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Comparison of efficacy and safety of different minimally invasive therapies for thyroid nodules: A network meta-analysis

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Abstract

Objective

This study aimed to compare efficacy and safety of minimally invasive therapies such as radiofrequency ablation (RFA), microwave ablation (MWA), ethanol ablation (EA), and laser ablation (LA) for thyroid nodules through network meta-analysis (NMA).

Methods

This study searched PubMed, Web of Science, Embase, and The Cochrane Library databases to collect randomized controlled trials (RCTs) or cohort studies comparing efficacy and safety of different minimally invasive therapies for thyroid nodules. Newcastle-Ottawa Scale (NOS) was implemented to assess quality of included cohort studies, and Cochrane risk of bias assessment tool was utilized to evaluate quality of included RCTs. Eligible studies contained at least one of the following clinical outcome measures: volume reduction rate (VRR), symptom score, cosmetic score, nodule regrowth rate, and complication rate. STATA software was utilized for NMA.

Results

Sixteen eligible studies (4 RCTs, 11 retrospective cohort studies, 1 prospective cohort study) involved 4094 patients. NMA results revealed that RFA group had the highest VRR at 1 months and 12 months. There were no significant differences in symptom scores and cosmetic scores among all treatment methods, with the lowest symptom scores and cosmetic scores in RFA group. LA group had a significantly higher nodule regrowth rate than RFA and MWA groups, with the lowest in RFA group. There were no significant differences in complication rate among all treatment methods.

Conclusion

RFA had the highest VRR for thyroid nodules, and it excelled in symptom scores, cosmetic scores, and nodule regrowth rates.

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References

  1. N.A. Cipriani, M.G. White, P. Angelos, R.H. Grogan, Large cytologically benign thyroid nodules do not have high rates of malignancy or false-negative rates and clinical observation should be considered: A meta-analysis. Thyroid 28, 1595–1608 (2018)

    Article  PubMed  Google Scholar 

  2. R.E. Weiss, J. Lado-Abeal, Thyroid nodules: diagnosis and therapy. Curr. Opin. Oncol. 14, 46–52 (2002)

    Article  PubMed  Google Scholar 

  3. E.K. Alexander, S. Hurwitz, J.P. Heering, C.B. Benson, M.C. Frates, P.M. Doubilet et al. Natural history of benign solid and cystic thyroid nodules. Ann. Intern Med. 138, 315–318 (2003)

    Article  PubMed  Google Scholar 

  4. C. Durante, G. Grani, L. Lamartina, S. Filetti, S.J. Mandel, D.S. Cooper, The diagnosis and management of thyroid nodules: A review. JAMA 319, 914–924 (2018)

    Article  PubMed  Google Scholar 

  5. K. Kariyama, A. Wakuta, M. Nishimura, M. Kishida, A. Oonishi, A. Ohyama et al. Percutaneous radiofrequency ablation for intermediate-stage hepatocellular carcinoma. Oncology 89(Suppl 2), 19–26 (2015)

    Article  PubMed  Google Scholar 

  6. M. Barral, A. Auperin, A. Hakime, V. Cartier, V. Tacher, Y. Otmezguine et al. Percutaneous thermal ablation of breast cancer metastases in oligometastatic patients. Cardiovasc Interv. Radio. 39, 885–893 (2016)

    Article  CAS  Google Scholar 

  7. S. Chheang, F. Abtin, A. Guteirrez, S. Genshaft, R. Suh, Imaging features following thermal ablation of lung malignancies. Semin Interv. Radio. 30, 157–168 (2013)

    Article  Google Scholar 

  8. Z. Cheng, P. Liang, Advances in ultrasound-guided thermal ablation for symptomatic benign thyroid nodules. Adv. Clin. Exp. Med 29, 1123–1129 (2020)

    Article  PubMed  Google Scholar 

  9. A.P. Mainini, C. Monaco, L.C. Pescatori, C. De Angelis, F. Sardanelli, L.M. Sconfienza et al. Image-guided thermal ablation of benign thyroid nodules. J. Ultrasound 20, 11–22 (2017)

    Article  PubMed  Google Scholar 

  10. N.M. Iniguez-Ariza, R.A. Lee, N.M. Singh-Ospina, M.N. Stan, M.R. Castro, Ethanol ablation for the treatment of cystic and predominantly cystic thyroid nodules. Mayo Clin. Proc. 93, 1009–1017 (2018)

    Article  CAS  PubMed  Google Scholar 

  11. A. Chorti, V. Bontinis, G. Tzikos, A. Bontinis, A. Ioannidis, A. Michalopoulos et al. Minimally invasive treatments of benign thyroid nodules: a network meta-analysis of short-term outcomes. Thyroid 33, 950–964 (2023)

    Article  PubMed  Google Scholar 

  12. F.N. Bennedbaek, L. Hegedus, Treatment of recurrent thyroid cysts with ethanol: a randomized double-blind controlled trial. J. Clin. Endocrinol. Metab. 88, 5773–5777 (2003)

    Article  CAS  PubMed  Google Scholar 

  13. S. Del Prete, M. Caraglia, D. Russo, G. Vitale, G. Giuberti, M. Marra et al. Percutaneous ethanol injection efficacy in the treatment of large symptomatic thyroid cystic nodules: ten-year follow-up of a large series. Thyroid 12, 815–821 (2002)

    Article  PubMed  Google Scholar 

  14. J.H. Kim, H.K. Lee, J.H. Lee, I.M. Ahn, C.G. Choi, Efficacy of sonographically guided percutaneous ethanol injection for treatment of thyroid cysts versus solid thyroid nodules. AJR Am. J. Roentgenol. 180, 1723–1726 (2003)

    Article  PubMed  Google Scholar 

  15. K. Yasuda, O. Ozaki, K. Sugino, T. Yamashita, K. Toshima, K. Ito et al. Treatment of cystic lesions of the thyroid by ethanol instillation. World J. Surg. 16, 958–961 (1992)

    Article  CAS  PubMed  Google Scholar 

  16. Y.S. Cho, H.K. Lee, I.M. Ahn, S.M. Lim, D.H. Kim, C.G. Choi et al. Sonographically guided ethanol sclerotherapy for benign thyroid cysts: results in 22 patients. AJR Am. J. Roentgenol. 174, 213–216 (2000)

    Article  CAS  PubMed  Google Scholar 

  17. F. Monzani, F. Lippi, O. Goletti, P. Del Guerra, N. Caraccio, P.V. Lippolis et al. Percutaneous aspiration and ethanol sclerotherapy for thyroid cysts. J. Clin. Endocrinol. Metab. 78, 800–802 (1994)

    CAS  PubMed  Google Scholar 

  18. M. Zingrillo, M. Torlontano, R. Chiarella, M.R. Ghiggi, V. Nirchio, M. Bisceglia et al. Percutaneous ethanol injection may be a definitive treatment for symptomatic thyroid cystic nodules not treatable by surgery: five-year follow-up study. Thyroid 9, 763–767 (1999)

    Article  CAS  PubMed  Google Scholar 

  19. G. Verde, E. Papini, C.M. Pacella, C. Gallotti, S. Delpiano, S. Strada et al. Ultrasound guided percutaneous ethanol injection in the treatment of cystic thyroid nodules. Clin. Endocrinol. (Oxf.) 41, 719–724 (1994)

    Article  CAS  PubMed  Google Scholar 

  20. S.J. Lee, I.M. Ahn, Effectiveness of percutaneous ethanol injection therapy in benign nodular and cystic thyroid diseases: long-term follow-up experience. Endocr. J. 52, 455–462 (2005)

    Article  CAS  PubMed  Google Scholar 

  21. F.N. Bennedbaek, L.K. Nielsen, L. Hegedus, Effect of percutaneous ethanol injection therapy versus suppressive doses of L-thyroxine on benign solitary solid cold thyroid nodules: a randomized trial. J. Clin. Endocrinol. Metab. 83, 830–835 (1998)

    Article  CAS  PubMed  Google Scholar 

  22. 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)

    Article  PubMed  Google Scholar 

  23. C.K. Baldwin, M.B. Natter, K.N. Patel, S.P. Hodak, Minimally invasive techniques for the management of thyroid nodules. Endocrinol. Metab. Clin. North Am. 51, 323–349 (2022)

    Article  PubMed  Google Scholar 

  24. T. Cui, C. Jin, D. Jiao, D. Teng, G. Sui, Safety and efficacy of microwave ablation for benign thyroid nodules and papillary thyroid microcarcinomas: A systematic review and meta-analysis. Eur. J. Radio. 118, 58–64 (2019)

    Article  Google Scholar 

  25. M. Ahmed, C.L. Brace, F.T. Lee Jr, S.N. Goldberg, Principles of and advances in percutaneous ablation. Radiology 258, 351–369 (2011)

    Article  PubMed  Google Scholar 

  26. E.M. Knavel, C.L. Brace, Tumor ablation: common modalities and general practices. Tech. Vasc. Inter. Radio. 16, 192–200 (2013)

    Article  Google Scholar 

  27. J.H. Shin, J.H. Baek, E.J. Ha, J.H. Lee, Radiofrequency ablation of thyroid nodules: basic principles and clinical application. Int J. Endocrinol. 2012, 919650 (2012)

    Article  PubMed  PubMed Central  Google Scholar 

  28. J.P. Ritz, K.S. Lehmann, U. Zurbuchen, V. Knappe, T. Schumann, H.J. Buhr et al. Ex vivo and in vivo evaluation of laser-induced thermotherapy for nodular thyroid disease. Lasers Surg. Med 41, 479–486 (2009)

    Article  PubMed  Google Scholar 

  29. S.N. Goldberg, G.S. Gazelle, S.L. Dawson, W.J. Rittman, P.R. Mueller, D.I. Rosenthal, Tissue ablation with radiofrequency: effect of probe size, gauge, duration, and temperature on lesion volume. Acad. Radio. 2, 399–404 (1995)

    Article  CAS  Google Scholar 

  30. G. Mauri, L. Cova, C.G. Monaco, L.M. Sconfienza, S. Corbetta, S. Benedini et al. Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA). Int J. Hyperth. 33, 295–299 (2017)

    Article  CAS  Google Scholar 

  31. J.S. Sim, J.H. Baek, Long-term outcomes following thermal ablation of benign thyroid nodules as an alternative to surgery: The importance of controlling regrowth. Endocrinol. Metab. (Seoul.) 34, 117–123 (2019)

    Article  PubMed  PubMed Central  Google Scholar 

  32. W.K. Jeong, J.H. Baek, H. Rhim, Y.S. Kim, M.S. Kwak, H.J. Jeong et al. Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. Eur. Radio. 18, 1244–1250 (2008)

    Article  Google Scholar 

  33. Y.S. Kim, H. Rhim, K. Tae, D.W. Park, S.T. Kim, Radiofrequency ablation of benign cold thyroid nodules: Initial clinical experience. Thyroid 16, 361–367 (2006)

    Article  PubMed  Google Scholar 

  34. H.K. Lim, J.H. Baek, J.H. Lee, W.B. Kim, T.Y. Kim, Y.K. Shong et al. Efficacy and safety of radiofrequency ablation for treating locoregional recurrence from papillary thyroid cancer. Eur. Radio. 25, 163–170 (2015)

    Article  Google Scholar 

  35. H. Jin, J. Fan, K. Liao, Z. He, W. Li, M. Cui, A propensity score matching study between ultrasound-guided percutaneous microwave ablation and conventional thyroidectomy for benign thyroid nodules treatment. Int. J. Hyperth. 35, 232–238 (2018)

    Article  Google Scholar 

  36. J.H. Baek, E.J. Ha, Y.J. Choi, J.Y. Sung, J.K. Kim, Y.K. Shong, Radiofrequency versus ethanol ablation for treating predominantly cystic thyroid nodules: A randomized clinical trial. Korean J. Radio. 16, 1332–1340 (2015)

    Article  Google Scholar 

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Funding

This study was supported by the Natural Science Foundation of Shanxi Health Commission (No. 2022018).

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Authors and Affiliations

  1. Department of Oncology, General Hospital of Yangquan Coal Industry Group, Yangquan, Shanxi Province, China

    Wei Yuan & Liju Di

  2. Department of Oncology and Interventional Radiology, Yang Quan Hospital of Shanxi Medical University, Yangquan, Shanxi Province, China

    Wei Yuan & Liju Di

  3. Department of ultrasonography, General Hospital of Yang Quan Coal Industry Group, Yangquan, Shanxi Province, China

    Xiaoxin Yu

  4. Department of endocrinology, General Hospital of Yang Quan Coal Industry Group, Yangquan, Shanxi Province, China

    Jian Li

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  1. Wei Yuan
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All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.

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Correspondence to Wei Yuan.

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Yuan, W., Di, L., Yu, X. et al. Comparison of efficacy and safety of different minimally invasive therapies for thyroid nodules: A network meta-analysis. Endocrine (2024). https://doi.org/10.1007/s12020-024-03782-8

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