Efficacy of radiofrequency ablation in autonomous functioning thyroid nodules. A systematic review and meta-analysis

Cesáreo, R.; Palermo, Andrea; Benvenuto, Domenico; Cella, Eleonora; Pasqualini, Valerio; Bernardi, Stella; Stacul, Fulvio; Angeletti, Silvia; Mauri, Giovanni; Ciccozzi, Massimo; Trimboli, Pierpaolo

doi:10.1007/s11154-019-09487-y

Cited by 55 publications

(49 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The trial was powered for volume reduction superiority of RFA compared with LA. Based on published data, we expected at least a 10% difference in nodule volume reduction between the RFA and the LA group (15). We calculated that a sample size of 30 participants per group was needed to have a power of about 90%, with a type I error rate of 5%, by estimating that the standard deviation (SD) would be as large as the expected difference.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Laser Ablation Versus Radiofrequency Ablation for Benign Non-Functioning Thyroid Nodules: Six-Month Results of a Randomized, Parallel, Open-Label, Trial (LARA Trial)

Cesareo

Pacella

Pasqualini

et al. 2020

Thyroid

Self Cite

View full text Add to dashboard Cite

Background: No direct prospective studies comparing laser ablation (LA) and radiofrequency ablation (RFA) for debulking benign non-functioning thyroid nodules (BNTNs) exist. We aimed at comparing the efficacy and safety of both techniques in patients with solid or predominantly solid BNTN. Methods: This six-month, single-use, randomized, open-label, parallel trial compared the following primary endpoints between the RFA and LA groups six months after treatment: (i) nodule volume reduction expressed as a percentage of nodule volume at baseline; (ii) proportion of nodules with more than 50% reduction (successful rate). We enrolled subjects with a solitary BNTN or dominant nodule characterized by pressure symptoms/cosmetic problems or patients without symptoms who experienced a volume increase >20% in one year. Nodules underwent core needle biopsy for diagnosis. Patients were randomly assigned (1:1) to receive LA or RFA. Safety was assessed in all randomly assigned participants. Results: Sixty patients were randomly assigned to receive either RFA or LA (1:1) between January 2016 and November 2018. Both groups were similar in basal nodule volume, thyroid function, histology, symptoms/ cosmetic score, and procedure time. At six months, the nodule volume reduction was 64.3% (95% confidence interval, CI 57.5-71.2) in the RFA group and 53.2% ([CI 47.2-95.2]; p = 0.02) in the LA group. This effect was also confirmed in the linear regression model adjusted for age, baseline volume, and proportion of cellular component (LA vs. RFA percent change Delta =-12.8, p = 0.02). No significant difference was observed in success rate six months after treatment (RFA vs. LA: 86.7% vs. 66.7%, p = 0.13) or in thyrotropin level between the groups. Although improved, no significant difference was observed between RFA and LA for compressive symptoms (RFA: 2.13 vs. 3.9, p < 0 $ 001; LA: 2.4 vs. 3.87, p < 0.001) and cosmetic score (RFA: 1.65 vs. 2.2, p < 0.001; LA: 1.85 vs. 2.2, p < 0.001). The adverse event rates (local pain, dysphonia, thyrotoxicosis, fever, hematoma) were 37% (n = 11) and 43% (n = 13) for RFA and LA, respectively, with no requirement for hospitalization. Conclusion: Although the success rate was similar in the RFA and LA groups, RFA achieved a significantly larger nodule volume reduction at six months.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Previous meta-analysis and retrospective studies reported contradictory results regarding RFA and LA efficacy for treating BTNs (11,(13)(14)(15)(16). However, there are no direct prospective studies that compare the two techniques.…”

Section: Introductionmentioning

confidence: 99%

Laser Ablation Versus Radiofrequency Ablation for Benign Non-Functioning Thyroid Nodules: Six-Month Results of a Randomized, Parallel, Open-Label, Trial (LARA Trial)

Cesareo

Pacella

Pasqualini

et al. 2020

Thyroid

Self Cite

View full text Add to dashboard Cite

show abstract

“…Image-guided thyroid ablation (I-GTA), such as radiofrequency (RF) and laser ablation, is mainly used to treat benign nonfunctioning thyroid nodules that show progressive growth over time, become symptomatic, or show cosmetic Twelve-Month Volume Reduction Ratio Predicts Regrowth and Time to Regrowth in Thyroid Nodules Submitted to Laser Ablation: A 5-Year Follow-Up Retrospective Study concerns (1,2). In the last decade, several studies confirmed that laser ablation and RF are effective for cystic and hot thyroid nodules and are considered safe and cost-effective (3)(4)(5)(6). Several studies demonstrated a significant benefit in the volume reduction ratio (VRR), usually by 50.0-80.0% over a follow-up period of up to 5 years (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Twelve-Month Volume Reduction Ratio Predicts Regrowth and Time to Regrowth in Thyroid Nodules Submitted to Laser Ablation: A 5-Year Follow-Up Retrospective Study

Negro

Greco

Deandrea³

et al. 2020

Korean J Radiol

Self Cite

View full text Add to dashboard Cite

Objective: Laser ablation is a therapeutic modality used to reduce the volume of large benign thyroid nodules. Unsatisfactory reduction and regrowth are observed in some treated nodules. The aim of the study was to evaluate the long-term outcomes of laser treatment for solid nodules during a 5-year follow-up period, the regrowth rate, and the predictive risk factors of nodule regrowth. Materials and Methods: We retrospectively evaluated patients with benign, solid, cold thyroid nodules who underwent laser ablation and were followed-up for 5 years. According to the selection criteria, 104 patients were included (median baseline nodule volume, 12.5 mL [25.0-75.0%, 8-18 mL]; median energy delivered, 481.5 J/mL [25.0-75.0%, 370-620 J/mL]). Nodule volume, thyroid function test results, and ultrasound were evaluated at baseline and then annually after the procedure. Results: Of 104 patients, 31 patients (29.8%) had a 12-month volume reduction ratio (VRR) < 50.0% and 39 (37.5%) experienced nodule regrowth. Of these 39 patients, 17 (43.6%) underwent surgery and 14 (35.9%) underwent a second laser treatment. The rate of nodule regrowth was inversely related to the 12-month VRR, i.e., the lower the 12-month VRR, the higher the risk of regrowth (p < 0.001). The mean time for nodule regrowth was 33.5 ± 16.6 months. The 12-month VRR was directly related to time to regrowth, i.e., the lower the 12-month VRR, the shorter the time to regrowth (p < 0.001; R 2 = 0.3516). Non-spongiform composition increased the risk of regrowth with an odds ratio of 4.3 (95% confidence interval [CI] 1.8-10.2; p < 0.001); 12-month VRR < 50.0% increased the risk of regrowth with an odds ratio of 11.7 (95% CI 4.2-32.2; p < 0.001). Conclusion: The VRR of thyroid nodules subjected to similar amounts of laser energy varies widely and depends on the nodule composition; non-spongiform nodules are reduced to a lesser extent and regrow more frequently than spongiform nodules. A 12-month VRR < 50.0% is a predictive risk factor for regrowth and correlates with the time to regrowth.

show abstract

“…Also, the use of PEI in solid thyroid nodules is contraindicated, unless it is the only available treatment [20][21][22][23][24]. According to the studies, PEI in nonfunctioning nodules had been associated with about 50% of nodular volume reduction [25][26][27]. Consistent with previous studies, in our research, the PEI was associated with the mean volume reduction of 37.4%, 55.6%, and 72.2%, at the baseline of the study, 1, 3 and six months after the intervention, respectively.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Ethanol Injection, Radiofrequency Ablation, and Levothyroxine Therapy in the Management of Benign Thyroid Nodules

Arefzadeh

Avankai

Abrishami

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Thyroid nodules are a common clinical finding. Even though there are various accepted treatments for the benign thyroid nodules, there are alternative methods for managing these patients with fewer expenses and also minimum complications. This study aims to compare the volume decline of radiofrequency (RF) ablation and single-session ethanol ablation (EA) and the effects of levothyroxine therapy for benign thyroid nodule treatment.Materials: In this clinical trial, 90 patients with benign thyroid nodules in different centers in Tehran, Iran, from December 6, 2018, to December 6, 2019, were included. Patients who had met the inclusion criteria were selected and randomly allocated into three groups (each of 30) of a single session of radiofrequency ablation (Group 1), a single session of ethanol injection (Group 2), or a 6-month LT4 treatment (Group 3). Thyroid tests, including TSH, T4, T3, anti-TPO, T3RU, and serum Calcitonin level, were recorded at baseline and again at 1, 3, and six months. Nodule volume was also assessed through sonography at baseline and the other checkpoints.Results: The mean volume reduction after 6 months of intervention for ethanol injection group, radiofrequency ablation group, and LT4 treatment group were 72.2%, 83.4%, and 21.8%, respectively. There was a significant relationship between mean volume reduction and months (1, 3, and six) (P<0.001).Conclusions: Although radiofrequency ablation therapy is the best modality for managing benign thyroid nodules in our study, it is more expensive than the other modalities despite comparable therapeutic effects.

show abstract

Efficacy of radiofrequency ablation in autonomous functioning thyroid nodules. A systematic review and meta-analysis

Cited by 55 publications

References 31 publications

Laser Ablation Versus Radiofrequency Ablation for Benign Non-Functioning Thyroid Nodules: Six-Month Results of a Randomized, Parallel, Open-Label, Trial (LARA Trial)

Laser Ablation Versus Radiofrequency Ablation for Benign Non-Functioning Thyroid Nodules: Six-Month Results of a Randomized, Parallel, Open-Label, Trial (LARA Trial)

Twelve-Month Volume Reduction Ratio Predicts Regrowth and Time to Regrowth in Thyroid Nodules Submitted to Laser Ablation: A 5-Year Follow-Up Retrospective Study

Evaluation of Ethanol Injection, Radiofrequency Ablation, and Levothyroxine Therapy in the Management of Benign Thyroid Nodules

Contact Info

Product

Resources

About