Efficacy of thermal ablation in benign non-functioning solid thyroid nodule: A systematic review and meta-analysis

Trimboli, Pierpaolo; Castellana, Marco; Sconfienza, Luca Maria; Virili, Camilla; Pescatori, Lorenzo; Cesareo, Roberto; Giorgino, Francesco; Negro, Roberto; Giovanella, Luca; Mauri, Giovanni

doi:10.1007/s12020-019-02019-3

Cited by 125 publications

(126 citation statements)

References 46 publications

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“…In the first study, a greater 6-month mean volume change (77.8 vs. 49.5%) was reported after RFA as compared to LTA [78]. Similarly, in the other meta-analysis, at 12 and 24 months RFA showed a greater VRR than LTA (75 vs. 52% and 87 vs. 45%, respectively) [49]. In a paper based on a direct comparison of RFA and LTA, both performed by the same skilled operators, the techniques demonstrated similar technique efficacy and rate of complications [79].…”

Section: Comparison Of Outcomes Of Different Ta Techniques For Benignmentioning

confidence: 82%

“…Mean volume reduction in randomized controlled trials, which did not always differentiate complex from solid nodules, ranged from 69 to 78% at 12-month follow-up [56,57], and a 5-year retrospective study demonstrated long-term clinical efficacy with a median 67% volume reduction [58]. In the previously quoted meta-analysis, RFA was associated with a 68, 75, and 87% mean VRR at 6, 12, and 24 months, respectively [49]. As a general rule, the smaller the treated nodule the higher the volume reduction (78-82% in ≤10to 12-mL nodules vs. 62-65% in > 20-to 30-mL nodules) [56,57].…”

Section: Radiofrequencymentioning

confidence: 94%

“…Accordingly, only a minority (5-9%) of treated nodules exhibit significant re-growth within a 3-year follow-up [43][44][45][46]. The results of LTA in benign non-functioning thyroid nodules have been synthesized in a recent meta-analysis which reported a 48, 52, 45, and 44% mean volume reduction rate (VRR) at 6, 12, 24, and 36 months, respectively [49].…”

Section: Solid Nodulesmentioning

confidence: 99%

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2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

et al. 2020

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Standard therapeutic approaches for benign thyroid lesions that warrant intervention are surgery for cold and either surgery or radioiodine for autonomously functioning thyroid nodules (AFTN). Image-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for selected clinical conditions. Due to mounting scientific evidence and widening availability, ETA considered it appropriate to develop guidelines for the use of TA in adult patients. TA procedures are well tolerated, but a dedicated training of the operators is required and information on possible complications needs to be shared with the patients. The following factors should be considered when weighing between observation, surgery, and TA for benign thyroid nodules. In solid non-hyperfunctioning nodules, TA induces a decrease in thyroid nodule volume, paralleled by improvement in symptoms. Nodule re-growth is possible over time and may necessitate repeat treatment, or surgery, in a dialogue with the patient. In AFTN, radioactive iodine is the first-line treatment, but TA may be considered in young patients with small AFTN due to higher probability of restoring normal thyroid function and avoidance of irradiation. In cystic nodules, ethanol ablation (EA) is the most effective and least expensive treatment. TA may be considered for cystic lesions that relapse after EA or have a significant residual solid component following drainage and EA. TA should be restricted to benign lesions that cause symptoms or cosmetic concern. Presently, laser and radiofrequency ablation are the most thoroughly assessed techniques, with similar satisfactory clinical results. Microwaves and high-intensity focused ultrasound therapy options remain to be fully evaluated.© 2020 European Thyroid Association Published by S. Karger AG, Basel Recommendation 1. In adult patients with benign thyroid nodules that cause pressure symptoms and/or cosmetic concerns and decline surgery, image-guided TA should be considered as a costand risk-effective alternative option to surgical treatment or observation alone (1, ØØOO).Recommendation 2. We recommend against the use of TA for asymptomatic lesions (1, ØØØO).

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Section: Comparison Of Outcomes Of Different Ta Techniques For Benignmentioning

confidence: 82%

Section: Radiofrequencymentioning

confidence: 94%

Section: Solid Nodulesmentioning

confidence: 99%

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2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

et al. 2020

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“…Both RF and L are able to induce a significant and durable volume reduction of benign thyroid nodules, thus representing a valid alternative option to surgery [22][23][24][25][26]. When the physician and patient have to decide between a thermal treatment or surgery, it would be important to know how much the nodule will be reduced once treated with thermal ablation and the duration of the effect.…”

Section: Discussionmentioning

confidence: 99%

Machine Learning Prediction of Radiofrequency Thermal Ablation Efficacy: A New Option to Optimize Thyroid Nodule Selection

Negro¹,

Rucco²,

Creanza³

et al. 2019

Eur Thyroid J

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Background: Radiofrequency (RF) is a therapeutic modality for reducing the volume of large benign thyroid nodules. If thermal therapies are interpreted as an alternative strategy to surgery, critical issues in their use are represented by the extent of nodule reduction and by the durability of nodule reduction over a long period of time. Objective: To assess the ability of machine learning to discriminate nodules with volume reduction rate (VRR) < or ≥50% at 12 months following RF treatment. Methods: A machine learning model was trained with a dataset of 402 cytologically benign thyroid nodules subjected to RF at six Italian Institutions. The model was trained with the following variables: baseline nodule volume, echostructure, macrocalcalcifications, vascularity, and 12-month VRR. Results: After training, the model could distinguish between nodules having VRR < 50% from those having VRR ≥50% in 85% of cases (accuracy: 0.85; 95% confidence interval [CI]: 0.80-0.90; sensitivity: 0.70; 95% CI: 0.62-0.75; specificity: 0.99; 95% CI: 0.98-1.0; positive predictive value: 0.95; 95% CI: 0.92-0.98; negative predictive value: 0.95; 95% CI: 0.92-0.98). Conclusions: This study demonstrates that a machine learning model can reliably identify those nodules that will have VRR < or ≥50% at 12 months after one RF treatment session. Predicting which nodules will be poor or good responders represents valuable data that may help physicians and patients decide on the best treatment option between thermal ablation and surgery or in predicting if more than one session might be necessary to obtain a significant volume reduction.

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“…Currently there is much more limited experience with microwave and high-focused ultrasound techniques. Well established data from the literature demonstrate that a significant shrinkage can be obtained in the vast majority of treated nodules, accompanied with relief or resolution of cosmetic concerns and compressive symptoms and a consequent improvement of health-related quality of life [2,3]. TA, preceded by percutaneous ethanol injection, may be also used to treat large relapsing thyroid cysts and autonomously functioning nodules, alone or in combination with radioiodine [4][5][6].…”

Section: Doi: 101159/000509310mentioning

confidence: 99%

Placing Thermal Ablation for Benign Thyroid Nodules into Context

Negro¹,

Trimboli²

2020

Eur Thyroid J

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Efficacy of thermal ablation in benign non-functioning solid thyroid nodule: A systematic review and meta-analysis

Cited by 125 publications

References 46 publications

2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

Machine Learning Prediction of Radiofrequency Thermal Ablation Efficacy: A New Option to Optimize Thyroid Nodule Selection

Placing Thermal Ablation for Benign Thyroid Nodules into Context

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