Radiofrequency ablation for benign thyroid nodules according to different ultrasound features: an Italian multicentre prospective study

in European Journal of Endocrinology
Correspondence should be addressed to M Deandrea; Email:
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The purpose of this study was to confirm the generalisation of radiofrequency ablation (RFA) in the treatment of benign thyroid nodules (BTN) and to look for a correlation between final shrinkage and some ultrasound (US) findings in a large Italian population data set.


This prospective study included 337 patients with solid cold BTN from six Italian institutions. Nodule volume, US pattern, thyroid function, symptom/cosmetic scores and complications were evaluated before treatment and at 6 and 12 months. The primary outcome was to find a correlation between basal volume and US pattern of the nodules and final shrinkage. The secondary outcome was to confirm the efficacy and safety of RFA in a large data set.


The median basal volume was 20.7 mL, and this significantly decreased after RFA at 6 months (7.3 mL (−63.5%), P < 0.001) and at 12 months (6 mL (−70%), P vs 6 months = 0.009). A significant correlation was found for US structure (a spongiform pattern showing a 76% reduction vs 67 and 66% of mix and solid patterns respectively, P < 0.01) as well as for vascularity (intense peripheral and intranodal patterns showing 71 vs 68 and 67% of weak peripheral and intranodal and peripheral patterns respectively, P < 0.03), but not for macrocalcifications. A slight inverse correlation was found between nodule basal volume and shrinkage (Spearman: −0.23). Mean symptoms/cosmetic scores were significantly reduced. No major complications were encountered.


This multicentre study validated the efficacy and safety of RFA for treating BTN and showed a clear correlation between final shrinkage and some common US findings.


     European Society of Endocrinology

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    Echostructure was scored as cystic (e1) when few medium-sized areas are present, microcystic (e2) when many little cystic areas <2 mm give a ‘spongiform’ appearance, solid (e3) when no cystic areas are detectable. Macrocalcifications, when present, may be only intranodular (m1), only perinodular eventually with ‘egg shell’ appearance (m2), both peripheral and intranodular (m3). Vascularisation can be intense perinodular (v1), peri- and intranodular (v2) or weak and just detectable around the nodule (v3).

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    Treatment procedure: (1) US evaluation before treatment; (2) US vascular pattern before treatment; (3) hyperechoic spot during treatment; (4) final US pattern at the end of procedure. A full colour version of this figure is available at

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    Nodules’ volume shrinkage by time after RFA. A full colour version of this figure is available at

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    Nodule volume reduction in six different centres participating the study. A full colour version of this figure is available at

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    Distribution of the entire nodules’ group in different Deciles of Percentage Reduction: (1) <10%; (2) 11–20%; (3) 21–30%; (4) 31–40%; (5) 41–50%; (6) 51–60%; (7) 61–70%; (8) 71–80%; (9) 81–90%; (10) 91–100%. A full colour version of this figure is available at



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