Abstract
BackgroundPercutaneous ablation is currently deemed an additionally treatment option for benign thyroid nodules in the world, but possibly different effect among the ablation modalities is not clear. So we aim to evaluate the efficacy and complications of thermal/chemical ablation by network meta-analysis.Materials and methodsIn the network meta-analysis, PubMed, EMBASE and the Cochrane Library databases were searched from 1980 to 2020. Studies of adults with thyroid benign nodules under percutaneous ablation therapy were included. Percentage mean volume change, symptom score change, cosmetic score change and complications were evaluated by network meta-analysis.ResultsIn the network meta-analysis, Radiofrequency Ablation(RFA) with 2 treatment sessions group was associated with the highest reduction for the mean volume change during 6-month follow-up (MD = 79.09 and 95% CrI:48.23–89.94). There is no significant difference in the incidence of complications. Subgroup analysis showed that 2 sessions of Radiofrequency Ablation (RFA) ranks the highest probability (surface under the cumulative ranking curve (SUCRA) values 77.9) of being the most efficacious treatment for solid or predominantly solid benign nodules. Ethanol ablation (EA) ranked first (SUCRA value 81.1) in the treatment for cyst or predominantly cyst benign nodules.ConclusionRFA appears to be superior to other US-guided percutaneous ablation in reducing benign thyroid nodule volume during short- and long-term follow-up. In the subgroup analysis, RFA with 2 treatment sessions showed the most significant effectiveness for solid benign thyroid nodules and EA showed more effectiveness to decrease the volume of cyst benign thyroid nodules.
Highlights
Thyroid nodule (TN) is one of the most common endocrine lesions and has been increasingly detected in approximately 34–52% of the general population in the past two decades due to the widespread use of the high frequency ultrasound (US) [1]
Subgroup analysis showed that 2 sessions of Radiofrequency Ablation (RFA) ranks the highest probability (surface under the cumulative ranking curve (SUCRA) values 77.9) of being the most efficacious treatment for solid or predominantly solid benign nodules
radiofrequency ablation (RFA) appears to be superior to other US-guided percutaneous ablation in reducing benign thyroid nodule volume during short- and long-term follow-up
Summary
Thyroid nodule (TN) is one of the most common endocrine lesions and has been increasingly detected in approximately 34–52% of the general population in the past two decades due to the widespread use of the high frequency ultrasound (US) [1]. According to the guideline of image-guided thyroid ablation in Europe and Asia, chemical and thermal ablation procedures have been proposed as the common modalities for non-surgical treatment for benign thyroid nodules [8,9,10,11,12]. Thermal ablation, including radiofrequency ablation (RFA) (which is generally used by monopolar electrodes during the procedure), laser ablation (LA), high-intensity focused ultrasound (HIFU) and microwave ablation (MWA), were widely evolved in the management of benign thyroid nodules complaining of symptomatic or cosmetic problems [16,17,18]. According to the current clinical practice guidelines for benign thyroid nodules, LA and RFA were recommended as the first-line thermal ablation treatment modalities while MWA was considered as a second-line procedure in patients who are not suitable for or decline other thermal ablation procedures [8,9,10]. We aim to evaluate the efficacy and complications of thermal/chemical ablation by network meta-analysis.
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