Ultrasound-Guided Thermal Ablation Versus Thyroidectomy in the Treatment of Benign Thyroid Nodules: Systematic Review and Meta Analysis

Abstract

Ultrasound-guided thermal ablation (TA) is a minimally invasive intervention for treating benign thyroid nodules (BTNs). This meta-analysis aims to systematically compare the safety and efficacy of ultrasound-guided TA with surgery in treating BTNs. Relevant studies were identified through searching electronic databases. Included studies focused on comparing TA for BTNs with surgical resection. Primary endpoints encompassed length of hospital stay, procedure time, symptom improvement, cosmetic score, and excellent cosmetic results. Other outcomes include all complications (hypothyroidism, hoarseness, hematoma, blood loss, wound infection, parathyroid injury, chocking, or cough), recurrence, postoperative pain, visual analog scale (VAS) score, scar length, thyroid hormone levels, and finally stress response outcomes. Twenty-six studies (7 randomized controlled trials and 19 cohort studies) were included. Our findings revealed that TA was associated with shorter hospital stays (MD = -3.30, 95% CI [-3.82, -2.79], P < .00001), reduced procedure time (MD = -47.75, 95% CI [-54.89, -40.61] P < .00001), superior cosmetic outcomes (RR = 1.11, 95% CI [1.00, 1.22], P = .04), lower postoperative pain levels, and lower VAS score. Additionally, surgical resection was linked to a higher incidence of hoarseness, hypothyroidism, parathyroid injury, and blood loss. However, no significant differences were observed in rates of wound infection, hematoma, or recurrence between the two treatment modalities. Our meta-analysis suggests that ultrasound-guided TA represents a viable alternative to surgery for treating BTNs, especially for patients unwilling or unable to undergo surgical intervention. This technique was found to be safe and effective. However, future evidence is mandatory to establish TA to a specific type of nodule, to preserve patients from second interventions.

Keywords: ablation; surgical resection; thermal ablation; thyroid; thyroid nodules; thyroidectomy.