Stella Bernardi1,2, Fabiola Giudici1,3, Roberto Cesareo4, Giovanni Antonelli5, Marco Cavallaro6, Maurilio Deandrea7, Massimo Giusti8, Alberto Mormile7, Roberto Negro9, Andrea Palermo10, Enrico Papini11, Valerio Pasqualini12, Bruno Raggiunti13, Duccio Rossi14, Luca Maria Sconfienza15,16, Luigi Solbiati17, Stefano Spiezia5, Doris Tina13, Lara Vera8, Fulvio Stacul6, Giovanni Mauri18,19. 1. Dipartimento di Scienze Mediche, Università degli Studi di Trieste, Trieste, Italy. 2. UO Medicina Clinica, Ospedale di Cattinara, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Trieste, Italy. 3. Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi di Padova, Padova, Italy. 4. UO Malattie Metaboliche, Ospedale Santa Maria Goretti, Latina, Italy. 5. UO Chirurgia Endocrina e Ecoguidata, Ospedale del Mare, ASL Napoli1, Napoli, Italy. 6. UO Radiologia, Ospedale Maggiore, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Trieste, Italy. 7. UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, Torino, Italy. 8. Dipartimento di Endocrinologia, AOU-IST IRCCS San Martino, Università degli Studi di Genova, Genova, Italy. 9. UO Endocrinologia, Ospedale "V. Fazzi," Lecce, Italy. 10. Policlinico Universitario Campus Bio-Medico, Roma, Italy. 11. Dipartimento di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy. 12. UO Radiologia, Ospedale San Filippo Neri, Roma, Italy. 13. UOC Malattie Endocrine e Diabetologia, PO di Atri, ASL Teramo, Teramo, Italy. 14. Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano. 15. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy. 16. IRCCS Istituto Ortopedico Galeazzi, Milano, Italy. 17. Dipartimento di Scienze Biomediche, Università Humanitas, Milano, Italy. 18. Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milano, Italy. 19. Divisione di Radiologia Interventistica, IEO, IRCCS Istituto Europeo di Oncologia, Milano, Italy.
Abstract
Background: Radiofrequency ablation (RFA) and laser ablation (LA) are effective treatments for benign thyroid nodules. Due to their relatively recent introduction into clinical practice, there are limited long-term follow-up studies. This study aimed to evaluate technique efficacy, rate of regrowth, and retreatment over 5 years after RFA or LA and to identify predictive factors of outcome. Methods: In this multicenter retrospective study, the rates of technique efficacy, regrowth, and retreatment were evaluated in 406 patients treated with either RFA or LA, and followed for 5 years after initial treatment. Propensity score matching was used to compare treatments. Cumulative incidence studies with hazard models were used to describe regrowth and retreatment trends, and to identify prognostic factors. Logistic regression models and receiver operating characteristic analyses were used for risk factors and their cutoffs. Results: RFA and LA significantly reduced benign thyroid nodule volume, and this reduction was generally maintained for 5 years. Technique efficacy (defined as a reduction ≥50% after 1 year from the treatment) was achieved in 74% of patients (85% in the RFA and 63% in the LA group). Regrowth occurred in 28% of patients (20% in the RFA and 38% in the LA group). In the majority of cases, further treatment was not required as only 18% of patients were retreated (12% in the RFA and 24% in the LA group). These data were confirmed by propensity score matching. Cumulative incidence studies showed that RFA was associated with a lower risk of regrowth and a lower risk of requiring retreatment over time. Overall, technique inefficacy and regrowth were associated with low-energy delivery. Retreatments were more frequent in young patients, in large nodules, in patients with lower volume reduction at 1 year, and in cases of low-energy delivery (optimal cutoff was 918 J/mL for RFA). Conclusions: Both thermal ablation techniques result in a clinically significant and long-lasting volume reduction of benign thyroid nodules. The risk of regrowth and needing retreatment was lower after RFA. The need for retreatment was associated with young age, large baseline volume, and treatment with low-energy delivery.
Background: Radiofrequency ablation (RFA) and laser ablation (LA) are effective treatments for benign thyroid nodules. Due to their relatively recent introduction into clinical practice, there are limited long-term follow-up studies. This study aimed to evaluate technique efficacy, rate of regrowth, and retreatment over 5 years after RFA or LA and to identify predictive factors of outcome. Methods: In this multicenter retrospective study, the rates of technique efficacy, regrowth, and retreatment were evaluated in 406 patients treated with either RFA or LA, and followed for 5 years after initial treatment. Propensity score matching was used to compare treatments. Cumulative incidence studies with hazard models were used to describe regrowth and retreatment trends, and to identify prognostic factors. Logistic regression models and receiver operating characteristic analyses were used for risk factors and their cutoffs. Results: RFA and LA significantly reduced benign thyroid nodule volume, and this reduction was generally maintained for 5 years. Technique efficacy (defined as a reduction ≥50% after 1 year from the treatment) was achieved in 74% of patients (85% in the RFA and 63% in the LA group). Regrowth occurred in 28% of patients (20% in the RFA and 38% in the LA group). In the majority of cases, further treatment was not required as only 18% of patients were retreated (12% in the RFA and 24% in the LA group). These data were confirmed by propensity score matching. Cumulative incidence studies showed that RFA was associated with a lower risk of regrowth and a lower risk of requiring retreatment over time. Overall, technique inefficacy and regrowth were associated with low-energy delivery. Retreatments were more frequent in young patients, in large nodules, in patients with lower volume reduction at 1 year, and in cases of low-energy delivery (optimal cutoff was 918 J/mL for RFA). Conclusions: Both thermal ablation techniques result in a clinically significant and long-lasting volume reduction of benign thyroid nodules. The risk of regrowth and needing retreatment was lower after RFA. The need for retreatment was associated with young age, large baseline volume, and treatment with low-energy delivery.
Authors: Ralph P Tufano; Pia Pace-Asciak; Jonathon O Russell; Carlos Suárez; Gregory W Randolph; Fernando López; Ashok R Shaha; Antti Mäkitie; Juan P Rodrigo; Luiz Paulo Kowalski; Mark Zafereo; Peter Angelos; Alfio Ferlito Journal: Front Endocrinol (Lausanne) Date: 2021-06-24 Impact factor: 5.555