Radiofrequency ablation for symptomatic, non-functioning, thyroid nodules: a single-center learning curve

Abstract

Objective: Radiofrequency ablation (RFA) is increasingly considered the prime option for treating symptomatic, benign, non-functioning thyroid nodules (NFTN). However, little is known about the degree of operator experience required to achieve optimal results. This study describes the RFA learning curve of a single-centre team. Methods: Retrospective cohort study of the first 103 patients receiving RFA treatment for a single, symptomatic, and benign NFTN, with a follow-up of at least one year. Primary outcome measure was technique efficacy, defined as the percentage of patients with a 6-month nodal volume reduction ratio (VRR) > 50% after single-session RFA. Optimal treatment efficacy was defined as a 6-month VRR > 50% achieved in at least 75% of patients. Secondary outcomes were complications of RFA and indications of secondary interventions. Results: Median nodal volume at baseline was 12.0 ml (range 2.0–58.0 ml). A 6-month VRR > 50% was achieved in 45% of the first 20 patients, 75% of the next 20, and 79% of the following 63 patients. Complications included minor bleeding (N = 4), transient hyperthyroidism (N = 4), and transient loss of voice (N = 1). Poor volume reduction or nodular regrowth led to diagnostic lobectomy in 11 patients and a second RFA in five. Lobectomy revealed a follicular carcinoma (T2N0M0) in two patients. In one patient, nodule regrowth was caused by an intranodular solitary B-cell lymphoma. Conclusion: About 40 procedures are required to achieve a 6-month VRR > 50% in the majority of patients. Appropriate follow-up with re-evaluation is recommended for all patients with a VRR < 50% and in those with regrowth to exclude underlying malignancy.

Proficiency in performing radiofrequency ablation procedure for non-functioning benign thyroid nodules: a qualitative rather than quantitative matter

“…According to a large body of evidence, demonstrating that RFA-associated complications are rather rare, the main outcome measure to determine RFA proficiency has become the rate of volume reduction ( 15 ). Thus, three previous studies have conventionally focused on a minimum threshold for procedural volume in order to achieve a higher 6-month VRR ( 7 – 9 ). Bom et al.…”

“…Bom et al. demonstrated that about 40 procedures are required to achieve a VRR >50% and of 79% in the following 63 patients ( 9 ). Russ et al, in their experience with the first 90 patients treated, showed that a LC existed regarding technical efficacy, VRR, and ablation ratio, a relatively new objective parameter to assess the percentage of the successfully ablated nodule.…”

Risk factors of recurrent thyroid nodules after radiofrequency ablation

“…Its pathogenesis is diffuse thyroid hyperplasia and enlargement caused by long-term iodine deficiency, and long-term proliferative and degenerative lesions alternate repeatedly, leading to nodules. However, in a small number of cases, nodule regrowth is caused by an underlying malignant tumor 13 . Li et al 14 reported that RFA had a low effective rate in the treatment in children, with a volume reduction rate (VPR) of 77.5% and a nodule regeneration rate of 22.9% at 12 months after operation.…”

Training of Radiofrequency Ablation for Thyroid Nodules in Korea: Current and Future Perspective

“…해당 연구는 고주파 절제술을 시행한 102명의 환자를 대상으로 하였고 치료된 결절의 VRR은 치료를 받은 순서대로 점진적으로 증가하였으며, 이를 바탕으로 저자들은 고주파 절제술에 대한 학습 곡선을 다음과 같이 3단계로 구성하여 제시하였다; 초기 학습 단계(20건 이하), 기술 통합 단계(21–65건), 숙련 단계(65건 초과). Bom 등( 21 )에 의한 가장 최근 연구는 103명의 단일 시술을 받은 환자에서 학습 곡선을 분석하였으며 앞선 연구들과 비슷하게 시술자가 40건의 시술 후 75%의 환자에서 6개월 후 VRR이 50% 이상에 도달하는 결과를 보였다고 보고하였다.…”