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.
GharibHPapiniE. Thyroid nodules: clinical importance, assessment, and treatment.Endocrinology and Metabolism Clinics of North America200736707–735 vi. Review. (https://doi.org/10.1016/j.ecl.2007.04.009)
CooperDSDohertyGMHaugenBRKloosRTLeeSLMandelSJMazzaferriELMcIverBPaciniFSchlumbergerMet al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid2009191167–1214. (https://doi.org/10.1089/thy.2009.0110)
GharibHPapiniEPaschkeRDuickDSValcaviRHegedüsLVittiP. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Journal of Endocrinological Investigation20103351–56.
RosatoLAveniaNBernantePDe PalmaMGulinoGNasiPGPelizzoMR. Complications of thyroid surgery: analysis of a multicentric study on 14 934 patients operated on in Italy over 5 years. World Journal of Surgery200428271–276. (https://doi.org/10.1007/s00268-003-6903-1)
FastSNielsenVEBonnemaSJHegedusL. Time to reconsider nonsurgical therapy of benign non-toxic multinodular goitre: focus on recombinant human TSH augmented radioiodine therapy. European Journal of Endocrinology2009160517–528. (https://doi.org/10.1530/EJE-08-0779)
BennedbaekFNNielsenLKHegedusL. Effect of percutaneous ethanol injection therapy versus suppressive doses of L-thyroxine on benign solitary solid cold thyroid nodules: a randomized trial. Journal of Clinical Endocrinology and Metabolism199883830–835. (https://doi.org/10.1210/jcem.83.3.4673)
DossingHBennedbaekFNHegedusL. Effect of ultrasound guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules – a randomized study. European Journal of Endocrinology2005152341–345. (https://doi.org/10.1530/eje.1.01865)
PapiniEGuglielmiRBizzarriGGrazianoFBianchiniABrufaniCPacellaSValleDPacellaCM. Treatment of benign cold thyroid nodules: a randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up. Thyroid200717229–235. (https://doi.org/10.1089/thy.2006.0204)
ValcaviRRigantiFBertaniAFormisanoDPacellaCMPercutaneous laser ablation of cold benign thyroid nodules: a 3-year follow-up study in 122 patients. Thyroid2010201253–1261. (https://doi.org/10.1089/thy.2010.0189)
DeandreaMLimonePBassoEMormileARagazzoniFGamarraESpieziaSFaggianoAColaoAMolinariFet al. US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules. Ultrasound in Medicine and Biology200834784–791. (https://doi.org/10.1016/j.ultrasmedbio.2007.10.018)
JeongWKBaekJHRhimHKimJSKwakMSJeongHJLeeD. Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. European Radiology2008181244–1250. (https://doi.org/10.1007/s00330-008-0880-6)
SpieziaSGarberoglioRMiloneFRamundoVCaiazzoCAssantiAPDeandreaMLimonePPMacchiaPELombardiGet al. Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid200919219–225. (https://doi.org/10.1089/thy.2008.0202)
BaekJHKimYSLeeDHuhJYLeeJH. Benign predominantly solid thyroid nodules: prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition. American Journal of Roentgenology20101941137–1142. (https://doi.org/10.2214/AJR.09.3372)
PaschkeRHegedusLAlexanderEValcaviRPapiniEGharibH. Thyroid nodule guidelines: agreement, disagreement and need for future research. Nature Reviews Endocrinology20117354–361. (https://doi.org/10.1038/nrendo.2011.1)
PapiniEPacellaCMHegedusL. Diagnosis of endocrine disease: thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications. European Journal of Endocrinology2014170R133–R146. (https://doi.org/10.1530/EJE-13-0917)
DeandreaMSungJYLimonePMormileAGarinoFRagazzoniFKimKSLeeDBaekJH. Efficacy and safety of radiofrequency ablation versus observation for nonfunctioning benign thyroid nodules: a randomized controlled international collaborative trial. Thyroid201525890–896 (https://doi.org/10.1089/thy.2015.0133)
ParkHSBaekJHParkAWChungSRChoiYJLEEJH. Thyroid radiofrequency ablation updates on innovative devices and techniques. Korean Journal of Radiology201718615–623. (https://doi.org/10.3348/kjr.2017.18.4.615)
BurkeDRLewisCACardellaJFCitronSJDroozATHaskalZJHustedJWMcCowanTCVan MooreAOglevieSBet al. Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. Journal of Vascular and Interventional Radiology200314S243–S246.
CesareoRPalermoAPasqualiniVCianniRGaspaGLManfriniSPacellaCM. Radiofrequency ablation for the management of thyroid nodules: a critical appraisal of the literature. Clinical Endocrinology201787639–648. (https://doi.org/10.1111/cen.13422)
NegroRSalemTMGrecoG. Laser ablation is more effective for spongiform than solid thyroid nodules. A 4-year retrospective follow-up study. International Journal of Hyperthermia201632822–828. (https://doi.org/10.1080/02656736.2016.1212279)
PacellaCMMauriGAchilleGBarbaroDBizzarriGDeFeoPDiStasioEEspositoRGambelungheGMisischiIet al. Outcomes and risk factors for complications of laser ablation for thyroid nodules: a multicenter study on 1531 patients. Journal of Clinical Endocrinology and Metabolism20151003903–3910. (https://doi.org/10.1210/jc.2015-1964)
PacellaCMMauriGCesareoRPaqualiniVCianniRDeFeoPGambelungheGRaggiuntiBTinaDDeandreaMet al. A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis. International Journal of Hyperthermia2017121–9.
CesareoRPasqualiniVSimeoniCSacchiMSaralliECampagnaGCianniR. Prospective study of effectiveness of ultrasound-guided radiofrequency ablation versus control group in patients affected by benign thyroid nodules. Journal of Clinical Endocrinology and Metabolism2015100460–466. (https://doi.org/10.1210/jc.2014-2186)
NaDGLeeJHJungSLKimJHSungJYShinJHKimEKLeeJHKimDWParkJSet al. Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations. Korean Journal of Radiology201213117–125. (https://doi.org/10.3348/kjr.2012.13.2.117)
GarberoglioRAlibertiCAppetecchiaMAttardMBoccuzziGBorasoFBorrettaGCarusoGDeandreaMFreddiMet al. Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement. Journal of Ultrasound201518423–430. (https://doi.org/10.1007/s40477-015-0169-y)
GharibHPapiniEGarberJRDuickDSHarrellRMHegedüsLPaschkeRValcaviRVittiP & AACE/ACE/AME Task Force on Thyroid Nodules. American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for clinical practice for the diagnosis and management of thyroid nodules – 2016 update. Endocrine Practice22622–639.
JungSLBaekJHLeeJHShongYKSungJYKimKSLeeDKimJHBaekSMSimJSNaDG. Efficacy and safety of radiofrequency ablation for benign thyroid nodules: a prospective multicenter study. Korean Journal of Radiology2018191–7. (https://doi.org/10.3348/kjr.2018.19.1.1)