Percutaneous laser ablation for benign thyroid nodules: a meta-analysis

Abstract

PurposeTo evaluate percutaneous laser ablation in treating benign thyroid nodules, we conducted a meta-analysis based on summarizing existing researches.Materials and MethodsA literature search for clinical trial was performed in PubMed, Cochrane Library and Excerpt Medica Database. The qualities of included studies were evaluated. We calculated the indexes with mean difference. Heterogeneity and publication bias were tested and explored. We performed subgroup analyses and sensitivity analysis further.ResultsA total of 19 researches and 2137 patients were included in this meta-analysis. The pooled estimates of nodule volume were statistically significant after percutaneous laser ablation for 1 month, 3 month, 6month, 12month, 24month and 36month(P < 0.05). The pooled estimate of thyroid-stimulating hormone was statistically significant after percutaneous laser ablation for 1 and 12 month (P = 0.008 and P = 0.03). The pooled estimate of free triiodothyronine was no statistically significant after percutaneous laser ablation for all follow-up intervals. The pooled estimate of free tetraiodothyronin was statistically significant after percutaneous laser ablation1 month (P = 0.004). The pooled estimate of thyroglobulin was statistically significant after percutaneous laser ablation 24 month (P = 0.04). The heterogeneity was found and the source of heterogeneity was explored in nodule volume for 6 and 12 month. No publication bias was found.ConclusionsThis meta-analysis demonstrated that percutaneous laser ablation was safe and useful in shrinking benign thyroid nodules volume, improving thyroid function, relieving symptoms of pressure and esthetic, especial for hyper-vascular benign thyroid nodules. Larger number of high-quality prospective studies still needs to be performed.

Safety and efficacy of thermal ablation (radiofrequency and laser): should we treat all types of thyroid nodules?

“…Thermal ablation is already used in clinical practice for primary and metastatic malignant liver, breast, renal, bone and lung tumors [20][21][22][23] but is not yet regularly used for TNs, despite their validation in Korean and Italian studies [24][25][26][27][28]. Radiofrequency ablation (RFA), and laser ablation have already been studied separately for the treatment of benign TNs [29][30][31][32][33][34] and in many retrospective and some prospective comparative studies with a long-term follow-up.…”

Laser and radiofrequency ablations for benign and malignant thyroid tumors

“…Moreover, laser ablation possibly reduces the invasiveness of the procedure due to its smaller energy applicators [10,22]. A recent meta-analysis of 19 papers and 2137 patients confirmed laser ablation to be safe and effective in reducing benign thyroid nodules volume, improving thyroid function and esthetic and ameliorating symptoms of compression, especially for hypervascular nodules [23]. For the treatment of benign thyroid nodule, outcomes of laser ablation seem comparable to RFA, as also shown by a propensity score analysis [10,24].…”

“…For larger goiters, methimazole discontinuation rate after the procedure depended on the baseline goiter volume [30]. Laser ablation has been compared to 131 I radioiodine therapy for the treatment of hyperfunctioning benign nodules [23,26,28,30]. Despite a similar reduction in nodule volume, normalization of serum TSH was superior in the radioiodine groups, suggesting laser ablation to be indicated only in the risk of radioiodine-induced hypothyroidism or in pregnant women.…”

Image‐guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications

“…A cost analysis in 2014 suggested that there were potential savings for regional healthcare systems that adopted laser ablation in the management of benign thyroid nodules . A recent meta‐analysis concluded that laser ablation was both safe and effective in volume reduction and relieving pressure symptoms in patients with benign thyroid nodules …”