US-guided percutaneous microwave ablation for the treatment of benign thyroid nodules

Wu, Wenjun; Gong, Xiaomeng; Zhou, Qi; Chen, Xiong; Shi, Bimin

doi:10.1507/endocrj.ej17-0152

Cited by 49 publications

(49 citation statements)

References 25 publications

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“…Although complete ablation could be achieved in all patients because the large sizes of the nodules, the volumes of nodules were reduced, and the patients' symptoms were relieved significantly at the 3-month follow-up. The 3-month VRR of the nodules was 66.7% AE 7.1%, which was close to the results from the latest studies 16,17,23 focusing on MWA for benign thyroid nodules. However, the initial nodule volumes in those studies were less than 15 mL.…”

Section: Discussionsupporting

confidence: 87%

“…Recent studies also supported the idea that thermal ablation is superior to surgery for benign thyroid nodules in the incidence of complications . In recent years, microwave ablation (MWA), as a relatively new ablation technique, has been increasingly used to treat benign thyroid nodules and has proved to be an effective treatment modality . However, because of the increasing complexity of surrounding structures, conducting MWA for SSG remains a challenge.…”

mentioning

confidence: 99%

“…[11][12][13][14] In recent years, microwave ablation (MWA), as a relatively new ablation technique, has been increasingly used to treat benign thyroid nodules and has proved to be an effective treatment modality. [15][16][17] However, because of the increasing complexity of surrounding structures, conducting MWA for SSG remains a challenge. With the extension of the thyroid toward the thoracic cavity, it becomes more arduous to image the spatial relationships between the thyroid and adjacent structures by US, which therefore increases the risk of injuring adjacent vessels and nerves.…”

mentioning

confidence: 99%

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Ultrasound‐Guided Percutaneous Microwave Ablation for Substernal Goiter: Initial Experience

Cui

Han

et al. 2019

J of Ultrasound Medicine

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Objectives To preliminarily evaluate the safety, effectiveness, and feasibility of microwave ablation (MWA) for substernal goiter (SSG) in select patients and to provide a relevant treatment reference for further studies. Methods From April 2017 to December 2017, 10 patients with SSG were treated by MWA. All patients were followed for at least 3 months to observe the therapeutic effects and complications. Therapeutic effects were assessed at follow‐up for the relief of patients’ symptoms, resolution of the cosmetic grade, and volume reduction rate (VRR) of SSG. Possibly related factors for the 3‐month VRR of the nodules were analyzed. Results The study included 9 female patients and 1 male patient with a mean age ± SD of 56.8 ± 10.1 years (range, 34–70 years). The mean volume of the nodules was 52.9 ± 27.9 mL (range, 23.7–122.6 mL). The nodule volume was significantly reduced at the 3‐month follow‐up (17.5 ± 9.5 mL; P < .05). The mean 3‐month VRR of the index nodule was 66.7% ± 7.1%. A higher ablated portion‐to‐nodule ratio 1 day after MWA predicted a higher 3‐month VRR (Spearman r = 0.646; P = .044). The mean symptom score (from 4.5 ± 1.7 to 1.5 ± 1.0; P = .005) and cosmetic grade (from 3.3 ± 0.5 to 2.2 ± 0.4; P = .004) declined significantly 3 months after the procedure. No complications or unexpected side effects were observed. Conclusions Our preliminary results support the effectiveness and safety of MWA for local control of SSG. This technology can be applied in select patients with SSG who are ineligible for surgery.

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

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confidence: 99%

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Ultrasound‐Guided Percutaneous Microwave Ablation for Substernal Goiter: Initial Experience

Cui

Han

et al. 2019

J of Ultrasound Medicine

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“…The equipment consists of a microwave generator, a flexible low-loss coaxial cable, and an internally cooled antenna corresponding to a 14-to 16-G needle [20][21][22]. Smaller and less invasive MWA applicators are currently under development.…”

Section: Microwavesmentioning

confidence: 99%

“…Smaller and less invasive MWA applicators are currently under development. The antenna is inserted into the nodule under US guidance, usually using a trans-isthmic approach, and the procedure is then performed according to a "moving-shot technique" until hyperechoic changes cover the entire nodule or a large part of it [20][21][22]. The cost of MWA applicators is about EUR 600 in Europe.…”

Section: Microwavesmentioning

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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Microwave ablation of benign thyroid nodules: 3‐year follow‐up outcomes

et al. 2021

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Purpose To evaluate the effectiveness of microwave ablation (MWA) for the treatment of thyroid nodules according to nodule composition. Materials and methods This study evaluated 171 patients with 180 benign thyroid nodules (BTNs) that had been treated with ultrasound‐guided MWA. The volume reduction rate (VRR) of thyroid nodules and factors, which had an influence on the VRR, were assessed. Therapeutic success was defined as a >50% volume reduction at the 12‐month follow‐up. Multivariate regression analysis was used to identify independent predictors of VRR for BTNs after MWA treatment. Results The mean diameter and volume of the nodules were 4.3 ± 1.3 cm and 18.9 ± 2.1 ml, respectively. The VRRs at the 1‐, 3‐, 6‐, 12‐, 24‐, and 36‐month follow‐ups were 47.1%, 68.2%, 79.7%, 87.4%, 90.1%, and 93.2%, respectively. Of the 180 BTNs, there were 87 solid, 74 predominantly solid, and 19 predominantly cystic nodules. Solid nodules showed significantly lower VRRs compared with the predominantly solid and predominantly cystic nodules at the 1‐, 3‐, and 6‐month follow‐ups. For the multivariate regression analysis, the cyst component was an active prognostic factor for the VRR at the 1‐, 3‐, and 6‐month follow‐ups; the cyst component was not significantly associated with the VRR at the 12‐, 24‐, and 36‐month follow‐ups. Conclusion Our study suggested that ultrasound‐guided MWA is an effective and safe procedure for the treatment of BTNs. Solid nodules indicate a lower VRR and less efficient than predominant solid nodules and predominant cystic nodules after MWA.

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US-guided percutaneous microwave ablation for the treatment of benign thyroid nodules

Cited by 49 publications

References 25 publications

Ultrasound‐Guided Percutaneous Microwave Ablation for Substernal Goiter: Initial Experience

Ultrasound‐Guided Percutaneous Microwave Ablation for Substernal Goiter: Initial Experience

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

Microwave ablation of benign thyroid nodules: 3‐year follow‐up outcomes

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