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Observational Study
. 2021 May 17:12:638880.
doi: 10.3389/fendo.2021.638880. eCollection 2021.

Predictor Analysis in Radiofrequency Ablation of Benign Thyroid Nodules: A Single Center Experience

Alessandro Bisceglia  1 , Ruth Rossetto  1 , Sara Garberoglio  1   2 , Angelica Franzin  1 , Alice Cerato  1 , Francesca Maletta  3 , Mauro Giulio Papotti  4 , Ezio Ghigo  1 , Loredana Pagano  1 , Mauro Maccario  1 , Roberto Garberoglio  1   2
Affiliations
Observational Study

Predictor Analysis in Radiofrequency Ablation of Benign Thyroid Nodules: A Single Center Experience

Alessandro Bisceglia et al. Front Endocrinol (Lausanne). .

Abstract

Purpose: To confirm the efficacy of ultrasound (US) guided radiofrequency ablation (RFA) in the treatment of benign thyroid nodules, we evaluated as primary outcome the technical efficacy and clinical success in a single center dataset. The secondary outcome was to find a correlation between nodules' pre-treatment features and volume reduction rate (VRR) ≥75% at 12 months after RFA and during follow-up period.

Methods: This retrospective study included 119 consecutive patients (99 females, 20 males, 51.5 ± 14.4 years) with benign thyroid nodules treated in our hospital between October 2014 and December 2018 with a mean follow-up of 26.8 months (range 3-48). Clinical and US features before and after RFA were evaluated by a US examination at 1, 3, 6, 12 months and annually thereafter up to 48 months.

Results: The median pre-treatment volume was 22.4 ml; after RFA we observed a statistically significant volume reduction from the first month (11.7 ml) to the last follow-up (p < 0.001 for all follow-up times). The median VRR was 47.1, 55.3, 61.2, 67.6, 72.8, 71.3, and 62.9% at 1, 3, 6, 12, 24, 36, and 48 months of follow-up respectively, showing a progressive significant improvement up to 24 months (VRRs 1 vs 3 months, 3 vs 6 months and 6 vs 12 months p < 0.001, 12 vs 24 months p = 0.05) while no differences at 24 vs 36 and 36 vs 48 months were observed. Symptoms improved significantly (complete resolution 64.35%, partial resolution 35.65%), and neck circumference was reduced as compared to pre-treatment (p < 0.001). Lower pre-treatment neck circumference (37.5 vs 36.0 cm, p = 0.01) was a positive predictor of VRR ≥75% at 12 months. Macrocystic echostructure (HR 2.48, p 0.046) and pre-treatment volume >22.4 ml (HR 0.54, p 0.036) were found to be independent positive and negative predictors of VRR ≥75% respectively. One-month post RFA VRR ≥50% represented the best positive predictor of technical success.

Conclusions: This study confirmed the efficacy of RFA in the treatment of benign thyroid nodules. In particular we show that by selecting macrocystic nodules smaller than 22.4 ml better long-term response can be achieved, which is predicted by an early shrinkage of the nodule.

Keywords: benign thyroid nodules; efficacy of radiofrequency ablation; predictive factors; radiofrequency ablation (RFA); volume reduction.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Nodules’ volume (A) and VRR (B) by time after RFA.
Figure 2
Figure 2
Nodules’ volume by time after RFA stratified by pre-treatment volume (A) and echostructure (B).
Figure 3
Figure 3
Nodules’ VRR by time after RFA stratified by pre-treatment volume (A) and echostructure (B).
Figure 4
Figure 4
Kaplan–Meier curves of cumulative incidence of technical success (VRR ≥ 75%) by median volume (A) and three volume categories (B).
Figure 5
Figure 5
Kaplan–Meier curves of cumulative incidence of technical success (VRR ≥ 75%) by echostructure (A) and VRR at 1 month (B).
See this image and copyright information in PMC

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