Efficacy and safety of cooled and uncooled microwave ablation for the treatment of benign thyroid nodules: a systematic review and meta-analysis

Zheng, Bowen; Wang, Jinfen; Ju, Jinxiu; Wu, Tao; Tao, Ge; Ren, Jie

doi:10.1007/s12020-018-1693-2

Cited by 49 publications

(48 citation statements)

References 51 publications

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“…MWA is a new local thermal ablation technique that has a fast heating speed, strong coagulation ability, and a large ablation zone, so this technique has become a major method in heat ablation therapy. It is an effective treatment of thyroid nodules worldwide (8)(9)(10)(11). We found that intracystic hemorrhage appeared occasionally when ultrasound-guided PMWA was used to treat cystic thyroid nodule, and interfered with treatment.…”

Section: Introductionmentioning

confidence: 93%

Intracystic Hemorrhage and Its Management During Ultrasound-Guided Percutaneous Microwave Ablation for Cystic Thyroid Nodules

Dong

Sun

et al. 2020

Front. Endocrinol.

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Background: Intracystic hemorrhage can present occasionally during ultrasound-guided percutaneous microwave ablation (PMWA) for cystic thyroid nodules. It can affect treatment outcome, can lead to ablation failure, and even conversion to open surgery. We aim to avoid such cases in the future by exploring their causes and management. Methods: From March 2017 to December 2019, we retrospectively studied 87 cystic thyroid nodules in 59 patients who underwent PMWA in the First Hospital of Jilin University. All patients were followed at 1, 3, 6, and 12 months after treatment. Results: All patients completed the treatment successfully. Nine cystic thyroid nodules presented with intracystic hemorrhage during the ultrasound-guided PMWA, giving an incidence of 10.3% (9/87 cysts). Larger cystic thyroid nodules were more likely to develop intracystic bleeding during ultrasound-guided PMWA. Intracystic hemorrhage resulted in significantly prolonged ablation time and had a negative effect on treatment outcome. No patients had other complications, but temporary post-operative pain and local swelling were more obvious in patients with intracystic hemorrhage. Conclusion: Intracystic hemorrhage is not rare during ultrasound-guided PMWA for cystic thyroid nodules. Doctors should pay more attention to it, learn to manage it and try to avoid it in clinical practice.

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Section: Introductionmentioning

confidence: 93%

Intracystic Hemorrhage and Its Management During Ultrasound-Guided Percutaneous Microwave Ablation for Cystic Thyroid Nodules

Dong

Sun

et al. 2020

Front. Endocrinol.

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“…High-quality evidence using MWA is limited. Retrospective studies describe a 74.6-90.0% mean volume reduction after 1 year [22], and in 2 meta-analyses volume reduction was 74% at 6 months and 89% at 12-month follow-up [65,66]. However, in a prospective study comparing the performance of cooled versus uncooled MWA applicators, the mean reduction rates at 3 months were only 40 and 29%, respectively [67].…”

Section: Microwave Ablationmentioning

confidence: 99%

“…As with LTA and RFA, this variability in technique efficacy could be due to the heterogeneous structure of the nodules of the patients enrolled in the studies. Currently, MWA appears associated with a higher risk of major and minor complications than LTA and RFA, probably due to a poorer control of the applied energy and to the larger bore of the applicators [66].…”

Section: Microwave Ablationmentioning

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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“…The VRRs of other minimally invasive techniques—RFA, LA, and MWA—are reported to be 76.1%, 49.9%, and 73.5, respectively, after six months (4,43). Although direct comparisons are limited by differences in the baseline characteristics of nodules, these findings indicate that RFA and MWA is somewhat more effective than HIFU, while LA is as effective as HIFU, for volume reduction after six months.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of high-intensity focused ultrasound (HIFU) for treating benign thyroid nodules: a systematic review and meta-analysis

et al. 2020

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Background High-intensity focused ultrasound (HIFU) is an emerging thermal ablation technique that has been successfully applied to various benign thyroid nodules. Purpose To evaluate the efficacy and safety of HIFU for the treatment of benign thyroid nodules. Material and Methods The Ovid-MEDLINE and EMBASE databases were searched up to 9 July 2018 for studies describing the use of HIFU to treat benign thyroid nodules. We included studies that have outcomes with sufficient detail to evaluate the volume reduction rate (VRR). The pooled proportions of VRR ≥50% and pooled VRR at one, three, and six months after HIFU were assessed using random-effects modeling. Heterogeneity among studies was determined using Chi-square statistics for pooled estimates and the inconsistency index I2. Results Seven studies were included in the systematic review and four in the meta-analysis. The pooled VRR at one, three, and six months after HIFU were 17.59 (95% confidence interval [CI] 12.56–22.62), 48.93 (95% CI 42.20–55.66), and 60.43 (95% CI 51.88–68.98). The pooled proportions of VRR ≥50% at six months after HIFU were 75% (95% CI 53–89; I2=73.6%). There were no major complications of HIFU. Conclusion HIFU may be a safe and effective treatment modality for benign thyroid nodules, especially for small nodules.

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Efficacy and safety of cooled and uncooled microwave ablation for the treatment of benign thyroid nodules: a systematic review and meta-analysis

Abstract: MWA is an effective treatment modality for BTNs. When considering the patient's comfort, cMWA would be a more preferable procedure with less complications.

Cited by 49 publications

References 51 publications

Intracystic Hemorrhage and Its Management During Ultrasound-Guided Percutaneous Microwave Ablation for Cystic Thyroid Nodules

Intracystic Hemorrhage and Its Management During Ultrasound-Guided Percutaneous Microwave Ablation for Cystic Thyroid Nodules

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

Efficacy and safety of high-intensity focused ultrasound (HIFU) for treating benign thyroid nodules: a systematic review and meta-analysis

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