Percutaneous Ultrasound-Guided Laser Ablation of Benign Thyroid Nodules

Results of 10-Year Follow-Up in 171 Patients

Giovanni Gambelunghe; Elisa Stefanetti; Nicola Avenia; Pierpaolo De Feo

Disclosures

J Endo Soc. 2021;5(7) 

In This Article

Abstract and Introduction

Abstract

Context: Percutaneous, ultrasound-guided laser ablation is effective in nodular thyroid disease.

Objective: The aim of this study was to evaluate the long-term (10-year) efficacy and safety of laser ablation in the treatment of benign thyroid nodules.

Methods: From 2009 to 2010, 171 patients received a single session of laser ablation. Evaluation of nodule volume was performed before treatment, at 6 months, and every year.

Results: Technique efficacy was achieved in 92% of patients at 1 year. Median nodule volume significantly decreased from 16.7 mL (range, 11.0–97.0 mL) at baseline to 5.0 mL (range, 4.1–32.0 mL) at 1 year, a volume reduction ratio (VRR) of 68%. The benefit of the treatment was durable (P < 0.001 vs baseline at all timepoints), with a VRR of 59% after 10 years. No cases of nodule regrowth > 50% were observed at 1 year, although such cases did occur after 4 years (n = 3; 1.7% of the overall cohort) and 7 years (n = 8; 4.7%). There were no further cases of regrowth beyond 7 years. When patients were stratified according to baseline nodule volume (< 15 mL, 15–25 mL, or > 25 mL), durable results were observed across all 3 categories, with the largest, most prolonged effect observed in patients with nodules < 15 mL. Treatment was well tolerated, with only minor, transient complications of fever and local pain, and 98% of patients willing to recommend the treatment.

Conclusion: Percutaneous, ultrasound-guided laser ablation of benign thyroid nodules provides long-term benefits and the treatment is well tolerated.

Introduction

Thyroid nodules are commonly seen in clinical practice, with an adult prevalence of 3% to 7% based on findings at palpation, and prevalence estimates ranging from 20% to 76% based on ultrasound examination.[1] Although the majority of thyroid nodules are cytologically benign, asymptomatic, and do not warrant treatment, some nodules will increase in size, producing compressive symptoms or causing cosmetic concerns for the patient. Therefore, in a proportion of patients with benign thyroid nodules, remedial treatment is required.

Alternatives to surgical treatment of benign thyroid nodules are preferable where clinically appropriate, and image-guided ablation of thyroid nodules using laser energy is recommended as a treatment strategy in recent management guidelines. According to recent guidelines on management of thyroid nodules, ultrasound-guided laser ablation (LA) may be considered for the treatment of solid or complex benign thyroid nodules that progressively enlarge, are symptomatic, or cause cosmetic concern.[1–3] The position of image-guided LA within recent management guidelines is based upon a large body of evidence gained over the last 2 decades.[4,5] Randomized controlled trials have demonstrated the efficacy and safety of image-guided LA when compared with an observational approach[6,7] and in comparison with treatment with radioiodine[8] or levothyroxine therapy.[9] One randomized comparison of image-guided LA vs radiofrequency ablation (RFA) in solid or predominantly solid thyroid nodules recently reported assessed outcome at 6 months postprocedure and observed similar success rates and safety in the 2 groups,[10] while numerous retrospective studies of image-guided LA have added to the evidence base for this procedure.[11–14]

The longest follow-up after ultrasound-guided LA for benign nodules reported in the literature is 5 years.[15,16] In one study, 5-year retrospective follow-up was reported for 104 patients with benign, solid, cold nodules.[15] More recently, 5-year results of LA were compared with those of RFA in a multicenter, retrospective evaluation of 406 patients with benign thyroid nodules.[16] The current literature does not contain reports of the efficacy and safety of the laser procedure over longer follow-up periods. Here, we report the findings from 10 years of follow-up of a cohort of 171 patients with benign thyroid nodules who were treated with a single session of ultrasound-guided LA.

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