Abstract
Objective
To assess severity and factors of pain during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules.
Methods
128 patients who underwent a HIFU ablation for a benign thyroid nodule were analysed. All patients received a bolus of intravenous pethidine and diazepam before treatment. After treatment, patients were asked to rate their overall pain experience on a visual analogue scale (0–100) (0 = no pain; 100 = worse possible pain) during treatment, 2 h after treatment and the following morning. Binary logistic regression was performed to evaluate associated factors for pain including patient demographics, nodule size, body mass index (BMI) and treatment parameters.
Results
At T1, median (range) pain score was 65.0 (0.00–100.00). Only 16 (12.5 %) patients had a pain score of zero. In multivariate analysis, only lower BMI (OR 1.265, 95 % CI 1.102–1.452, p=0.001) and longer nodule diameter (OR 1.462, 95 % CI 1.071–1.996, p=0.017) were independent factors for pain score at T1 ≤ 65.0.
Conclusions
A moderate to severe amount of pain was reported during ablation of benign thyroid nodules in over 50 % of patients. Patients’ BMI and length of nodule diameter were independent variables for pain during HIFU ablation.
Key Points
• Pain was moderate to severe during HIFU ablation of thyroid nodules.
• Only one in eight patients reported no pain during ablation.
• Level of energy per pulse did not affect pain.
• Patients with lower BMI and larger nodules had less pain.
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Abbreviations
- BMI:
-
Body mass index
- HIFU:
-
High-intensity focused ultrasound
- RFA:
-
Radiofrequency ablation
- US:
-
Ultrasonography
- VAS:
-
Visual analogue scale
- VRR:
-
Volume reduction ratio
References
Gharib H, Papini E, Garber JR et al (2016) AACE/ACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the diagnosis and management of thyroid nodules - 2016 Update. Endocr Pract 22:622–639
Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26:1–133
Durante C, Costante G, Lucisano G et al (2015) The natural history of benign thyroid nodules. JAMA 313:926–935
Korkusuz Y, Gröner D, Raczynski N, Relin O, Kingeter Y, Grünwald F, Happel C (2017) Thermal ablation of thyroid nodules: are radiofrequency ablation, microwave ablation and high intensity focused ultrasound equally safe and effective methods? Eur Radiol. https://doi.org/10.1007/s00330-017-5039-x
Sung JY, Baek JH, Kim KS, Lee D, Yoo H, Kim JK, Park SH (2013) Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation: a prospective randomized study. Radiology 269:293–300
Wong KP, Lang BH (2013) Use of radiofrequency ablation in benign thyroid nodules: a literature review and updates. Int J Endocrinol 2013:428363
Korkusuz H, Sennert M, Fehre N, Happel C, Grünwald F (2014) Local thyroid tissue ablation by high-intensity focused ultrasound: effects on thyroid function and first human feasibility study with hot and cold thyroid nodules. Int J Hyperth 30:480–485
Kovatcheva RD, Vlahov JD, Stoinov JI, Zaletel K (2015) Benign solid thyroid nodules: US-guided high-intensity focused ultrasound ablation-initial clinical outcomes. Radiology 276:597–605
Lang BH, Woo YC, Wong CKH (2017) High-intensity focused ultrasound for treatment of symptomatic benign thyroid nodules: a prospective study. Radiology 284:897–906
Esnault O, Franc B, Ménégaux F et al (2011) High-intensity focused ultrasound ablation of thyroid nodules: first human feasibility study. Thyroid 21:965–973
Lang BH, Wong CKH, Ma EPM (2017) Single-session high intensity focused ablation (HIFU) versus open cervical hemithyroidectomy for benign thyroid nodule: analysis on early efficacy, safety and voice quality. Int J Hyperthermia 33(8):868–874
Peek MCL, Ahmed M, Scudder J, Baker R, Charalampoudis P, Pinder SE, Douek M; HIFU-F Collaborators. (2017) High-intensity focused ultrasound in the treatment of breast fibroadenomata (HIFU-F trial). Int J Hyperthermia 1-8. doi:https://doi.org/10.1080/02656736.2017.1373865
Vaessen HHB, Knuttel FM, van Breugel JMM et al (2017) Moderate-to-deep sedation technique, using propofol and ketamine, allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids: a pilot study. J Ther Ultrasound 5:8. https://doi.org/10.1186/s40349-017-0088-9
Korkusuz H, Fehre N, Sennert M, Happel C, Grünwald F (2014) Early assessment of high-intensity focused ultrasound treatment of benign thyroid nodules by scintigraphic means. J Ther Ultrasound 2:18
Bini F, Trimboli P, Marinozzi F, Giovanella L (2017) Treatment of benign thyroid nodules by high intensity focused ultrasound (HIFU) at different acoustic powers: a study on in-silico phantom. Endocrine. https://doi.org/10.1007/s12020-017-1350-1
Kovatcheva R, Zaletel K (2017) High-intensity focused ultrasound for thyroid nodule ablation: the evidence to date. Rep Med Imaging 10:9–16
McKendall MJ, Haier RJ (1983) Pain sensitivity and obesity. Psychiatry Res 8:119–125
Zahorska-Markiewicz B, Zych P, Kucio C (1988) Pain sensitivity in obesity. Acta Physiol Polon 39:183–187
Lang BH, Woo YC, Chiu KW (2017) Single-session high-intensity focused ultrasound treatment in large-sized benign thyroid nodules. Thyroid 27:714–721
Acknowledgments
We would like to thank Mr. Hill Yu for conducting all the pain assessments during and after HIFU treatment and Professor Stephen Cheng (Head of Department of Surgery, University of Hong Kong) for agreeing to be the guarantor of this paper.
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The authors state that this work has not received any funding.
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The scientific guarantor of this publication is Professor Stephen Cheng (Head of Department)
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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Informed consent
Written informed consent was obtained from all subjects (patients) in this study.
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Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Outcomes of some study subjects or cohorts have been previously reported but data on the appearance of hyperechoic marks have never been reported.
Methodology
• Retrospective
• Observational
• Single institution
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Lang, B.H.H., Woo, YC. & Chiu, K.WH. Evaluation of pain during high-intensity focused ultrasound ablation of benign thyroid nodules. Eur Radiol 28, 2620–2627 (2018). https://doi.org/10.1007/s00330-017-5200-6
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DOI: https://doi.org/10.1007/s00330-017-5200-6