Radiofrequency ablation for treatment of benign thyroid nodules: Systematic review

Fuller, Colin W; Nguyen, Shaun A.; Lohia, Shivangi; Gillespie, M. Boyd

doi:10.1002/lary.24406

Cited by 65 publications

(40 citation statements)

References 36 publications

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“…This technique has been used successfully to ablate tumors in the liver, lung, and kidney. 92 A recent systematic review of prospective studies found that it is safe and effective in the treatment for symptomatic benign thyroid nodules and is effective in treating locoregional recurrence of thyroid cancers. 92 93 However, no studies have yet been reported for primary treatment of low risk thyroid cancer.…”

Section: Stat E O F T H E a Rt R E V I E Wmentioning

confidence: 99%

Low risk papillary thyroid cancer

Brito

Hay

Morris

2014

BMJ

109

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Thyroid cancer is one of the fastest growing diagnoses; more cases of thyroid cancer are found every year than all leukemias and cancers of the liver, pancreas, and stomach. Most of these incident cases are papillary in origin and are both small and localized. Patients with these small localized papillary thyroid cancers have a 99% survival rate at 20 years. In view of the excellent prognosis of these tumors, they have been denoted as low risk. The incidence of these low risk thyroid cancers is growing, probably because of the use of imaging technologies capable of exposing a large reservoir of subclinical disease. Despite their excellent prognosis, these subclinical low risk cancers are often treated aggressively. Although surgery is traditionally viewed as the cornerstone treatment for these tumors, there is less agreement about the extent of surgery (lobectomy v near total thyroidectomy) and whether prophylactic central neck dissection for removal of lymph nodes is needed. Many of these tumors are treated with radioactive iodine ablation and thyrotropin suppressive therapy, which-although effective for more aggressive forms of thyroid cancer-have not been shown to be of benefit in the management of these lesions. This review offers an evidence based approach to managing low risk papillary thyroid cancer. It also looks at the future of promising alternative surgical techniques, non-surgical minimally localized invasive therapies (ethanol ablation and laser ablation), and active surveillance, all of which form part of a more individualized treatment approach for low risk papillary thyroid tumors.

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Section: Stat E O F T H E a Rt R E V I E Wmentioning

confidence: 99%

Low risk papillary thyroid cancer

Brito

Hay

Morris

2014

BMJ

109

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“…Low complication rates and high nodular VRRs for RFA and LA have been confirmed in the treatment of BTNs [7][8][9] , and the preservation of thyroid…”

mentioning

confidence: 92%

US-guided percutaneous radiofrequency versus microwave ablation for benign thyroid nodules: A prospective multicenter study.

Cheng

2017

JCO

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Compared with microwave ablation (MWA), percutaneous radiofrequency ablation (RFA) and laser ablation (LA) have been recommended as minimally invasive treatments for patients with symptomatic benign thyroid nodules (BTNs) because of the large number of clinical applications. This prospective multicenter study sought to evaluate the clinical outcomes of RFA and MWA for BTNs. In eight participating institutions, the total number of 1252 patients treated by RFA and MWA were 649 ones with 687 BTNs and 603 ones with 664 BTNs, respectively. The clinical outcomes including the nodular maximal diameter reduction ratio (MDRR), the nodular volume reduction ratio (VRR), and the incidence of complications were compared to evaluate the efficacy and safety of the two techniques. The results for the nodular MDRR and VRR in the RFA group were significantly better than those in the MWA group at 6 months and later follow-up, and the major complication rates of 4.78% and 6.63% in RFA and MWA groups showed no statistically significant differences. In conclusion, both RFA and MWA are safe and effective techniques for selected patients with symptomatic BTNs. The achieved MDRR and VRR in the RFA group were greater than those in the MWA group at 6 months and later follow-up.The thyroid nodule is one of the most common lesions in clinical practice 1 and has been increasingly detected in approximately 50% of the general population by ultrasound (US) examination 2 in the past two decades due to the widespread use of radiological imaging. Benign thyroid nodules (BTNs) proven cytologically by fine-needle aspiration biopsy (FNAB) account for 85 to 95% of all thyroid nodules 3 . It is unnecessary to treat most BTNs because of their lack of symptoms and slow growth 4 . Therapy is mainly focused on patients with progressive nodular growth or cosmetic problems and symptoms, which are related to nodular volume 5 . Therefore, it is essential for the treatment of BTNs to maximize the nodular volume reduction ratio (VRR) and minimize complications because of the anatomical features of the thyroid and its adjacent important structures.After over a decade of clinical application, percutaneous radiofrequency ablation (RFA) and laser ablation (LA) under US guidance have become minimally invasive treatments for patients with BTNs, especially for nonsurgical candidates, surgical high-risk individuals or those refusing surgery 5,6 . Low complication rates and high nodular VRRs for RFA and LA have been confirmed in the treatment of BTNs [7][8][9] , and the preservation of thyroid

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“…Over the last two decades, nonsurgical, minimally invasive, US-guided techniques have been proposed for the treatment of thyroid nodules [11][12][13][14][15][16]. Percutaneous ethanol injection (PEI) is recommended for the treatment of relapsing cysts and dominantly cystic thyroid nodules [17].…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement

Garberoglio

Aliberti

Appetecchia³

et al. 2015

J Ultrasound

111

136

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Nodular thyroid disease is a very common finding in\ud clinical practice, discovered by ultrasound (US) in about\ud 50 % of the general population, with higher prevalence in\ud women and in the elderly [1–4].\ud Whereas therapeutic flowchart is quite established and\ud shared for malignant lesions, multiple options are now\ud available for patients presenting with benign thyroid nod-\ud ules, ranging from simple clinical and US follow-up to\ud thyroid surgery. The majority of thyroid nodules, benign by\ud fine-needle aspiration, are asymptomatic, stable, or slow-\ud growing over time and require no treatmen

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Radiofrequency ablation for treatment of benign thyroid nodules: Systematic review

Abstract: Radiofrequency ablation is a safe and effective treatment for symptomatic thyroid nodules that are confirmed benign. However, the paucity of level 1 evidence comparing RFA to surgical or to other nonsurgical treatment modalities is concerning.

Cited by 65 publications

References 36 publications

Low risk papillary thyroid cancer

Low risk papillary thyroid cancer

US-guided percutaneous radiofrequency versus microwave ablation for benign thyroid nodules: A prospective multicenter study.

Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement

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