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Endocrine

pp 1–6 | Cite as

Successful radiofrequency ablation strategies for benign thyroid nodules

  • Gee Mun Lee
  • Ji Young You
  • Hoon Yub Kim
  • Young Jun Chai
  • Hong Kyu Kim
  • Gianlorenzo Dionigi
  • Ralph P. Tufano
Original Article

Abstract

Purpose

This study aimed to evaluate the effectiveness of ultrasound (US)-guided radiofrequency ablation (RFA) treatment of benign thyroid nodules in consecutive large number series. To find out whether there is any difference according to the nature of the nodules, nodules were subdivided into two groups of predominantly solid vs. predominantly cystic lesions.

Methods

We retrospectively analyzed clinical data of thyroid nodules receiving percutaneous RFA treatment in our institution. We subdivided data into two groups according to the nodule’s sonographic characteristics. We defined therapeutic success as a volume reduction rate >50% at 6 months post-RFA. The second ablation was performed in case where <50% VRR was achieved at 6 months. The primary endpoint was to identify factors prognosticating response to RFA treatment.

Results

A total of 1000 patients with 1619 thyroid nodules received US-guided RFA treatment. A volume reduction of >50% (therapeutic success) after the first ablation was 78.9% vs. 78.2% (p = 0.439) and 91.4% vs. 93.4% (p = 0.148) after the final ablation for predominantly cystic vs. predominantly solid lesions, respectively, with comparable post-interventional morbidity. RFA sessions were more frequent in the solid group than in the cystic group. Small volume of thyroid nodule (<4 mL) was the only factor significantly associated with therapeutic success in the multivariate analysis (OR 1.848; 95% CI 1.537–2.789, p = 0.030).

Conclusion

RFA was effective in reducing the volume of benign thyroid nodules volume with non-inferior result in PS group comparing to PC group and can be considered a principal treatment method for treating benign thyroid nodules, including cystic nodules.

Keywords

Radiofrequency ablation Benign thyroid nodule Volume reduction Therapeutic success Nature of thyroid nodule 

Notes

Acknowledgements

This work was supported by a Korea University grant (K1710691).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent is not required.

References

  1. 1.
    H. Gharib, E. Papini, R. Paschke, D.S. Duick, R. Valcavi, L. Hegedus, P. Vitti, A.A.E.T.Fo.T. Nodules, American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. J. Endocrinol. Invest. 33, 1–50 (2010). 5 SupplCrossRefGoogle Scholar
  2. 2.
    S. Guth, U. Theune, J. Aberle, A. Galach, C.M. Bamberger, Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur. J. Clin. Invest. 39, 699–706 (2009)CrossRefGoogle Scholar
  3. 3.
    R. Smith-Bindman, D.L. Miglioretti, E. Johnson, C. Lee, H.S. Feigelson, M. Flynn, R.T. Greenlee, R.L. Kruger, M.C. Hornbrook, D. Roblin, L.I. Solberg, N. Vanneman, S. Weinmann, A.E. Williams, Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA 307, 2400–2409 (2012)CrossRefGoogle Scholar
  4. 4.
    American Thyroid Association Guidelines Taskforce on Thyroid, Nodules and Differentiated Thyroid Cancer, D.S. Cooper, G.M. Doherty, B.R. Haugen, R.T. Kloos, S.L. Lee, S.J. Mandel, E.L. Mazzaferri, B. McIver, F. Pacini, M. Schlumberger, S.I. Sherman, D.L. Steward, R.M: Tuttle, Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19, 1167–1214 (2009)CrossRefGoogle Scholar
  5. 5.
    C.C. Tsai, D. Pei, Y.J. Hung, T.F. Wang, W.C. Tsai, C.Y. Yao, M.C. Hsieh, S.W. Kuo, The effect of thyroxine-suppressive therapy in patients with solitary non-toxic thyroid nodules -- a randomised, double-blind, placebo-controlled study. Int. J. Clin. Pract. 60, 23–26 (2006)CrossRefGoogle Scholar
  6. 6.
    N. Lima, M. Knobel, H. Cavaliere, C. Sztejnsznajd, E. Tomimori, G. Medeiros-Neto, Levothyroxine suppressive therapy is partially effective in treating patients with benign, solid thyroid nodules and multinodular goiters. Thyroid 7, 691–697 (1997)CrossRefGoogle Scholar
  7. 7.
    H. Gharib, L. Hegedus, C.M. Pacella, J.H. Baek, E. Papini, Clinical review: Nonsurgical, image-guided, minimally invasive therapy for thyroid nodules. J. Clin. Endocrinol. Metab. 98, 3949–3957 (2013)CrossRefGoogle Scholar
  8. 8.
    A. Bergenfelz, S. Jansson, A. Kristoffersson, H. Martensson, E. Reihner, G. Wallin, I. Lausen, Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Lange. Arch. Surg. 393, 667–673 (2008)CrossRefGoogle Scholar
  9. 9.
    L. Hegedus, Therapy: a new nonsurgical therapy option for benign thyroid nodules? Nat. Rev. Endocrinol. 5, 476–478 (2009)CrossRefGoogle Scholar
  10. 10.
    E. Papini, R. Guglielmi, G. Bizzarri, F. Graziano, A. Bianchini, C. Brufani, S. Pacella, D. Valle, C.M. Pacella, Treatment of benign cold thyroid nodules: a randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up. Thyroid 17, 229–235 (2007)CrossRefGoogle Scholar
  11. 11.
    M. Deandrea, P. Limone, E. Basso, A. Mormile, F. Ragazzoni, E. Gamarra, S. Spiezia, A. Faggiano, A. Colao, F. Molinari, R. Garberoglio, US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules. Ultrasound Med. Biol. 34, 784–791 (2008)CrossRefGoogle Scholar
  12. 12.
    S.M. Kim, J.H. Baek, Y.S. Kim, J.Y. Sung, H.K. Lim, H. Choi, J.H. Lee, Efficacy and safety of ethanol ablation for thyroglossal duct cysts. AJNR Am. J. Neuroradiol. 32, 306–309 (2011)CrossRefGoogle Scholar
  13. 13.
    E.J. Ha, J.H. Baek, K.W. Kim, J. Pyo, J.H. Lee, S.H. Baek, H. Dossing, L. Hegedus, Comparative efficacy of radiofrequency and laser ablation for the treatment of benign thyroid nodules: systematic review including traditional pooling and Bayesian network meta-analysis. J. Clin. Endocrinol. Metab. 100, 1903–1911 (2015)CrossRefGoogle Scholar
  14. 14.
    D.E. Dupuy, S.N. Goldberg, Image-guided radiofrequency tumor ablation: challenges and opportunities--part II. J. Vasc. Interv. Radiol. 12, 1135–1148 (2001)CrossRefGoogle Scholar
  15. 15.
    J.H. Baek, H.J. Jeong, Y.S. Kim, M.S. Kwak, D. Lee, Radiofrequency ablation for an autonomously functioning thyroid nodule. Thyroid 18, 675–676 (2008)CrossRefGoogle Scholar
  16. 16.
    W.K. Jeong, J.H. Baek, H. Rhim, Y.S. Kim, M.S. Kwak, H.J. Jeong, D. Lee, Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. Eur. Radiol. 18, 1244–1250 (2008)CrossRefGoogle Scholar
  17. 17.
    C.W. Fuller, S.A. Nguyen, S. Lohia, M.B. Gillespie, Radiofrequency ablation for treatment of benign thyroid nodules: systematic review. Laryngoscope 124, 346–353 (2014)CrossRefGoogle Scholar
  18. 18.
    W.J. Moon, J.H. Baek, S.L. Jung, D.W. Kim, E.K. Kim, J.Y. Kim, J.Y. Kwak, J.H. Lee, J.H. Lee, Y.H. Lee, D.G. Na, J.S. Park, S.W. Park, Korean Society of Thyroid Radiology, Korean Society of Radiology, Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J. Radiol. 12, 1–14 (2011).CrossRefGoogle Scholar
  19. 19.
    J.Y. Sung, Y.S. Kim, H. Choi, J.H. Lee, J.H. Baek, Optimum first-line treatment technique for benign cystic thyroid nodules: ethanol ablation or radiofrequency ablation? AJR Am. J. Roentgenol. 196, W210–W214 (2011)CrossRefGoogle Scholar
  20. 20.
    E.J. Ha, J.H. Baek, J.H. Lee, Moving-shot versus fixed electrode techniques for radiofrequency ablation: comparison in an ex-vivo bovine liver tissue model. Korean J. Radiol. 15, 836–843 (2014)CrossRefGoogle Scholar
  21. 21.
    R. Cesareo, V. Pasqualini, C. Simeoni, M. Sacchi, E. Saralli, G. Campagna, R. Cianni, Prospective study of effectiveness of ultrasound-guided radiofrequency ablation versus control group in patients affected by benign thyroid nodules. J. Clin. Endocrinol. Metab. 100, 460–466 (2015)CrossRefGoogle Scholar
  22. 22.
    G. Mauri, L. Cova, C.G. Monaco, L.M. Sconfienza, S. Corbetta, S. Benedini, F. Ambrogi, V. Milani, A. Baroli, T. Ierace, L. Solbiati, Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA). Int. J. Hyperthermia (2016).  https://doi.org/10.1080/02656736.2016.1244707
  23. 23.
    M. Radzina, V. Cantisani, M. Rauda, M.B. Nielsen, C. Ewertsen, F. D’Ambrosio, P. Prieditis, S. Sorrenti, Update on the role of ultrasound guided radiofrequency ablation for thyroid nodule treatment. Int. J. Surg. 41(Suppl 1), S82–S93 (2017).CrossRefGoogle Scholar
  24. 24.
    J.H. Shin, J.H. Baek, J. Chung, E.J. Ha, J.H. Kim, Y.H. Lee, H.K. Lim, W.J. Moon, D.G. Na, J.S. Park, Y.J. Choi, S.Y. Hahn, S.J. Jeon, S.L. Jung, D.W. Kim, E.K. Kim, J.Y. Kwak, C.Y. Lee, H.J. Lee, J.H. Lee, J.H. Lee, K.H. Lee, S.W. Park, J.Y. Sung, Korean Society of Thyroid Radiology, Korean Society of Radiology, Ultrasonography diagnosis and imaging-based management of thyroid nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J. Radiol. 17, 370–395 (2016)CrossRefGoogle Scholar
  25. 25.
    J.H. Lee, Y.S. Kim, D. Lee, H. Choi, H. Yoo, J.H. Baek, Radiofrequency ablation (RFA) of benign thyroid nodules in patients with incompletely resolved clinical problems after ethanol ablation (EA). World J. Surg. 34, 1488–1493 (2010)CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Gee Mun Lee
    • 1
  • Ji Young You
    • 2
  • Hoon Yub Kim
    • 2
  • Young Jun Chai
    • 3
  • Hong Kyu Kim
    • 2
  • Gianlorenzo Dionigi
    • 4
  • Ralph P. Tufano
    • 5
  1. 1.Kangbuk Seoul SurgerySeoulKorea
  2. 2.Department of Surgery, KUMC Thyroid Center, Korea University HospitalKorea University College of MedicineSeoulKorea
  3. 3.Department of SurgerySeoul Metropolitan Government – Seoul National University Boramae Medical CenterSeoulKorea
  4. 4.Division for Endocrine and Minimal Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi’, University Hospital “G. Martino”University of MessinaMessinaItaly
  5. 5.Department of Otolaryngology – Head and Neck SurgeryThe Johns Hopkins University School of MedicineBaltimoreUSA

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