Image-Guided Thyroid Ablation: Proposal for Standardization of Terminology and Reporting Criteria

Mauri, Giovanni; Pacella, Claudio Maurizio; Papini, Enrico; Solbiati, Luigi; Goldberg, S. Nahum; Ahmed, Muneeb; Sconfienza, Luca Maria

doi:10.1089/thy.2018.0604

Cited by 166 publications

(174 citation statements)

References 41 publications

Supporting

Mentioning

172

Contrasting

Order By: Relevance

“…The "technique efficacy" was conventionally defined as VRR ≥50% [21]. The "primary efficacy rate" was conventionally defined as the percentage of nodules successfully treated following the initial procedure (VRR ≥50%) [21].…”

Section: Methodsmentioning

confidence: 99%

Machine Learning Prediction of Radiofrequency Thermal Ablation Efficacy: A New Option to Optimize Thyroid Nodule Selection

Negro¹,

Rucco²,

Creanza³

et al. 2019

Eur Thyroid J

View full text Add to dashboard Cite

Background: Radiofrequency (RF) is a therapeutic modality for reducing the volume of large benign thyroid nodules. If thermal therapies are interpreted as an alternative strategy to surgery, critical issues in their use are represented by the extent of nodule reduction and by the durability of nodule reduction over a long period of time. Objective: To assess the ability of machine learning to discriminate nodules with volume reduction rate (VRR) < or ≥50% at 12 months following RF treatment. Methods: A machine learning model was trained with a dataset of 402 cytologically benign thyroid nodules subjected to RF at six Italian Institutions. The model was trained with the following variables: baseline nodule volume, echostructure, macrocalcalcifications, vascularity, and 12-month VRR. Results: After training, the model could distinguish between nodules having VRR < 50% from those having VRR ≥50% in 85% of cases (accuracy: 0.85; 95% confidence interval [CI]: 0.80-0.90; sensitivity: 0.70; 95% CI: 0.62-0.75; specificity: 0.99; 95% CI: 0.98-1.0; positive predictive value: 0.95; 95% CI: 0.92-0.98; negative predictive value: 0.95; 95% CI: 0.92-0.98). Conclusions: This study demonstrates that a machine learning model can reliably identify those nodules that will have VRR < or ≥50% at 12 months after one RF treatment session. Predicting which nodules will be poor or good responders represents valuable data that may help physicians and patients decide on the best treatment option between thermal ablation and surgery or in predicting if more than one session might be necessary to obtain a significant volume reduction.

show abstract

Section: Methodsmentioning

confidence: 99%

Machine Learning Prediction of Radiofrequency Thermal Ablation Efficacy: A New Option to Optimize Thyroid Nodule Selection

Negro¹,

Rucco²,

Creanza³

et al. 2019

Eur Thyroid J

View full text Add to dashboard Cite

show abstract

“…In order to compensate for current non-homogeneous data reporting and trial terminology, the text has been standardized according to the "Image-Guided Thyroid Ablation Procedures: Proposal for Standardization of Terminology and Reporting Criteria" recommendations [14]. In view of this being an ETA guideline, the focus has been on the highest possible level of evidence derived from studies carried out in a European setting.…”

Section: Scope Of the Documentmentioning

confidence: 99%

“…Among the currently available TA techniques for benign thyroid nodules, laser thermal ablation (LTA), radiofrequency ablation (RFA), microwave ablation (MWA), and high-intensity focused ultrasound (HIFU) have been tested in clinical practice and will be addressed in the present document. The devices employed by the different technologies are also defined as applicators [14].…”

Section: Thermal Treatment: Currently Available Techniquesmentioning

confidence: 99%

“…In these patients, a careful evaluation with CT or MR imaging should be performed to rule out the presence of intra-thoracic extension or potentially threatening compression of the vital structures [31]. In these cases, if used at all, TA should be restricted to patients with a dominant nodule who are not candidates for thyroid surgery, as a palliative therapy option [11,14,20]. Vocal cord function should be carefully considered before TA and laryngoscopic examination is warranted in patients with hoarseness, previous thyroid surgery, or with nodules close to the trachea or nerve structures [32].…”

Section: Patient Eligibility and Preparationmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2020

Self Cite

View full text Add to dashboard Cite

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).

show abstract

“…Side effects, complications, tolerability and satisfaction were documented. The terminology and reporting criteria followed consensus guidelines [19,[21][22][23][24].…”

Section: Adverse Eventsmentioning

confidence: 99%

Laser Ablation of Benign Thyroid Nodules: A Prospective Pilot Study With a Preliminary Analysis of the Employed Energy

et al. 2019

View full text Add to dashboard Cite

Background and Objectives To assess the effectiveness of ultrasound (US)‐guided laser ablation of benign thyroid nodules (TNs) under different amounts of applied energy. Study Design/Materials and Methods Thirty‐four euthyroid patients with 5–18 ml TNs were enrolled: 21 (laser ablation) and 13 (clinical follow up) patients with a mean age of 56.2 ± 12.0 and 54.7 ± 14.7 years, respectively. The laser ablation protocol used a 1.064 mm wavelength diode laser source; 3.5 W output power; 1,100–1,500 J and 5–8 min/illumination; and one or two fibers/session. Clinical, laboratory, and US data were obtained immediately before treatment and at 6 and 12 months follow‐up and were analyzed by Student's t test and Fisher's exact test. Low‐ and high‐energy subgroups were subsequently defined, and the receiver operating characteristic (ROC) curves were calculated. Results Laser ablation follow‐up showed an overall nodule volume reduction of more than 50%; improvement of symptoms and cosmetic complaints (P = 0.001); and stable laboratory data compared with the baseline and control groups. Minor complications were 9.5% ( n = 2). One or two fibers/session resulted in a similar nodule volume reduction among 10–18 ml nodules. Analysis of the applied energy suggested a 398.8 J/ml inferior cutoff (ROC curve: 0.889 sensitivity; 0.545 specificity) for the high‐energy subgroup ( n = 14, mean 599.9 ± 136.5 J/ml) to reduce the nodule volume over time (−55.1% vs. −58.4%, P = 0.55). The low‐energy subgroup ( n = 7, mean 240.2 ± 74.6 J/ml) did not show a persistent volume reduction ( P < 0.05) from the 6‐ to 12‐month follow‐ups (−56.6% vs. −53.7%). Conclusions Laser ablation of benign TNs achieved technique efficacy at 12 months posttreatment, with clinical improvement and few minor side effects. A single fiber in a single session with a high deployed energy (>398.8 J/ml) may be associated with improved results, a finding to be confirmed with a larger series. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

show abstract

Image-Guided Thyroid Ablation: Proposal for Standardization of Terminology and Reporting Criteria

Cited by 166 publications

References 41 publications

Machine Learning Prediction of Radiofrequency Thermal Ablation Efficacy: A New Option to Optimize Thyroid Nodule Selection

Machine Learning Prediction of Radiofrequency Thermal Ablation Efficacy: A New Option to Optimize Thyroid Nodule Selection

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

Laser Ablation of Benign Thyroid Nodules: A Prospective Pilot Study With a Preliminary Analysis of the Employed Energy

Contact Info

Product

Resources

About