Comparative Efficacy of Radiofrequency and Laser Ablation for the Treatment of Benign Thyroid Nodules: Systematic Review Including Traditional Pooling and Bayesian Network Meta-analysis

Abstract

To compare the efficacy of radiofrequency ablation (RFA) and laser ablation (LA) for treatment of benign solid thyroid nodules, using a systematic review including traditional pooling and Bayesian network meta-analysis. A comprehensive literature search in PubMed-MEDLINE, EMBASE, and the Cochrane Library databases identified prospective studies evaluating the percentage mean change [absolute mean change (mL)] in nodule volume after RFA or LA. Studies from January 1, 2000, to November 1, 2013, were included. Review of 128 potential papers, including a full-text review of 33, identified 10 eligible papers covering a total of 184 patients for meta-analysis. The percentage mean change [absolute mean change] in nodule volume over a 6-month follow-up was compared between RFA and LA. Based on the traditional frequentist approach, the pooled percentage mean changes (95% confidence interval) of RFA and LA were 76.1% (70.1-82.1) and 49.9% (41.4-58.5), respectively, and the pooled absolute mean changes (95% confidence interval) of RFA and LA were 8.9 mL (6.6-11.2) and 5.2 mL (4.3-6.1), respectively. Based on the Bayesian network meta-analysis, RFA achieved a larger pooled percentage mean change (95% credible interval) and absolute mean change (95% credible interval) compared to LA [77.8% (67.7-88.0) vs 49.5% (26.7-72.4), and 9.2 mL (5.8-11.9) vs 5.3 mL (2.1-8.5), respectively]. The RFA group has the highest probability of having the most efficacious treatment (98.7%). There were no major complications after either RFA or LA. RFA appears to be superior to LA in reducing benign solid thyroid nodule volume, despite the smaller number of treatment sessions without major side effects.