Comparison of ultrasound guided percutaneous radiofrequency ablation and open thyroidectomy in the treatment of low-risk papillary thyroid microcarcinoma: A propensity score matching study

Zhang, Chao; Yin, J F; Hu, C.; Ye, Qin; Wang, Ping; Huang, Pintong

doi:10.3233/ch-201087

Cited by 20 publications

(20 citation statements)

References 24 publications

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“…Twelve studies were case series (11 retrospective and 1 prospective), which are generally considered to have a high risk of bias and low certainty . Three studies were retrospective cohort studies . All included studies originated from China (n = 11) or Korea (n = 4) and were published after 2016.…”

Section: Resultsmentioning

confidence: 99%

Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid

Dijk

Coerts

Gunput

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Papillary microcarcinomas of the thyroid (mPTCs) account for an increasing proportion of thyroid cancers in past decades. The use of radiofrequency ablation (RFA) has been investigated as an alternative to surgery. The effectiveness and safety of RFA has yet to be determined. OBJECTIVE To evaluate the effectiveness and safety of RFA for low-risk mPTC. DATA SOURCES Embase, MEDLINE via Ovid, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and the top 100 references of Google Scholar were searched from inception to May 28, 2021. STUDY SELECTION Articles reporting on adult patients with mPTC treated with RFA were included. Studies that involved patients with pre-ablation lymph node or distant metastases, recurrence of disease, or extrathyroidal extension were excluded. Final article selection was conducted by multiple reviewers based on consensus. The proportion of eligible articles was 1%.DATA EXTRACTION AND SYNTHESIS This meta-analysis was conducted in accordance with the MOOSE guidelines. Random and fixed-effect models were applied to obtain pooled proportions and 95% CIs. MAIN OUTCOMES AND MEASURESThe primary outcome was the complete disappearance rate of mPTC. Secondary outcomes were tumor progression and complications. RESULTSFifteen studies were included in this meta-analysis. A total of 1770 patients (1379 women [77.9%]; mean [SD] age, 45.4 [11.4] years; age range, 42.5-66.0 years) with 1822 tumors were treated with RFA; 49 tumors underwent 1 additional RFA session and 1 tumor underwent 2 additional RFA sessions. Mean (SD) follow-up time was 33.0 (11.4) months (range, 6-131 months). The pooled complete disappearance rate at the end of follow-up was 79% (95% CI, 65%-94%). The overall tumor progression rate was 1.5% (n = 26 patients), local residual mPTC in the ablation area was found in 7 tumors (0.4%), new mPTC in the thyroid was found in 15 patients (0.9%), and 4 patients (0.2%) developed lymph node metastases during follow-up. No distant metastases were detected. Three major complications occurred (2 voice changes lasting >2 months and 1 cardiac arrhythmia). Minor complications were described in 45 patients. CONCLUSIONS AND RELEVANCEThe findings of this systematic review and meta-analysis suggest that RFA is a safe and efficient method to treat selected low-risk mPTCs. Radiofrequency ablation could be envisioned as step-up treatment after local tumor growth under active surveillance for an mPTC or initial treatment in patients with mPTCs with anxiety about active surveillance.

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Section: Resultsmentioning

confidence: 99%

Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid

Dijk

Coerts

Gunput

et al. 2022

JAMA Otolaryngol Head Neck Surg

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“…In addition, the rich blood supply to the thyroid gland can lead to transient bleeding at the end of the ablation, although this can be relieved with compression. Finally, a small number of patients experience complications such as altered thyroid function (24,27,49,50,60,77) and cough (21,36,45) after thermal ablation, which normally resolve during the postoperative period.…”

Section: Complicationsmentioning

confidence: 99%

Research Review of Thermal Ablation in the Treatment of Papillary Thyroid Carcinoma

Chen

Tian

et al. 2022

Front. Oncol.

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BackgroundMinimally invasive treatment of thyroid tumors has become increasingly common, but has mainly focused on benign thyroid tumors, whereas thermal ablation of thyroid cancer remains controversial. Clinical studies analyzing the efficacy of thermal ablation of papillary thyroid carcinoma (PTC) have been conducted in several countries to verify its safety. Here, we screened and reviewed recent studies on the efficacy and safety of thermal ablation of PTC as well as psychological assessment, patient prognosis, recurrence, and factors affecting ablation.SummaryThe most significant controversy surrounding ablative treatment of PTC centers on its effectiveness and safety, and >40 studies have been conducted to address this issue. The studies include papillary thyroid microcarcinoma (PTMC) and non-PTMC, single PTC and multiple PTC, and controlled studies of ablative therapy and surgical treatment. In general, ablation techniques can be carefully performed and promoted under certain conditions and with active follow-up of postoperative patients. Ablation is a promising alternative treatment especially in patients who are inoperable.ConclusionsClinical studies on PTC ablation have provided new perspectives on local treatment. However, because PTC grows very slowly, it is an indolent tumor; therefore, studies with larger sample sizes and extended post-procedure follow-ups are necessary to confirm the investigators’ hypotheses.

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“…RFA can be performed in a clinic, removing the cost of an operating room. From a financial perspective, RFA of indeterminate nodules could potentially be more cost-friendly than thyroidectomy, as is the case for both benign [ 31 ] and low-risk papillary thyroid carcinomas [ 32 ]. Finally, patients undergoing RFA typically only complain of minimally discomforting symptoms, which typically resolve on their own.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation of Indeterminate Thyroid Nodules: The First North American Comparative Analysis

Issa

Omar

Issa

et al. 2022

IJMS

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Thyroid nodules can be classified as benign, malignant, or indeterminate, the latter of which make up 10–30% of nodules. Radiofrequency ablation (RFA) has become an attractive and promising therapy for the treatment of benign thyroid nodules. However, few studies have investigated the safety and efficacy of RFA for the management of indeterminate thyroid nodules. In this study, 178 patients with thyroid nodules diagnosed as benign (Bethesda II) or indeterminate (Bethesda III/IV) by preoperative cytopathological analysis were included. Patients in the benign and indeterminate cohorts had similar thyroid nodule volume reduction rates at 65.60% and 64.20%, respectively (p = 0.68). The two groups had similar nodular regrowth rates, at 11.2% for benign nodules and 9.40% for indeterminate nodules (p = 0.72). A total of three cases of transient dysphonia were reported. RFA of indeterminate thyroid nodules was comparable to that of benign thyroid nodules in all parameters of interest, including volume reduction rate. To our best knowledge, our work is the first North American analysis comparing benign and indeterminate thyroid nodules and suggests RFA to be a promising modality for the management of indeterminate thyroid nodules.

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Comparison of ultrasound guided percutaneous radiofrequency ablation and open thyroidectomy in the treatment of low-risk papillary thyroid microcarcinoma: A propensity score matching study

Cited by 20 publications

References 24 publications

Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid

Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid

Research Review of Thermal Ablation in the Treatment of Papillary Thyroid Carcinoma

Radiofrequency Ablation of Indeterminate Thyroid Nodules: The First North American Comparative Analysis

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