European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules

Abstract

Objective: Image-guided interventional ultrasound (US) techniques represent diagnostic and therapeutic tools for non-surgical management of thyroid nodular disease. We sought to investigate the attitude of European Thyroid Association (ETA) members towards the use of minimally invasive techniques (MIT) in diagnosis/therapy of symptomatic nodular goitre.

Methods: ETA members were invited to participate in an online survey investigating the use of MIT in benign and malignant thyroid nodular disease. Of 865 invited members, 221 (25.5%) completed the survey. The respondents were from 40 countries; 139 (74.7%) were from European countries.

Results: Respondents personally performed thyroid US (91.6%), Fine needle aspiration (FNA; 75.3%), ethanol ablation (EA; 22.1%), core needle biopsy (CNB; 11%) and thermal treatments (4.8%). When skills and/or technology were unavailable, only 13.4% referred patients "often" or "always" to other centres with specific expertise in this field. Surgery was the preferred first option in patients with recurrent cysts, 4.0 cm benign nodules, local (radioiodine-avid or non-avid) lymph node metastases, or papillary cancers <1.0 cm. For autonomously functioning nodules radioactive iodine treatment was the preferred choice, followed by surgery. Thermal ablation (TA) was the preferred option only for a 4 cm benign nodule in old patients with comorbidities.

Conclusions: US, US-guided FNA and surgery were available to nearly all respondents, while MIT was not. CNB and EA were employed only by about 1/3 of the respondents and TA procedures were available and personally performed only by a minority. For most thyroid lesions, surgery was the preferred option versus thermal therapies. The ETA needs to develop guidelines and establish teaching to overcome geographic inequality and promote the use of MIT as a valid therapy option in appropriate cases.

Keywords: Ethanol ablation; European thyroid association; Laser ablation; Questionnaire; Radiofrequency ablation; Thermal ablation; Thyroid cancer; Thyroid cysts; Thyroid nodules.

Fig. 1

Reasons given for physicians never, or rarely, referring patients to MIT (Question 14). The sum exceeds 100% because >1 option could be selected by the respondents. MIT, minimally invasive techniques.

Fig. 2

a Choice of therapy for a 25-year old female with a 4.0 cm spongiform nodule (EU-TIRADS 2 with a benign FNA) causing symptoms of compression (Question 19). b Choice of therapy for a 75-year old male patient with a similar thyroid nodule, but now suffering from diabetes, cardiovascular disease and renal failure (Question 20). HIFU, high intensity focused US.

Fig. 3

a Choice of therapy for a 65-year-old female patient with a 4.0 cm AFTN causing symptoms of compression and subclinical hyperthyroidism (Question 22). b Choice of therapy for a 20-year-old female patient with a 2.5 cm autonomously functioning nodule causing subclinical hyperthyroidism but no symptoms of compression (Question 23). MIT, minimally invasive techniques; RAI, radioiodine ablation.

Fig. 4

a Choice of therapy for a 75-year-old female patient who underwent thyroidectomy with lateral and central compartment neck dissection for differentiated cancer and afterwards developed local non radioiodine-avid lymph node metastases (Question 24). b Choice of therapy for a 25-year-old female patient who underwent thyroidectomy with lateral and central compartment neck dissection for differentiated cancer and afterwards developed local lymph node metastases and considered at high surgical risk (Question 25). c Choice of therapy for a 78-year-old female patient harbouring a cytologically confirmed 8 mm intra-thyroidally located papillary thyroid cancer (Question 26). HIFU, high intensity focused US.