Long-Term Efficacy of a Single Session of RFA for Benign Thyroid Nodules: A Longitudinal 5-Year Observational Study

Deandrea, Maurilio; Trimboli, Pierpaolo; Garino, Francesca; Mormile, Alberto; Magliona, Gabriella; Ramunni, M; Giovanella, Luca; Limone, Piero Paolo

doi:10.1210/jc.2018-02808

Cited by 109 publications

(100 citation statements)

References 30 publications

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“…It should be noted that few patients reached the 4 or 5-year follow-up milestone (57 and 6, respectively), and two RF sessions were necessary for 20% of the patients, with a mean time to additional RF ablation of 8.5 ± 7.5 months after the initial RF ablation. Another Italian single-center study evaluating 215 patients treated with only one session, found a mean 5-year VRR of 67% [10]. For L, studies with a 3-to 6-year follow-up, showed a reduction rate of approximately 50-60%.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, thermal treatments such as radiofrequency (RF) and laser (L) therapy have shown to be a reliable alternative to surgery as a result of their ability to induce a significant reduction of benign nodules that, in most cases, is sustained long term [6][7][8]. In 5-30% of nodules, two unfavorable outcomes have been observed: a volume reduction rate (VRR) < 50% after the first thermal ablation and progressive regrowth [9][10][11][12][13]. These two outcomes represent two sides of the same coin, as it has been shown that nodules, which decrease to a lesser extent, are those which are prone to regrowth in 4-5 years [14].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…RFA is an effective TA treatment for thyroid nodules [54,55]. 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].…”

Section: Radiofrequencymentioning

confidence: 99%

“…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]. As tissue structure affects the alternating current flow, compact tissues are more resistant than soft tissues and, as for LTA, spongiform and mixed nodules respond better to RFA than solid lesions [58,59]. RFA treatment has been shown to ameliorate pressure as well as cosmetic symptom scores [58,60].…”

Section: Radiofrequencymentioning

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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Microwave ablation of benign thyroid nodules: 3‐year follow‐up outcomes

et al. 2021

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Purpose To evaluate the effectiveness of microwave ablation (MWA) for the treatment of thyroid nodules according to nodule composition. Materials and methods This study evaluated 171 patients with 180 benign thyroid nodules (BTNs) that had been treated with ultrasound‐guided MWA. The volume reduction rate (VRR) of thyroid nodules and factors, which had an influence on the VRR, were assessed. Therapeutic success was defined as a >50% volume reduction at the 12‐month follow‐up. Multivariate regression analysis was used to identify independent predictors of VRR for BTNs after MWA treatment. Results The mean diameter and volume of the nodules were 4.3 ± 1.3 cm and 18.9 ± 2.1 ml, respectively. The VRRs at the 1‐, 3‐, 6‐, 12‐, 24‐, and 36‐month follow‐ups were 47.1%, 68.2%, 79.7%, 87.4%, 90.1%, and 93.2%, respectively. Of the 180 BTNs, there were 87 solid, 74 predominantly solid, and 19 predominantly cystic nodules. Solid nodules showed significantly lower VRRs compared with the predominantly solid and predominantly cystic nodules at the 1‐, 3‐, and 6‐month follow‐ups. For the multivariate regression analysis, the cyst component was an active prognostic factor for the VRR at the 1‐, 3‐, and 6‐month follow‐ups; the cyst component was not significantly associated with the VRR at the 12‐, 24‐, and 36‐month follow‐ups. Conclusion Our study suggested that ultrasound‐guided MWA is an effective and safe procedure for the treatment of BTNs. Solid nodules indicate a lower VRR and less efficient than predominant solid nodules and predominant cystic nodules after MWA.

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Long-Term Efficacy of a Single Session of RFA for Benign Thyroid Nodules: A Longitudinal 5-Year Observational Study

Cited by 109 publications

References 30 publications

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

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

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

Microwave ablation of benign thyroid nodules: 3‐year follow‐up outcomes

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