Ultrasound‐Guided Percutaneous Microwave Ablation for Substernal Goiter: Initial Experience

Abstract

Objectives To preliminarily evaluate the safety, effectiveness, and feasibility of microwave ablation (MWA) for substernal goiter (SSG) in select patients and to provide a relevant treatment reference for further studies. Methods From April 2017 to December 2017, 10 patients with SSG were treated by MWA. All patients were followed for at least 3 months to observe the therapeutic effects and complications. Therapeutic effects were assessed at follow‐up for the relief of patients’ symptoms, resolution of the cosmetic grade, and volume reduction rate (VRR) of SSG. Possibly related factors for the 3‐month VRR of the nodules were analyzed. Results The study included 9 female patients and 1 male patient with a mean age ± SD of 56.8 ± 10.1 years (range, 34–70 years). The mean volume of the nodules was 52.9 ± 27.9 mL (range, 23.7–122.6 mL). The nodule volume was significantly reduced at the 3‐month follow‐up (17.5 ± 9.5 mL; P < .05). The mean 3‐month VRR of the index nodule was 66.7% ± 7.1%. A higher ablated portion‐to‐nodule ratio 1 day after MWA predicted a higher 3‐month VRR (Spearman r = 0.646; P = .044). The mean symptom score (from 4.5 ± 1.7 to 1.5 ± 1.0; P = .005) and cosmetic grade (from 3.3 ± 0.5 to 2.2 ± 0.4; P = .004) declined significantly 3 months after the procedure. No complications or unexpected side effects were observed. Conclusions Our preliminary results support the effectiveness and safety of MWA for local control of SSG. This technology can be applied in select patients with SSG who are ineligible for surgery.

Frailty is More Predictive than Age for Complications After Thyroidectomy for Multinodular Goiter

“…These data support the notion that perhaps MNG patients with demonstrated goiter growth should be offered surgery earlier in life instead of observation, either before the age of 80 or prior to the development of frailty‐associated comorbidities. Symptomatic MNG patients ≥80 years old should be counseled regarding the more substantial risks of surgery accordingly, while keeping more minimal interventions in mind such as hemithyroidectomy or even ablative procedures [23, 24].…”

Analysis of the risk factors of negative emotions in patients undergoing microwave ablation of thyroid nodules during the perioperative period and its impact on prognosis: a prospective cohort study

“…Liang et al conducted ultrasound guided MWA in 474 cases of benign TNs and followed up for one year. The study showed that the volume reduction rate (VRR) was 94% 12 months later, and the VRR of nodules with cystic components was significantly higher than that of solid and solid components, which confirmed the safety and effectiveness of MWA in treating benign TNs (7)(8)(9)(10). In addition, some studies have demonstrated the efficacy of MWA on solid TNs, with a VRR of 45-65% over a 1-12 months follow-up period (7,(11)(12)(13)(14).…”

A critical update on the management of retrosternal goiter

“…Ultrasound-guided microwave TCA of RG combined with ethanol injection was reported as an effective and safe treatment for solitary nodular RG, especially for patients who are ineligible or unwilling to receive surgical treatment 46,47 . A first preliminary experience was presented by Cui et al in 2018 on 10 patients a mean volume reduction ratio (VRR) of around 67% was reported after one month, while no local (pain, hematoma, etc.)…”

“…or functional (thyrotoxicosis crisis, changes in TSH, etc.) adverse events were reported 46 . In a subsequent prospective study from the same hospital involving 72 patients (mean age 47.8 years) and with a mean follow-up of 23.9 months, TCA yielded a mean VRR of 83.12 ± 12.74 % (range: 52.01-100%) after one year; 57 patients (79.2%) showed a total regression of the intrathoracic extension (by CT scan) while 8 patients (11.1%) needed a second procedure because of "regrowth of unsatisfactory reduction".…”