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. 2014:2014:934595.
doi: 10.1155/2014/934595. Epub 2014 Jun 22.

Radiofrequency ablation compared to surgery for the treatment of benign thyroid nodules

Stella Bernardi  1 , Chiara Dobrinja  2 , Bruno Fabris  1 , Gabriele Bazzocchi  3 , Nicoletta Sabato  1 , Veronica Ulcigrai  4 , Massimo Giacca  2 , Enrica Barro  1 , Nicolò De Manzini  2 , Fulvio Stacul  3
Affiliations

Radiofrequency ablation compared to surgery for the treatment of benign thyroid nodules

Stella Bernardi et al. Int J Endocrinol. 2014.

Abstract

Objective. Benign thyroid nodules are a common occurrence whose only remedy, in case of symptoms, has always been surgery until the advent of new techniques, such as radiofrequency ablation (RFA). This study aimed at evaluating RFA efficacy, tolerability, and costs and comparing them to hemithyroidectomy for the treatment of benign thyroid nodules. Design and Methods. 37 patients who underwent RFA were retrospectively compared to 74 patients surgically treated, either in a standard inpatient or in a short-stay surgical regimen. Efficacy, tolerability, and costs were compared. The contribution of final pathology was also taken into account. Results. RFA reduced nodular volume by 70% after 12 months and it was an effective method for treating nodule-related clinical problems, but it was not as effective as surgery for the treatment of hot nodules. RFA and surgery were both safe, although RFA had less complications and pain was rare. RFA costed €1,661.50, surgery costed €4,556.30, and short-stay surgery costed €4,139.40 per patient. RFA, however, did not allow for any pathologic analysis of the nodules, which, in 6 patients who had undergone surgery (8%), revealed that the nodules harboured malignant cells. Conclusions. RFA might transform our approach to benign thyroid nodules.

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Figures

Figure 1
Figure 1
(a) Transverse US image shows the transisthmic approach. The probe, whose active part is placed in the nodule through its isthmus, is inserted from the medial to the lateral part of the nodule and is visible along its longitudinal axis. (b-c) Transverse US images show the moving-shot technique. RFA is performed unit by unit, aiming at ablating all the subunits of the nodule, which turn into microbubbles (hyperechoic areas with posterior barrage of the ultrasound beam). Initially, (a) the probe tip is positioned in the medial and deepest part of the nodule and subsequently (b-c) in its most superficial and lateral parts.
Figure 2
Figure 2
Longitudinal B-mode and power Doppler US images, obtained before (a-b) and after RFA (c-d), show the effects of the procedure at 1 month. The danger triangle, which remains undertreated, is clearly visible on the medial side of the nodule (c-d). Apart from the overall reduction in size, the treated area of the nodule appears hypoechoic and avascular (c-d).
Figure 3
Figure 3
Volume (mL) reduction at 1, 3, 6, and 12 months after RFA. Data are expressed as mean ± SEM. *P < 0.05 versus baseline.
See this image and copyright information in PMC

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