Abstract
Benign thyroid nodules (BTNs), which account for 85-95% of all thyroid nodules (TNs), are a common clinical issue and have been increasingly detected over the last 2 decades due to the widespread use of ultrasound (US) imaging. The clinical treatment for BTNs is mainly focused on patients with nodular growth or clinical problems, either cosmetic or symptom-related. Percutaneous thermal ablation (TA) under US guidance has increasingly become a satisfactorily minimally invasive alternative to surgery for patients with symptomatic BTNs, especially for those in nonsurgical candidates, surgically high-risk individuals or patients refusing surgery. Based on the available English-language literature, the brief principles, procedures and clinical outcomes of 4 TA techniques, including laser ablation therapy (LAT), radiofrequency ablation (RFA), microwave ablation (MWA), and high-intensity focused ultrasound (HIFU) in the treatment of BTNs were retrospectively reviewed in this article. Good curative efficacy and clinical safety were noted in the published reports of the 4 TA techniques in the treatment of BTNs, with nodular volume reduction ratios of 46-93.5%, significant improvement in symptomatic and cosmetic problems, and euthyroid preservation for most patients. The conclusion is that all 4 TA techniques can be safe and effective treatment for patients with symptomatic BTNs; RFA seems to be the best because of the highest nodular volume reduction ratio (VRR) at follow-up. Furthermore, the image fusion navigation technique will play an important role through assisting in precise ablation for BTNs.
Highlights
Thyroid nodules (TNs) are a common clinical issue, and their prevalence has been increasing over the last 2 decades[1] due to the widespread use of ultrasound (US) imaging
Based on the available English-language literature, the brief principles, procedures and clinical outcomes of 4 thermal ablation (TA) techniques, including laser ablation therapy (LAT), radiofrequency ablation (RFA), microwave ablation (MWA), and high-intensity focused ultrasound (HIFU) in the treatment of Benign thyroid nodules (BTNs) were retrospectively reviewed in this article
Comparing the clinical outcomes of RFA and LAT for BTNs, the procedures are similar in terms of safety, but the efficacy of RFA has been found to be superior to LAT,[5,40,41] no randomized controlled trials with large-scale cohorts and long-term follow-up have been published
Summary
Thyroid nodules (TNs) are a common clinical issue, and their prevalence has been increasing over the last 2 decades[1] due to the widespread use of ultrasound (US) imaging. The thyroid is a small and superficial organ in the cervical region,[6] adjacent to several vital structures, such as the common carotid artery, internal jugular vein, vagus nerve, recurrent laryngeal nerve, superior laryngeal nerve, trachea, and esophagus, with high risks and possibilities of complications if surgical treatment is undertaken. This has led to an ongoing search for a minimally invasive procedure to maximize BTN patients’ relief in terms of symptoms and cosmetics, and at the same time to minimize the occurrence of complications. Based on the available English-language literature, the brief principles, procedures and clinical outcomes in the treatment of BTNs using 4 TA techniques were retrospectively reviewed, with the aim was of evaluating these 4 TA techniques in clinical applications, exploring feasible methods of further improvement, and providing an effective reference for clinical TA treatment of BTNs
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