Unfavorable Outcomes in Solid and Spongiform Thyroid Nodules Treated with Laser Ablation. A 5-Year Follow-up Retrospective Study

Abstract

ObjectiveLaser Ablation (LA) is a therapeutic modality for reducing the volume of large benign thyroid nodules. This retrospective study was aimed at assessing the outcome of LA in patients with benign nonfunctioning thyroid nodules in a 5-years follow-up.MethodsSixty-two patients (47 females; mean age 54.7±12 yr) with benign cold thyroid nodules underwent LA from July 2009 to March 2012. Nodule volume, thyroid function test, and ultrasound were monitored at baseline, and at 3, 6 and 12 months after the procedure, then annually. After dividing nodules in solid and spongiform, we evaluated unfavourable outcomes: 1) nodule’s volume reduction <50%; 2) need for surgery; 3) need for additive LA session (due to nodule re-growth with persistence of cosmetic concern or compressive symptoms).ResultsBaseline volume did not differ between solid and spongiform nodules as well as energy delivered and the number of needles used. Unfavourable outcomes occurred in 24 patients (38.7%). Nineteen/24 (79.2%) patients who experienced unfavourable outcomes belonged to the solid nodules group (P<0.01). When considering only those who benefited from LA, the 5-years reduction was 59.7% for solid and 78.6% for spongiform nodules (P<0.05). One/6 patients who underwent surgery (solid nodules group) had a final diagnosis of Follicular Variant of Papillary Thyroid Cancer (FVPTC).ConclusionLarge solid nodules, unlike spongiform, submitted to LA are characterized by a long-term unfavourable outcome and entail a potential risk of false negative cytologic results.