European Radiology

, Volume 29, Issue 1, pp 93–101 | Cite as

Two-year efficacy of single-session high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules

  • Brian H. H. LangEmail author
  • Yu-Cho Woo
  • Keith Wan-Hang Chiu



Assessing the efficacy of single high-intensity focused ultrasound (HIFU) ablation in benign thyroid nodules beyond 12 months.


One hundred and eight patients underwent single HIFU treatment. Extent of nodule shrinkage [by volume reduction ratio (VRR)] and obstructive symptom score [by 0-10 visual analogue scale (VAS)] were evaluated for 24 months after treatment. VRR (%) was calculated based on the formula: [baseline volume – volume at visit] / [baseline volume] × 100. Binary logistic regression was performed to evaluate factors associated with 24-month treatment success (VRR ≥ 50%).


After treatment, the mean (± SD) VRR at 3, 6, 12 ,18 and 24 months were 51.32 ± 20.71%, 62.99 ± 22.05%, 68.66 ± 18.48%, 69.76 ± 17.88% and 70.41 ± 17.39%, respectively, while the median (IQR) VAS at baseline, 6, 12 and 24 months was gradually lowered from 4.0 (2.0), 2.0 (1.0), 2.0 (1.0) to 1.0 (2.0), respectively. Sixty-three (58.3%) nodules had a further volume reduction (i.e. > 4.5%) from 12 to 24 months, while 22 (20.4%) nodules had a volume increase of > 4.5% from 12 to 24 months. Small pre-ablation nodule volume was a significant determinant for treatment success at 24 months (OR=1.045, 95% CI=1.021–1.092, p = 0.038).


A majority of nodules had further volume reduction beyond 12 months after single HIFU ablation, but since one-fifth of nodules had a notable volume increase beyond 12 months, a longer period of surveillance would be necessary. Small pre-ablation nodule volume was a significant factor determining 24-month treatment success.

Key Points

• Small but significant nodule shrinkage continues beyond 12 months after single treatment.

• Obstructive symptom continues to improve beyond 12 months after single treatment

• Smaller-sized nodules have a greater chance of treatment success at 24 months


Interventional ultrasonography High-intensity focused ultrasound ablation Treatment efficacy Ultrasound imaging Ablation techniques 



High-intensity focused ultrasound


Thyroid stimulating hormone


Vocal cord palsy


Volume reduction ratio



We would like to thank Mr. Hill Yu for conducting all the symptom assessments for the entire study period and Professor Stephen Cheng (Head of Department of Surgery, University of Hong Kong) for agreeing to be the guarantor of this paper.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Professor Stephen Cheng (Head of Department).

Conflict of interest

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.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The 6- and 12-month outcomes of 22 patients were previously reported in a small prospective study [9].


• Retrospective

• Observational

• Single institution


  1. 1.
    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 22:622–639CrossRefGoogle Scholar
  2. 2.
    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 26:1–133CrossRefGoogle Scholar
  3. 3.
    Durante C, Costante G, Lucisano G et al (2015) The natural history of benign thyroid nodules. JAMA 313:926–935CrossRefGoogle Scholar
  4. 4.
    Mauri G, Cova L, Monaco CG et al (2016) Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA). Int J Hyperth 15:1–5Google Scholar
  5. 5.
    Pacella CM, Mauri G, Achille G et al (2015) Outcomes and risk factors for complications of laser ablation for thyroid nodules: a multicenter study on 1531 patients. J Clin Endocrinol Metab 100:3903–3910CrossRefGoogle Scholar
  6. 6.
    Pacella CM, Mauri G, Cesareo R et al (2017) A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis. Int J Hyperth 33:911–919Google Scholar
  7. 7.
    Korkusuz H, Fehre N, Sennert M, Happel C, Grünwald F (2015) Volume reduction of benign thyroid nodules 3 months after a single treatment with high-intensity focused ultrasound (HIFU). J Ther Ultrasound 3:4. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kovatcheva RD, Vlahov JD, Stoinov JI, Zaletel K (2015) Benign solid thyroid nodules: US-guided high-intensity focused ultrasound ablation-initial clinical outcomes. Radiology 276:597–605CrossRefGoogle Scholar
  9. 9.
    Lang BH, Woo YC, Wong CKH (2017) High-intensity focused ultrasound for treatment of symptomatic benign thyroid nodules: a prospective study. Radiology 284:897–906CrossRefGoogle Scholar
  10. 10.
    Mauri G, Nicosia L, Xu Z et al (2018) Focused ultrasound: tumour ablation and its potential to enhance immunological therapy to cancer. Br J Radiol 91:20170641CrossRefGoogle Scholar
  11. 11.
    Hoogenboom M, Eikelenboom D, den Brok MH, Heerschap A, Fütterer JJ, Adema GJ (2015) Mechanical high-intensity focused ultrasound destruction of soft tissue: working mechanisms and physiologic effects. Ultrasound Med Biol 41:1500–1517CrossRefGoogle Scholar
  12. 12.
    Lim HK, Lee JH, Ha EJ, Sung JY, Kim JK, Baek JH (2013) Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients. Eur Radiol 23:1044–1049CrossRefGoogle Scholar
  13. 13.
    Papini E, Rago T, Gambelunghe G et al (2014) Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules. Results of a three-year multicenter prospective randomized trial. J Clin Endocrinol Metab 99:3653–3659CrossRefGoogle Scholar
  14. 14.
    Spiezia S, Garberoglio R, Milone F et al (2009) Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid 19:219–225CrossRefGoogle Scholar
  15. 15.
    Valcavi R, Riganti F, Bertani A, Formisano D, Pacella CM (2010) Percutaneous laser ablation of cold benign thyroid nodules: a 3-year follow-up study in 122 patients. Thyroid 20:1253–1261CrossRefGoogle Scholar
  16. 16.
    Lang BH, Wong CKH, Wong KP, Chu KK, Shek TWH (2017) Effect of thyroid remnant volume on the risk of hypothyroidism after hemithyroidectomy: a prospective study. Ann Surg Oncol 24:1525–1532CrossRefGoogle Scholar
  17. 17.
    Zimmermann M, Saad A, Hess S, Torresani T, Chaouki N (2000) Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency. Eur J Endocrinol 143:727–731CrossRefGoogle Scholar
  18. 18.
    Wong KP, Lang BH, Ng SH, Cheung CY, Chan CT, Lo CY (2013) A prospective, assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surgery 154:1158–1164CrossRefGoogle Scholar
  19. 19.
    Baek JH (2017) Factors related to the efficacy of radiofrequency ablation for benign thyroid nodules. Ultrasonography 36:385–386CrossRefGoogle Scholar
  20. 20.
    Huh JY, Baek JH, Choi H, Kim JK, Lee JH (2012) Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session: prospective randomized study. Radiology 263:909–916CrossRefGoogle Scholar
  21. 21.
    Lang BH, Woo YC, Chiu KW (2017) Single-session high-intensity focused ultrasound treatment in large-sized benign thyroid nodules. Thyroid 27:714–721CrossRefGoogle Scholar
  22. 22.
    Lang BHH, Woo YC, Chiu KW (2018) Sequential high intensity focused ultrasound (HIFU) ablation in the treatment of benign multinodular goitre: an observational retrospective study. Eur Radiol.

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of SurgeryThe University of Hong KongHong KongChina
  2. 2.Department of SurgeryQueen Mary HospitalHong KongChina
  3. 3.Department of MedicineThe University of Hong KongHong KongChina
  4. 4.Department of RadiologyThe University of Hong KongHong KongChina

Personalised recommendations