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

Hamou, Adrien Ben; Ghanassia, É.; Espiard, Stéphanie; Rached, Henry Abi; Jannin, Arnaud; Corréas, J.M.; Cao, Christine Do; Kyheng, Maéva; Vantyghem, Marie-Christine; Monpeyssen, Hervé

doi:10.1080/02656736.2019.1627432

Cited by 42 publications

(33 citation statements)

References 56 publications

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“…Similarly, in the other meta-analysis, at 12 and 24 months RFA showed a greater VRR than LTA (75 vs. 52% and 87 vs. 45%, respectively) [49]. In a paper based on a direct comparison of RFA and LTA, both performed by the same skilled operators, the techniques demonstrated similar technique efficacy and rate of complications [79]. Finally, a recent single-use, randomized, open-label, parallel trial compared the outcomes of RFA and LA groups.…”

Section: Comparison Of Outcomes Of Different Ta Techniques For Benignmentioning

confidence: 72%

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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Section: Comparison Of Outcomes Of Different Ta Techniques For Benignmentioning

confidence: 72%

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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“…Our analysis did not provide relevant data to support the assumption that CEUS could be a useful tool to predict the final, post-ablation, volumetric reduction. From the analysis of previous studies focused on the use of LA and RFA, data are discordant on the correlation between nodule structure indirectly assessed by US investigation and final nodule volume reductions (11,12,(26)(27)(28)(29). Therefore, to avoid potential confounding, we used a very restrictive criterion enrolling patients only with solid or predominantly solid nodules with a fluid component £20%.…”

Section: Discussionmentioning

confidence: 99%

Laser Ablation Versus Radiofrequency Ablation for Benign Non-Functioning Thyroid Nodules: Six-Month Results of a Randomized, Parallel, Open-Label, Trial (LARA Trial)

Cesareo

Pacella

Pasqualini

et al. 2020

Thyroid

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Background: No direct prospective studies comparing laser ablation (LA) and radiofrequency ablation (RFA) for debulking benign non-functioning thyroid nodules (BNTNs) exist. We aimed at comparing the efficacy and safety of both techniques in patients with solid or predominantly solid BNTN. Methods: This six-month, single-use, randomized, open-label, parallel trial compared the following primary endpoints between the RFA and LA groups six months after treatment: (i) nodule volume reduction expressed as a percentage of nodule volume at baseline; (ii) proportion of nodules with more than 50% reduction (successful rate). We enrolled subjects with a solitary BNTN or dominant nodule characterized by pressure symptoms/cosmetic problems or patients without symptoms who experienced a volume increase >20% in one year. Nodules underwent core needle biopsy for diagnosis. Patients were randomly assigned (1:1) to receive LA or RFA. Safety was assessed in all randomly assigned participants. Results: Sixty patients were randomly assigned to receive either RFA or LA (1:1) between January 2016 and November 2018. Both groups were similar in basal nodule volume, thyroid function, histology, symptoms/ cosmetic score, and procedure time. At six months, the nodule volume reduction was 64.3% (95% confidence interval, CI 57.5-71.2) in the RFA group and 53.2% ([CI 47.2-95.2]; p = 0.02) in the LA group. This effect was also confirmed in the linear regression model adjusted for age, baseline volume, and proportion of cellular component (LA vs. RFA percent change Delta =-12.8, p = 0.02). No significant difference was observed in success rate six months after treatment (RFA vs. LA: 86.7% vs. 66.7%, p = 0.13) or in thyrotropin level between the groups. Although improved, no significant difference was observed between RFA and LA for compressive symptoms (RFA: 2.13 vs. 3.9, p < 0 $ 001; LA: 2.4 vs. 3.87, p < 0.001) and cosmetic score (RFA: 1.65 vs. 2.2, p < 0.001; LA: 1.85 vs. 2.2, p < 0.001). The adverse event rates (local pain, dysphonia, thyrotoxicosis, fever, hematoma) were 37% (n = 11) and 43% (n = 13) for RFA and LA, respectively, with no requirement for hospitalization. Conclusion: Although the success rate was similar in the RFA and LA groups, RFA achieved a significantly larger nodule volume reduction at six months.

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“…This leads to a high frequency of thyroidectomy performed for benign lesions, as demonstrated by recent comprehensive studies in Europe and the United States [19,20]. The direct and societal costs of surgery, the low but inevitable risk of complications, and the aesthetic damage induced, represent relevant concerns [21]. Notably, in order to decrease the cosmetic consequences of neck surgery, novel time-consuming and expensive surgical approaches, such as transoral robotic thyroidectomy, requiring specific skills and dedicated tools and carrying risk of further complications, have been proposed [22].…”

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

Abstract: View related articles View Crossmark data Citing articles: 6 View citing articles Safety and efficacy of thermal ablation (radiofrequency and laser): should we treat all types of thyroid nodules? †

Cited by 42 publications

References 56 publications

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

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

Laser Ablation Versus Radiofrequency Ablation for Benign Non-Functioning Thyroid Nodules: Six-Month Results of a Randomized, Parallel, Open-Label, Trial (LARA Trial)

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

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