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Role of second high-intensity focused ultrasound (HIFU) treatment for unsatisfactory benign thyroid nodules after first treatment

European Radiology volume 29, pages 1469–1478 (2019)Cite this article

Abstract

Background

We aimed to assess the efficacy and safety of second high-intensity focused ultrasound (HIFU) ablation treatment in benign thyroid nodules that had failed to shrink by > 50% 6 months after the first treatment.

Methods

Twenty-eight patients who did not achieve 50% volume reduction at 6 months after the first HIFU treatment underwent a second HIFU treatment. Nodule volume was measured on ultrasound at baseline, 3 months and 6 months. Extent of nodule shrinkage (by volume reduction ratio) (VRR) = [Baseline volume – volume at 6 months]/[Baseline volume] * 100. Treatment success was defined as VRR > 50%. Obstructive symptom score (by 0–10 visual analogue scale, VAS) was evaluated for 6 months after treatment.

Results

No complications occurred after the second treatment. The mean 6-month VRR was 21.78 ± 16.87% with a median (range) of 16.16 (1.63–54.07)%. At 6 months, only two (7.1%) patients achieved treatment success, while nine (32.1%) patients had VRR < 10%. However, relative to baseline (3.96 ± 1.04), the mean VAS significantly improved at 3 and 6 months (2.96 ± 1.43, p<0.001 and 2.58 ± 1.39, p<0.001, respectively). There was a significant correlation between VRR and improvement in VAS score at 6 months (ρ=0.438, p=0.025). Greater nodule volume before the second treatment (OR=1.169, 95% CI=1.004–1.361, p=0.045) was a significant factor for greater VRR after the second treatment.

Conclusions

Although subjective obstructive symptoms continued to improve after the second treatment, the actual extent of nodule shrinkage was small. Larger-volume nodules tended to shrink more significantly than smaller-volume nodules in the second treatment.

Key Points

• Second treatment resulted in small shrinkage in unsatisfactory nodules after first treatment.

• Obstructive symptoms tended to continue to improve after second treatment.

• Larger-size nodules tended to respond better in the second treatment.

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Abbreviations

HIFU:

High-intensity focused ultrasound

TSH:

Thyroid stimulating hormone

US:

Ultrasonography

VCP:

Vocal cord palsy

VRR:

Volume reduction ratio

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Acknowledgements

We would like to thank Mr. Hill Yu and Ms. Li Wing Kar for conducting all the symptom (or VAS score) 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.

Funding

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

Author information

Affiliations

  1. Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China

    Brian Hung-Hin Lang

  2. Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, SAR, China

    Brian Hung-Hin Lang

  3. Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China

    Yu-Cho Woo

  4. Department of Radiology, The University of Hong Kong, Hong Kong, SAR, China

    Keith Wan-Hang Chiu

Authors
  1. Brian Hung-Hin Lang
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  2. Yu-Cho Woo
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  3. Keith Wan-Hang Chiu
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Corresponding author

Correspondence to Brian Hung-Hin Lang.

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Guarantor

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.

Methodology

• Retrospective

• Observational

• Single institution

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Cite this article

Lang, B.HH., Woo, YC. & Chiu, K.WH. Role of second high-intensity focused ultrasound (HIFU) treatment for unsatisfactory benign thyroid nodules after first treatment. Eur Radiol 29, 1469–1478 (2019). https://doi.org/10.1007/s00330-018-5671-0

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  • DOI: https://doi.org/10.1007/s00330-018-5671-0

Keywords

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