A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis

Abstract Purpose: To compare technique efficacy and safety of laser ablation (LA) and radiofrequency ablation (RFA) in treatment of benign thyroid nodules. Materials and methods: Institutional review board approval was obtained, and patients’ consent was waived. 601 nodules were treated from May 2009 to December 2014 at eight centres, 449 (309 females, age 57 ± 14 years) with LA and 152 (107 females, age 57 ± 14 years) with RFA. A matched cohort composed of 138 patients from each group was selected after adjustment with propensity score matching. Factors influencing volume reduction at 6 and 12 months and complications were evaluated. Results: No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. Mean nodule reduction at 6 and 12 months was −67 ± 19% vs. −57 ± 21% (p < 0.001) − 70 ± 19% vs. −62 ± 22% (p = 0.001) in LA group and in RFA group, respectively. Nodules with volume >30 mL had significantly higher percentage volume reduction at 6 and 12 months (−69 ± 19 vs. −50 ± 21, p = 0.001) and (−73 ± 18 vs. −54 ± 23 8, p = 0.001) in the LA group than in the RFA group, respectively. In both groups, operator’s skills affected the results. Major complications occurred in 4 cases in each group (p = 0.116) Conclusions: LA and RFA showed nearly similar outcome but LA was slightly more effective than RFA in large nodules. Operator’s skills could be crucial in determining the extent of nodule volume reduction regardless of the used technique.

[1]  L. Solbiati,et al.  Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA) , 2017, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[2]  M. Sughayer,et al.  The Bethesda System for Reporting Thyroid Cytopathology: A Meta-Analysis , 2017, Acta Cytologica.

[3]  R. Negro,et al.  Laser ablation is more effective for spongiform than solid thyroid nodules. A 4-year retrospective follow-up study , 2016, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[4]  Christopher L Brace,et al.  Hepatic Thermal Ablation: Effect of Device and Heating Parameters on Local Tissue Reactions and Distant Tumor Growth. , 2016, Radiology.

[5]  H. Gharib,et al.  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. , 2016, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[6]  E. di Stasio,et al.  Ultrasound‐guided percutaneous laser ablation in treating symptomatic solid benign thyroid nodules: Our experience in 45 patients , 2016, Head & neck.

[7]  J. Haukoos,et al.  The Propensity Score. , 2015, JAMA.

[8]  E. Papini,et al.  Outcomes and Risk Factors for Complications of Laser Ablation for Thyroid Nodules: A Multicenter Study on 1531 Patients. , 2015, The Journal of clinical endocrinology and metabolism.

[9]  J. Baek,et al.  Efficacy and Safety of Radiofrequency Ablation Versus Observation for Nonfunctioning Benign Thyroid Nodules: A Randomized Controlled International Collaborative Trial. , 2015, Thyroid : official journal of the American Thyroid Association.

[10]  S. Goldberg,et al.  Radiofrequency Ablation: Inflammatory Changes in the Periablative Zone Can Induce Global Organ Effects, including Liver Regeneration. , 2015, Radiology.

[11]  S. Goldberg,et al.  Oncogenesis: An "Off-Target" Effect of Radiofrequency Ablation. , 2015, Radiology.

[12]  Jeong Hyun Lee,et al.  Comparative efficacy of radiofrequency and laser ablation for the treatment of benign thyroid nodules: systematic review including traditional pooling and bayesian network meta-analysis. , 2015, The Journal of clinical endocrinology and metabolism.

[13]  R. Cesareo,et al.  Prospective study of effectiveness of ultrasound-guided radiofrequency ablation versus control group in patients affected by benign thyroid nodules. , 2015, The Journal of clinical endocrinology and metabolism.

[14]  T. Vogl,et al.  Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. , 2014, Journal of vascular and interventional radiology : JVIR.

[15]  E. Papini,et al.  The advent of ultrasound-guided ablation techniques in nodular thyroid disease: towards a patient-tailored approach. , 2014, Best practice & research. Clinical endocrinology & metabolism.

[16]  Y. Yang,et al.  Microwave ablation of benign thyroid nodules. , 2014, Future oncology.

[17]  E. Papini,et al.  Diagnosis of endocrine disease: thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications. , 2014, European journal of endocrinology.

[18]  D. Kallmes,et al.  Behind the numbers: propensity score analysis-a primer for the diagnostic radiologist. , 2013, Radiology.

[19]  Hiroshi Yamamoto,et al.  Comparison of combined transcatheter arterial chemoembolization and radiofrequency ablation with surgical resection by using propensity score matching in patients with hepatocellular carcinoma within Milan criteria. , 2013, Radiology.

[20]  B. Lang,et al.  Use of Radiofrequency Ablation in Benign Thyroid Nodules: A Literature Review and Updates , 2013, International journal of endocrinology.

[21]  H. Gharib,et al.  Clinical review: Nonsurgical, image-guided, minimally invasive therapy for thyroid nodules. , 2013, The Journal of clinical endocrinology and metabolism.

[22]  V. Bini,et al.  Ultrasound-Guided Interstitial Laser Ablation for Thyroid Nodules Is Effective Only at High Total Amounts of Energy , 2013, Surgical innovation.

[23]  S. Goldberg,et al.  Percutaneous laser ablation of metastatic lymph nodes in the neck from papillary thyroid carcinoma: preliminary results. , 2013, The Journal of clinical endocrinology and metabolism.

[24]  Jeong Hyun Lee,et al.  Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients , 2013, European Radiology.

[25]  Jeong Hyun Lee,et al.  Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session--prospective randomized study. , 2012, Radiology.

[26]  F. Liu,et al.  Ultrasound-guided percutaneous microwave ablation of benign thyroid nodules: experimental and clinical studies. , 2012, European journal of endocrinology.

[27]  L. Hegedüs,et al.  Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules. , 2011, European journal of endocrinology.

[28]  Jeong Hyun Lee,et al.  Optimum first-line treatment technique for benign cystic thyroid nodules: ethanol ablation or radiofrequency ablation? , 2011, AJR. American journal of roentgenology.

[29]  R. Valcavi,et al.  Percutaneous laser ablation of cold benign thyroid nodules: a 3-year follow-up study in 122 patients. , 2010, Thyroid : official journal of the American Thyroid Association.

[30]  Paolo Vitti,et al.  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: executive summary of recommendations. , 2010, Journal of endocrinological investigation.

[31]  Jung Yin Huh,et al.  Benign predominantly solid thyroid nodules: prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition. , 2010, AJR. American journal of roentgenology.

[32]  Stephanie L. Lee,et al.  Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. , 2009, Thyroid : official journal of the American Thyroid Association.

[33]  R. Stasi,et al.  Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[34]  E. Papini,et al.  Percutaneous laser ablation of unresectable primary and metastatic adrenocortical carcinoma. , 2008, European journal of radiology.

[35]  Jung Hwan Baek,et al.  Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients , 2008, European Radiology.

[36]  Giancarlo Bizzarri,et al.  Treatment of benign cold thyroid nodules: a randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up. , 2007, Thyroid : official journal of the American Thyroid Association.

[37]  S. Uğraş,et al.  Effects of percutaneous laser ablation treatment in benign solitary thyroid nodules on nodule volume, thyroglobulin and anti-thyroglobulin levels, and cytopathology of nodule in 1 yr follow-up , 2006, Journal of endocrinological investigation.

[38]  P. Lucidi,et al.  A randomized controlled trial to evaluate the efficacy of ultrasound-guided laser photocoagulation for treatment of benign thyroid nodules , 2006, Journal of endocrinological investigation.

[39]  L. Hegedüs,et al.  Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules: one versus three treatments. , 2006, Thyroid : official journal of the American Thyroid Association.

[40]  H. Rhim,et al.  Radiofrequency ablation of benign cold thyroid nodules: initial clinical experience. , 2006, Thyroid : official journal of the American Thyroid Association.

[41]  S Nahum Goldberg,et al.  Image-guided tumor ablation: standardization of terminology and reporting criteria. , 2005, Radiology.

[42]  L. Hegedüs,et al.  Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules - a randomised study. , 2005, European journal of endocrinology.

[43]  E. Papini,et al.  Ultrasound-guided laser thermal ablation for treatment of benign thyroid nodules. , 2004, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[44]  Giancarlo Bizzarri,et al.  Thyroid tissue: US-guided percutaneous laser thermal ablation. , 2004, Radiology.

[45]  J. Cardella,et al.  Society of Interventional Radiology clinical practice guidelines. , 2003, Journal of vascular and interventional radiology : JVIR.

[46]  G. Gazelle,et al.  Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. , 2000, Radiology.

[47]  Qingling Xu,et al.  Ultrasound guided percutaneous microwave ablation of benign thyroid nodules: safety and imaging follow-up in 222 patients. , 2013, European journal of radiology.