Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid (MITT) group

Papini, Enrico; Pacella, Claudio Maurizio; Solbiati, Luigi; Achille, Gaetano; Bari, Lorenzo Di; Bernardi, Stella; Cantisani, Vito; Cesareo, Roberto; Chiti, Arturo; Cozzaglio, Luca; Crescenzi, Anna; Cobelli, Francesco De; Deandrea, Maurilio; Fugazzola, Laura; Gambelunghe, Giovanni; Garberoglio, R; Giugliano, Gioacchino; Luzi, Livio; Negro, Roberto; Persani, Luca; Raggiunti, Bruno; Sardanelli, Francesco; Seregni, Ettore; Sollini, Martina; Spiezia, Stefano; Stacul, Fulvio; Doorne, Dominique Van; Sconfienza, Luca Maria; Mauri, Giovanni

doi:10.1080/02656736.2019.1575482

Cited by 161 publications

(199 citation statements)

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“…Various image-guided ablation techniques, with different modes of action, are available for the management of symptomatic benign thyroid nodules [24,25]. EA for cystic, and TA techniques for solid lesions, have been thoroughly evaluated and considered both safe and effective when used by operators with specific expertise [26]. In the light of the above, and in order to better characterize the diffusion of MIT procedures into current European clinical practice, the ETA conducted a survey among its members.…”

Section: Discussionmentioning

confidence: 99%

European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules

Hegedűs¹,

Frasoldati²,

Negro³

et al. 2020

Eur Thyroid J

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Objective: Image-guided interventional ultrasound (US) techniques represent diagnostic and therapeutic tools for non-surgical management of thyroid nodular disease. We sought to investigate the attitude of European Thyroid Association (ETA) members towards the use of minimally invasive techniques (MIT) in diagnosis/therapy of symptomatic nodular goitre. Methods: ETA members were invited to participate in an online survey investigating the use of MIT in benign and malignant thyroid nodular disease. Of 865 invited members, 221 (25.5%) completed the survey. The respondents were from 40 countries; 139 (74.7%) were from European countries. Results: Respondents personally performed thyroid US (91.6%), Fine needle aspiration (FNA; 75.3%), ethanol ablation (EA; 22.1%), core needle biopsy (CNB; 11%) and thermal treatments (4.8%). When skills and/or technology were unavailable, only 13.4% referred patients "often" or "always" to other centres with specific expertise in this field. Surgery was the preferred first option in patients with recurrent cysts, 4.0 cm benign nodules, local (radioiodine-avid or non-avid) lymph node metastases, or papillary cancers < 1.0 cm. For autonomously functioning nodules radioactive iodine treatment was the preferred choice, followed by surgery. Thermal ablation (TA) was the preferred option only for a 4 cm benign nodule in old patients with comorbidities. Conclusions: US, US-guided FNA and surgery were available to nearly all respondents, while MIT was not. CNB and EA were employed only by about 1/3 of the respondents and TA procedures were available and personally performed only by a minority. For most thyroid lesions, surgery was the preferred option versus thermal therapies. The ETA needs to develop guidelines and establish teaching to overcome geographic inequality and promote the use of MIT as a valid therapy option in appropriate cases.

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Section: Discussionmentioning

confidence: 99%

European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules

Hegedűs¹,

Frasoldati²,

Negro³

et al. 2020

Eur Thyroid J

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“…These non-surgical techniques are implemented over large parts of Europe and the Far East and are used in several thyroid centers. Despite this, there is little guidance, besides a few national consensus papers [9][10][11][12], on the appropriate use of TA in clinical practice. While US-guided diagnostic procedures are widely employed by European endocrinologists, routine use of US-guided therapeutic procedures is still limited to specialized thyroid centers [13].…”

Section: Scope Of the Documentmentioning

confidence: 99%

“…TA should never be performed on nodules with high-risk US features (EU-TI-RADS Class 5) due to their considerable risk of harboring malignancy [15,29]. Since medullary thyroid cancer may not display suspicious sonographic features or unambiguous cytological findings, a single calcitonin determina-tion should be considered, together with TSH, in the initial biochemical evaluation [2,11].…”

Section: Patient Eligibility and Preparationmentioning

confidence: 99%

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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“…Side effects, complications, tolerability and satisfaction were documented. The terminology and reporting criteria followed consensus guidelines [19,[21][22][23][24].…”

Section: Adverse Eventsmentioning

confidence: 99%

Laser Ablation of Benign Thyroid Nodules: A Prospective Pilot Study With a Preliminary Analysis of the Employed Energy

et al. 2019

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Background and Objectives To assess the effectiveness of ultrasound (US)‐guided laser ablation of benign thyroid nodules (TNs) under different amounts of applied energy. Study Design/Materials and Methods Thirty‐four euthyroid patients with 5–18 ml TNs were enrolled: 21 (laser ablation) and 13 (clinical follow up) patients with a mean age of 56.2 ± 12.0 and 54.7 ± 14.7 years, respectively. The laser ablation protocol used a 1.064 mm wavelength diode laser source; 3.5 W output power; 1,100–1,500 J and 5–8 min/illumination; and one or two fibers/session. Clinical, laboratory, and US data were obtained immediately before treatment and at 6 and 12 months follow‐up and were analyzed by Student's t test and Fisher's exact test. Low‐ and high‐energy subgroups were subsequently defined, and the receiver operating characteristic (ROC) curves were calculated. Results Laser ablation follow‐up showed an overall nodule volume reduction of more than 50%; improvement of symptoms and cosmetic complaints (P = 0.001); and stable laboratory data compared with the baseline and control groups. Minor complications were 9.5% ( n = 2). One or two fibers/session resulted in a similar nodule volume reduction among 10–18 ml nodules. Analysis of the applied energy suggested a 398.8 J/ml inferior cutoff (ROC curve: 0.889 sensitivity; 0.545 specificity) for the high‐energy subgroup ( n = 14, mean 599.9 ± 136.5 J/ml) to reduce the nodule volume over time (−55.1% vs. −58.4%, P = 0.55). The low‐energy subgroup ( n = 7, mean 240.2 ± 74.6 J/ml) did not show a persistent volume reduction ( P < 0.05) from the 6‐ to 12‐month follow‐ups (−56.6% vs. −53.7%). Conclusions Laser ablation of benign TNs achieved technique efficacy at 12 months posttreatment, with clinical improvement and few minor side effects. A single fiber in a single session with a high deployed energy (>398.8 J/ml) may be associated with improved results, a finding to be confirmed with a larger series. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid (MITT) group

Abstract: Mauri (2019) Minimallyinvasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid (MITT) group,

Cited by 161 publications

References 70 publications

European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules

European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules

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

Laser Ablation of Benign Thyroid Nodules: A Prospective Pilot Study With a Preliminary Analysis of the Employed Energy

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