Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth

Sim, Jung Suk; Baek, Jung Hwan

doi:10.3803/enm.2019.34.2.117

Cited by 69 publications

(69 citation statements)

References 37 publications

(68 reference statements)

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“…As a quantitative parameter of how much nodular tissue was ablated after the ablation procedure, RVR could not only indicate whether a complete ablation was performed, but also be helpful for physicians to improve the experience and skills Besides RVR, initial volume, location close to critical structures and vascularity were also independent factors related to nodule regrowth by multivariate logistic regression analysis. It was well known that initial volume was the most common factor for regrowth [19,20,43]. In this study, the initial volume in the regrowth group was significantly larger than in the non-regrowth group.…”

Section: Discussionmentioning

confidence: 50%

Residual vital ratio: predicting regrowth after radiofrequency ablation for benign thyroid nodules

Yan

Luo

Xie

et al. 2020

International Journal of Hyperthermia

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Purpose: To determine a novel quantitative index, residual vital ratio(RVR) by contrast-enhanced ultrasound(CEUS) with conventional Ultrasound(US), to early predict nodule regrowth after radiofrequency ablation (RFA)for benign thyroid nodules. Methods: This retrospective study evaluated 186 patients with 206 benign thyroid nodules underwent RFA. Patients were followed at 1, 3, 6, 12 months and every 12 months thereafter by conventional US, CEUS and clinical evaluation. RVR was defined as the initial ratio of residual vital volume to the total volume calculated by CEUS and conventional US at the first follow-up period after RFA. The relationship between RVR and regrowth was investigated. Results: The mean volume of thyroid nodules was 10.09 ± 12.90 ml (range 0.40-71.39 ml), which decreased significantly to 2.33 ± 4.65 ml (range 0-36.75 ml) (p < .001) after a mean follow-up time of 22.50 ± 13.29 months (range 6-68 months) with a mean VRR as 85.26 ± 15.02% (range 32.23-100%). The overall incidence of regrowth was 12.62% (26/206) and the mean timing of regrowth was 20.77 ± 12.03 months (range 6-48 months). Multivariate logistic regression revealed that RVR (OR ¼ 1.050, 95%CI 1.025-1.075), initial volume(OR ¼ 1.033, 95%CI 1.000-1.066), location close to critical structures (OR ¼ 5.967, 95%CI 1.898-18.760) and vascularity (OR ¼ 2.216, 95%CI 1.185-4.143) were independent factors associated with regrowth. According to receiver-operating characteristic curve, the area under curve for RVR to regrowth was 0.819 (95% CI 0.740-0.897, p < .001) with the optimal cutoff value of 44.5% (sensitivity 80.8%, specificity 74.7%). Conclusion: RVR was not only an independent factor but also an early quantitative predictor for regrowth. If RVR was larger than 44.5%, the nodule tended to regrowth in the follow-up.

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Section: Discussionmentioning

confidence: 50%

Residual vital ratio: predicting regrowth after radiofrequency ablation for benign thyroid nodules

Yan

Luo

Xie

et al. 2020

International Journal of Hyperthermia

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“…Color-Doppler mapping improves defining the treated area, which appears as devoid of vascular signals. Contrast-enhanced US provides a more accurate assessment of the loss of small vessel signals and better depicts the incompletely treated peripheral areas [14,[35][36][37][38][39][40]. Notably, in a few European countries, thyroid nodular disease is not among the licensed indications for the use of US contrast agents.…”

Section: Post-procedural Management and Follow-upmentioning

confidence: 99%

“…Main predictive factors for recurrence appear to be large initial size, functional autonomy, low applied energy, and incomplete ablation of the marginal areas of the nodules [36][37][38]. Therefore, during follow-up, demonstration of initial regrowth in untreated peripheral areas should prompt a second targeted TA to prevent further volume increase and recurrence of symptoms over time [39]. Notably, a repeat cytological assessment should be considered before retreatment, as nodule regrowth could be a potential sign of overlooked malignancy [11,28].…”

Section: Post-procedural Management and Follow-upmentioning

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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“…months) demonstrated no regrowth[15], our long-term metaanalysis of more than 3 years of follow-up demonstrated a number of treated benign nodules showing regrowth during followup period, as reflected by the long-term changes in VRR and the requirement for delayed surgery.Several factors have been suggested for determining the effectiveness of treatments for benign thyroid nodules, including change in the mean volume of the index nodule, the proportion of the solid component, and the multiplicity of treatment sessions[9,13,15,36,37]. Other factors could be the ablation method and the completion of margin ablation to avoid marginal regrowth[38]. First, as RFA generally uses the moving-shot technique, the ablation of the entire nodular margins can be maximized[13,36,39].…”

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confidence: 99%

Long-Term Results of Thermal Ablation of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis

et al. 2020

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Background: Ultrasound-guided thermal ablations have become one of the main options for treating benign thyroid nodules. To determine efficacy of thermal ablation of benign thyroid nodules, we performed a meta-analysis of studies with long-term follow-up of more than 3 years. Methods: Databases were searched for studies published up to August 25, 2019, reporting patients with benign thyroid nodules treated with thermal ablation and with follow-up data of more than 3 years. Data extraction and quality assessment were performed according to PRISMA guidelines. The analysis yielded serial volume reduction rates (VRRs) of ablated nodules for up to 3 years or more, and adverse effect of ablation during follow-up. Radiofrequency ablation (RFA) and laser ablation (LA) were compared in a subgroup analysis. Results: The pooled VRRs for ablated nodules showed rapid volume reduction before 12 months, a plateau from 12 to 36 months, and more volume reduction appearing after 36 months, demonstrating long-term maintenance of treatment efficacy. Thermal ablation had an acceptable complication rate of 3.8%. Moreover, patients undergoing nodule ablation showed no unexpected delayed complications during the follow-up period. In the subgroup analysis, RFA was shown to be superior to LA in terms of the pooled VRR and the number of patients who underwent delayed surgery. Conclusion: Thermal ablations are safe and effective methods for treating benign thyroid nodules, as shown by a long follow-up analysis of more than 3 years. In addition, RFA showed superior VRRs compared with LA for the treatment of benign thyroid nodules, with less regrowth and less delayed surgery.

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Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth

Cited by 69 publications

References 37 publications

Residual vital ratio: predicting regrowth after radiofrequency ablation for benign thyroid nodules

Residual vital ratio: predicting regrowth after radiofrequency ablation for benign thyroid nodules

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

Long-Term Results of Thermal Ablation of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis

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