The Efficacy and Safety of High‐Intensity Focused Ultrasound (HIFU) Therapy for Benign Thyroid Nodules—A Single Center Experience from Singapore

Abstract

Background High-intensity focused ultrasound (HIFU) is a recent noninvasive technique of treating thyroid nodules. Our study aims to investigate the efficacy and safety of HIFU in treating benign thyroid nodules. Methods This is a retrospective analysis of consecutive patients who underwent HIFU of benign thyroid nodules at our institution from July 2017-2018. All procedures were performed by a single surgeon. Patients were evaluated immediately post-procedure, and at subsequent intervals of 1 week, 1 month, 3 months, and 6 months. The primary endpoint was thyroid nodule volume reduction at 6 months posttreatment. Secondary endpoints were post-procedure local complications. Results Ten patients with 13 thyroid nodules were included. The median follow-up period was 426 days (range 238-573). Mean maximum diameter reduced from 2.6 cm (±0.8) pretreatment to 1.4 cm (±0.7, P \ 0.05) 6 months posttreatment. Mean nodule volume reduced from 5.2 cm 3 (±4.2) pretreatment to 1.5 cm 3 (±1.3,P= 0.01) 6 months posttreatment. Mean volume reduction ratio (VRR) at 6 months posttreatment was 63.2% (±22.5, P \ 0.05), with volume reduction of C50% in 10 of 13 (76.9%) nodules. Two nodules (15.4%) showed size increases from 4 months posttreatment. No patients experienced local skin burns or hematomas. Mean pain scores were 1.5 (±1.2) immediate post-procedure, 0.8 (±1.5) at 1 week, and 0.6 (±1.2) at 1 month post-procedure, respectively, with no reports of pain beyond 1 month. Only two (20.0%) patients had early, temporary posttreatment voice hoarseness. Conclusion Our study shows HIFU ablation to be efficacious and safe-with significant thyroid nodule volume reductions, and no significant or prolonged local complications.

Identifying predictive factors for efficacy in high intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a retrospective analysis

“…For predominantly-solid or solid nodules, several thermal ablation techniques such as laser, microwave and radiofrequency ablation (RFA) have been shown to be effective [4][5][6]. High intensity focused ultrasound (HIFU) is one of the newer ablation techniques that is effective in inducing significant nodule shrinkage and in alleviating nodule-related symptoms [7][8][9][10][11][12].…”

Image-Guided High-Intensity Focused Ultrasound, A Novel Application for Interventional Nuclear Medicine?

“…The pathological analysis showed significant nodule destruction, and histological examination demonstrated that ablated lesions were confined to the target region without damage to surrounding tissues. The safety and efficiency of the treatment were confirmed by Prakash et al (21). The diameters of the thyroid nodules were reduced at 6 months post-treatment without complications (e.g., skin burn and hematoma), demonstrating the great potential of HIFU in the treatment of thyroid nodules.…”

The efficacy and safety of high-intensity focused ultrasound in the treatment of benign thyroid nodules: A systematic review and meta-analysis from 1990 to 2021

“…6 Side effects include pain that is usually transient and mild, 5,7,8 skin blisters 5 and hoarseness. 9 There have been only 2 systematic reviews 3,5 and 1 systematic review and meta-analysis 10 on HIFU and benign thyroid nodules to date. The present systematic review and meta-analysis seeks to evaluate the efficacy and safety of HIFU treatment for benign thyroid nodules, with the aim of updating the information presented in previous studies given the emergence of new studies.…”

“…Six (66.7%) out of the 9 studies included in this review reported pain as a common side effect. 4,8,9,15,16,18 This was scored either based on a visual analogue scale 4,8,9,15,16 or a numeric rating scale. 18 The mean pain score during and post-procedure were 4.85 and 1.54, respectively.…”

“…4 A major complication from HIFU treatment includes vocal cord paresis and voice hoarseness, which were reported in 2 studies. 9,15 Overall, 5/346 patients (0.014%) experienced vocal cord palsy but all were transient. Lang et al reported vocal cord paresis in 3 (2.78%) patients that resolved within 3 months, 15 whereas Prakash et al reported voice hoarseness in 2 (20%) patients that resolved after 10 days.…”