Patient satisfaction after thyroid RFA versus surgery for benign thyroid nodules: a telephone survey

Bernardi, Stella; Dobrinja, Chiara; Carere, Anna; Giudici, Fabiola; Calabrò, Veronica; Zanconati, Fabrizio; Manzini, Nicoló de; Fabris, Bruno; Stacul, Fulvio

doi:10.1080/02656736.2018.1487590

Cited by 39 publications

(30 citation statements)

References 39 publications

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“…Indeed, in young hyperthyroid patients, both males and females, the RFA can have advantages: (a) rapid efficacy of the therapy without wash‐out period in which it is not possible to attempt conception. As demonstrated by Sung et al, no postprocedural aggravation of symptoms was experienced, and, because of the RFA efficacy, the ATDs can be interrupted or significantly reduced immediately after the procedure; (b) low risk of major complications, which include permanent voice change (0%‐2.3%), nodule rupture (0.1%), Horner syndrome (0.1%) and spinal accessory nerve injury (0%‐2.3%); (c) finally, the absence of postprocedural scars . At the same time, in patients affected by cardiovascular comorbidities, RFA allows the ATDs administration until the day before the procedure.…”

Section: Discussionmentioning

confidence: 85%

Comparison between radioiodine therapy and single‐session radiofrequency ablation of autonomously functioning thyroid nodules: A retrospective study

Cervelli

Mazzeo

Boni

et al. 2019

Clinical Endocrinology

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Objective:To compare the efficacy of Radioiodine (RI) and Radiofrequency ablation (RFA) in the treatment of autonomously functioning thyroid nodules (AFTNs). Endpoints: nodule volume reduction (NVR) and thyroid function normalization.Design, patients and measurements: Twenty-two patients (2:20 M:F; 51.9 ± 13.9 years) affected by 25 AFTNs, treated by RFA were retrospectively compared with 25 patients (8:17 M:F; 57.2 ± 12.8 years) affected by a single AFTN treated by RI. Both group showed analogous characteristics as to age, gender, toxic/ pretoxic phase and pretreatment nodule volume (calculated by the ellipsoid formula).Thyroid hormone levels and autoimmune thyroid profile were assessed before treatment. A fixed RI activity of 555 MBq (15 mCi) was administered. RFA was performed with an 18G, single-tipped electrode, by the "modified moving shot technique." Thyroid hormones were assessed and the nodule post-treatment volume calculated 12 months after treatment. Results:No statistical difference was found between the post-treatment NVR by comparing RI and RFA (P = 0.69). The volume reduction rates were 68.4 ± 28.9% and 76.4 ± 16.9% after RI and RFA, respectively. As to the thyroid function, 5/25 patients developed clinical hypothyroidism after RI. After RFA, all the 22 patients silenced their AFTN and normalized the thyroid hormones. Subclinical hypothyroidism was recorded in two patients after both RI and RFA. Thus, the functional therapeutic success, defined as the restoration of euthyroidism, was achieved in 18/25 (72%) patients treated by RI and in 20/22 (90.9%) treated by RFA. Conclusions:No statistical difference in NVR was found between RI and RFA. All patients responded to RI but 5/25 were "over-treated" developing hypothyroidism.RFA was effective in all patients with no case of post-treatment clinical hypothyroidism. No radiation exposure and lower risk of post-treatment hypothyroidism might make RFA the favourite option especially for young patients. | 609CERVELLI Et aL.

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Section: Discussionmentioning

confidence: 85%

Comparison between radioiodine therapy and single‐session radiofrequency ablation of autonomously functioning thyroid nodules: A retrospective study

Cervelli

Mazzeo

Boni

et al. 2019

Clinical Endocrinology

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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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“…Data on patient satisfaction are limited, and head-tohead prospective studies of RFA versus surgical treatment are lacking. In a cross-sectional study, patients were significantly more satisfied with cosmetic results in the RFAtreated than in the surgical group, but no significant differences were demonstrated in overall satisfaction [63]. In a study of 404 patients, RFA resulted in significantly better HRQoL scores than thyroidectomy, and qualityadjusted life years following RFA were higher than following surgery [64].…”

Section: Radiofrequencymentioning

confidence: 92%

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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Patient satisfaction after thyroid RFA versus surgery for benign thyroid nodules: a telephone survey

Abstract: Our data on postoperative patient satisfaction support the notion that both RFA and surgery are valid therapeutic options for nonfunctioning thyroid nodules, while surgery should be still preferred for AFTN.

Cited by 39 publications

References 39 publications

Comparison between radioiodine therapy and single‐session radiofrequency ablation of autonomously functioning thyroid nodules: A retrospective study

Comparison between radioiodine therapy and single‐session radiofrequency ablation of autonomously functioning thyroid nodules: A retrospective study

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

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