Comparative efficacy of different ultrasound-guided ablation for the treatment of benign thyroid nodules: Systematic review and network meta-analysis of randomized controlled trials

Abstract

Background Percutaneous ablation is currently deemed an additionally treatment option for benign thyroid nodules in the world, but possibly different effect among the ablation modalities is not clear. So we aim to evaluate the efficacy and complications of thermal/chemical ablation by network meta-analysis. Materials and methods In the network meta-analysis, PubMed, EMBASE and the Cochrane Library databases were searched from 1980 to 2020. Studies of adults with thyroid benign nodules under percutaneous ablation therapy were included. Percentage mean volume change, symptom score change, cosmetic score change and complications were evaluated by network meta-analysis. Results In the network meta-analysis, Radiofrequency Ablation(RFA) with 2 treatment sessions group was associated with the highest reduction for the mean volume change during 6-month follow-up (MD = 79.09 and 95% CrI:48.23–89.94). There is no significant difference in the incidence of complications. Subgroup analysis showed that 2 sessions of Radiofrequency Ablation (RFA) ranks the highest probability (surface under the cumulative ranking curve (SUCRA) values 77.9) of being the most efficacious treatment for solid or predominantly solid benign nodules. Ethanol ablation (EA) ranked first (SUCRA value 81.1) in the treatment for cyst or predominantly cyst benign nodules. Conclusion RFA appears to be superior to other US-guided percutaneous ablation in reducing benign thyroid nodule volume during short- and long-term follow-up. In the subgroup analysis, RFA with 2 treatment sessions showed the most significant effectiveness for solid benign thyroid nodules and EA showed more effectiveness to decrease the volume of cyst benign thyroid nodules.

High Intensity Focused Ultrasound Ablation for Patients With Locally Advanced Pancreatic Adenocarcinoma: A Propensity Score‐Matching Analysis

“…HIFU has an advantage in safety especially in local complication, compared with other interventional procedures, such as radiofrequency ablation (RFA). It is mainly due to the difference in mechanism, even though there are some general similarities 51 . In HIFU treatment, the temperature at the focus of ultrasound is about 60°C, relatively milder than that in RFA of >90°C 13 .…”

“…It is mainly due to the difference in mechanism, even though there are some general similarities. 51 In HIFU treatment, the temperature at the focus of ultrasound is about 60 C, relatively milder than that in RFA of >90 C. 13 Also, our clinical practice of one session per day with about continuous 10 days for each patient will make the procedure more milder, during which the density and strength could be adjusted flexibly.…”

Efficacy and safety of radiofrequency ablation versus parathyroidectomy for secondary hyperparathyroidism in dialysis patients: a single-center retrospective study

“…Some studies 32 – 34 have applied ethanol ablation (EA) to parathyroid adenoma, which can decrease iPTH levels and adenoma volumes; however, it is prone to recurrence and requires multiple injections. There is no consensus regarding the amount of ethanol used or ideal treatment interval 35 , 36 . RFA appears to be superior to other ablation types in reducing the volume of thyroid nodules, and EA was more effective in the treatment of cyst lesions.…”

Microwave ablation of thyroid nodules: effects on recurrence and outcome

“…An ambitious network metaanalysis comparing different thyroid ablation modalities found two subsequent treatment sessions with radiofrequency ablation most effective in the treatment of benign thyoid nodules. 19 This suggests upfront planning two procedures to treat larger nodules an accepted recommendation.…”