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

Abstract

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.

Image-guided thermal ablation of benign thyroid nodules

“…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.…”

“…In most studies, a 21-G needle is inserted into the lesion along its longest axis. In some studies, an 18-or 22-G needle is used [61,66,68,69,71,72,74]. For small nodules, usually, only one needle is used, while for larger nodules, two-to-three needles are applied.…”

“…A 300-lm-diameter plane-cut quartz optical fibers are subsequently introduced and advanced up to the needle tip. The introducer needle is withdrawn to expose the fiber tip by at last 5 mm [57, 59, 63-65, 67, 69, 70], 20 mm according to Dossing et al [61,66,68,71,72,74].…”

“…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]. A laser source, a continuous-wave Nd-YAG laser operating at 1.064 lm, is used with an optical beam-splitting device with as many as four separate fibers that can be illuminated separately or concurrently [12].…”

“…During LA, the necrosis of the tissue is visible as an irregular echogenic area, enlarging during the procedure. The treatment stops when this area is stationary in size [61]. Each treatment is performed under conscious sedation or local anesthesia with lidocaine.…”