Image-guided thermal ablation might be a way to compensate for image deriving cancer overdiagnosis

145

Objective: We evaluated long-term follow-up results of radiofrequency ablation of benign thyroid nodules to analyse the role of marginal vital tissue on nodule regrowth. Materials and methods: We reviewed the medical records of 54 patients who underwent radiofrequency ablation between June 2008 and November 2013 with pressure symptoms, and/or cosmetic problems. All patients were followed up at least 12 months on three occasions. To evaluate an early sign of regrowth, three types of nodule volumes (total volume, ablated volume and vital volume) were measured and calculated using ultrasonography. Regrowth was defined as a more than a 50% increase in the total volume and vital volume increase was defined as a more than 50% increase compared to the previously reported smallest volume on ultrasonography. Results: The mean follow-up period was 39.4 ± 21.7 (range, 13-87) months. Vital volume increases occurred in 31 nodules (57.4%) and there was regrowth in 13 nodules (24.1%). The mean timing of the vital volume increase was 27.5 ± 18.5 months, and for regrowth it was 39.9 ± 17.5 months. Vital volume increase tended to precede regrowth. Conclusion: Vital volume increase tended to occur earlier than regrowth and might be an early sign of regrowth in following-up after the radiofrequency ablation of benign thyroid nodules. ARTICLE HISTORY

Section: Discussionsupporting

confidence: 82%

Radiofrequency ablation of benign thyroid nodules: depicting early sign of regrowth by calculating vital volume

Sim¹,

Baek

Lee

et al. 2017

145

“…In recent years, improved imaging could detect PTC in their very initial stage [1], which was thought to be overdiagnosis because the medical treatment might not be beneficial [2]. As a minimally invasive treatment, image-guided thermal ablation might be a good solution for the above situation [29]. In our study, none of the patients had severe complications.…”

Section: Discussionmentioning

confidence: 63%

“…The advantage of minimal invasiveness of image-guided thermal ablation had been reported previously and widely accepted [16,19,23,24]. Some authors even thought that images-guided thermal ablation might be a way to compensate for image deriving cancer overdiagnosis [29]. In recent years, improved imaging could detect PTC in their very initial stage [1], which was thought to be overdiagnosis because the medical treatment might not be beneficial [2].…”

Section: Discussionmentioning

confidence: 95%

Ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma: a retrospective analysis of 198 patients

Luo

Tang

et al. 2020

Purpose: To evaluate the safety and efficacy of ultrasound-guided RFA for the treatment of papillary thyroid microcarcinoma (PTMC). Materials and methods: The data of 204 nodules from 198 PTMC patients who were treated using RFA were retrospectively reviewed in this study. Demographic variables, complication details and CEUS results in different time points were collected. The volumes and volume reduction rate (VRR) of the ablated area under CEUS at different follow-up time points were calculated and compared. Results: All the patients were successfully treated without major complication. Mild complications included cervical discomfort in three cases, postoperative cervical pain in one case, and transient hoarse voice in five cases. The volume of the ablated area in the 1st, 3rd, 6th, 12th, 18th and 24th month postoperatively were 241.7 ± 298.3mm 3 , 89.8 ± 147.2 mm 3 , 37.6 ± 87.2 mm 3 , 13.6 ± 59.8 mm 3 , 2.4 ± 14.4 mm 3 , and 0.2 ± 2.0 mm 3 respectively, with a statistically significant decrease (F ¼ 138.1, p ¼ .000), and the VRR in those time points were 73.9 ± 13.7%, 90.5 ± 8.2%, 96.1 ± 5.9%, 98.8 ± 3.2%, 99.6 ± 1.9% and 99.8 ± 1.0% respectively, with a statistically significant decrease (F ¼ 695.3, p ¼ .000). Conclusions: US-guided RFA is safe and effective for PTMC, with a good oncological outcome and VRR. Further randomized controlled prospective trials are still needed to compare the value of RFA and surgery.

“…Although traditional surgery may facilitate accurate staging of the patient and the low recurrence rate, complications from surgery such as injury to the recurrent laryngeal nerve and parathyroid might exceed the degree of morbidity of the disease itself. In this setting, imaging-guided therapies could play a key role, representing potentially less invasive treatment alternatives to operation, thus being able to provide treatment to the PTMC patients, but lowering its invasiveness [6].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided laser ablation versus surgery for solitary papillary thyroid microcarcinoma: a retrospective study

Zhou

et al. 2019

Objectives: To compare the clinical outcomes of ultrasound-guided laser ablation (LA) and surgery for treatment of solitary papillary thyroid microcarcinoma (PTMC). Methods: A total of 81 consecutive patients with solitary PTMC were included in this retrospective study. Among them, 36 received LA and 45 underwent surgery. Surgery was performed by hemithyroidectomy with unilateral central neck dissection. The follow-up consisted of a physical examination, neck ultrasonography, chest X-ray or CT scan and thyroid function tests. The procedure time, hospital stay, complication and recurrence rates were compared between the two groups after treatment. Results: The follow-up period for the LA and surgical group were 49.2 ± 4.5 months (range, 30-54 months) and 48.5 ± 6.2 months (range, 24-54 months), respectively. The mean hospital stay and procedure time in the LA group were shorter than those in the surgical group. After LA, the largest diameter and average volume decreased from 4.7 ± 1.4 mm to 0.2 ± 0.8 mm, and from 43.2 ± 38.8 mm 3 to 0.7 ± 4.1 mm 3 (p < .05 for both), respectively. The complication rates and recurrence rates did not differ between the LA group (2.8% [1 of 36] and 5.6% [2 of 36]) and the surgical group (6.7% [3 of 45] and 6.7% [3 of 45]) (p > .05 for both). No distant metastasis occurred in the either group during the follow-up period. Conclusions: Compared with hemithyroidectomy with unilateral central neck dissection, ultrasoundguided LA was also a safe and effective therapy for treating solitary PTMC, and it may be considered as a treatment alternative for patients who are ineligible or refusal to undergo surgery.