guidelines. Over half appreciated the suggested ultrasound (US) risk categories. Fine-needle aspiration (FNA) was obtained more frequently than recommended. Follow-up of a cytologically benign nodule was largely performed according to the guidelines. Molecular testing would be most commonly requested when cytology reports showed atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (TIR3A for Italian System). Iodine and/or levothyroxine were largely prescribed for cytologically benign asymptomatic nodules. Laser/radiofrequency ablation and percutaneous ethanol injection were commonly considered as alternatives to surgery (46.2 and 71.4%, respectively). Conclusions: Efforts are needed to make the guidelines more user-friendly and to encourage the use of codified risk categories in thyroid US reports. FNA indications remain a matter of debate as FNA is obtained in clinical practice more often than is recommended. Current US follow-up modalities for a benign nodule are correct, but probably could be performed less frequently without any harm. Molecular testing, if accessible, would be helpful in guiding clinicians' strategies in cases of AUS/FLUS-TIR3A cytologic results. Nonsurgical procedures are favorably embraced.

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Efficacy and Safety of Radiofrequency Ablation Versus Observation for Nonfunctioning Benign Thyroid Nodules: A Randomized Controlled International Collaborative Trial

Abstract: RFA was effective in reducing the volume of BTN. The outcome was similar in centers with different experience in the moving-shot technique.

Cited by 131 publications

References 35 publications

Efficacy and safety of a single radiofrequency ablation of solid benign non-functioning thyroid nodules

Efficacy and safety of a single radiofrequency ablation of solid benign non-functioning thyroid nodules

High intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a systematic review

A 2016 Italian Survey about Guidelines and Clinical Management of Thyroid Nodules

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