Twelve-Month Volume Reduction Ratio Predicts Regrowth and Time to Regrowth in Thyroid Nodules Submitted to Laser Ablation: A 5-Year Follow-Up Retrospective Study

다국어 초록 (Multilingual Abstract)

Objective: Laser ablation is a therapeutic modality used to reduce the volume of large benign thyroid nodules. Unsatisfactory reduction and regrowth are observed in some treated nodules. The aim of the study was to evaluate the long-term outcomes of laser treatment for solid nodules during a 5-year follow-up period, the regrowth rate, and the predictive risk factors of nodule regrowth.
Materials and Methods: We retrospectively evaluated patients with benign, solid, cold thyroid nodules who underwent laser ablation and were followed-up for 5 years. According to the selection criteria, 104 patients were included (median baseline nodule volume, 12.5 mL [25.0–75.0%, 8–18 mL]; median energy delivered, 481.5 J/mL [25.0–75.0%, 370–620 J/mL]). Nodule volume, thyroid function test results, and ultrasound were evaluated at baseline and then annually after the procedure.
Results: Of 104 patients, 31 patients (29.8%) had a 12-month volume reduction ratio (VRR) < 50.0% and 39 (37.5%) experienced nodule regrowth. Of these 39 patients, 17 (43.6%) underwent surgery and 14 (35.9%) underwent a second laser treatment. The rate of nodule regrowth was inversely related to the 12-month VRR, i.e., the lower the 12-month VRR, the higher the risk of regrowth (p < 0.001). The mean time for nodule regrowth was 33.5 ± 16.6 months. The 12-month VRR was directly related to time to regrowth, i.e., the lower the 12-month VRR, the shorter the time to regrowth (p < 0.001; R2 = 0.3516). Non-spongiform composition increased the risk of regrowth with an odds ratio of 4.3 (95% confidence interval [CI] 1.8–10.2; p < 0.001); 12-month VRR < 50.0% increased the risk of regrowth with an odds ratio of 11.7 (95% CI 4.2–32.2; p < 0.001).
Conclusion: The VRR of thyroid nodules subjected to similar amounts of laser energy varies widely and depends on the nodule composition; non-spongiform nodules are reduced to a lesser extent and regrow more frequently than spongiform nodules. A 12-month VRR < 50.0% is a predictive risk factor for regrowth and correlates with the time to regrowth.

참고문헌 (Reference)

1 Negro R, "Unfavorable outcomes in solid and spongiform thyroid nodules treated with laser ablation. A 5-year follow-up retrospective study" 19 : 1041-1045, 2019

2 Spiezia S, "Ultrasound-guided laser thermal ablation in the treatment of autonomous hyperfunctioning thyroid nodules and compressive nontoxic nodular goiter" 13 : 941-947, 2003

3 Che Y, "Treatment of benign thyroid nodules : comparison of surgery with radiofrequency ablation" 36 : 1321-1325, 2015

4 Bellantone R, "Total thyroidectomy for management of benign thyroid disease : review of 526 cases" 26 : 1468-1471, 2002

5 Pacella CM, "Thyroid tissue : US-guided percutaneous interstitial laser ablation-a feasibility study" 217 : 673-677, 2000

6 Gambelunghe G, "Thyroid nodule morphology affects the efficacy of ultrasound-guided interstitial laser ablation : a nested case-control study" 30 : 486-489, 2014

7 박혜선, "Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques" 대한영상의학회 18 (18): 615-623, 2017

8 Døssing H, "Randomized prospective study comparing a single radioiodine dose and a single laser therapy session in autonomously functioning thyroid nodules" 157 : 95-100, 2007

9 Sim JS, "Radiofrequency ablation of benign thyroid nodules : depicting early sign of regrowth by calculating vital volume" 33 : 905-910, 2017

10 Lim HK, "Radiofrequency ablation of benign non-functioning thyroid nodules : 4-year follow-up results for 111 patients" 23 : 1044-1049, 2013

11 Cesareo R, "Radiofrequency ablation for the management of thyroid nodules: a critical appraisal of the literature" 87 : 639-648, 2017

12 Deandrea M, "Radiofrequency ablation for benign thyroid nodules according to different ultrasound features : an Italian multicentre prospective study" 180 : 79-87, 2019

13 Mertyna P, "Radiofrequency ablation : variability in heat sensitivity in tumors and tissues" 18 : 647-654, 2007

14 Solazzo SA, "Radiofrequency ablation : importance of background tissue electrical conductivity—An agar phantom and computer modeling study" 236 : 495-502, 2005

15 Bernardi S, "Patient satisfaction after thyroid RFA versus surgery for benign thyroid nodules : a telephone survey" 35 : 150-158, 2018

16 Cesareo R, "Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules" 34 : 617-623, 2018

17 Døssing H, "Long-term outcome following laser therapy of benign cystic-solid thyroid nodules" 8 : 846-852, 2019

18 Døssing H, "Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules" 165 : 123-128, 2011

19 Papini E, "Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules. Results of a three-year multicenter prospective randomized trial" 99 : 3653-3659, 2014

20 Deandrea M, "Long-term efficacy of a single session of RFA for benign thyroid nodules : a longitudinal 5-year observational study" 104 : 3751-3756, 2019

21 신정숙, "Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth" 대한내분비학회 34 (34): 117-123, 2019

22 Magri F, "Laser photocoagulation therapy for thyroid nodules : long-term outcome and predictors of efficacy" 43 : 95-100, 2020

23 de Freitas RMC, "Laser ablation of benign thyroid nodules : a prospective pilot study with a preliminary analysis of the employed energy" 2019

24 Negro R, "Laser ablation is more effective for spongiform than solid thyroid nodules. A 4-year retrospective follow-up study" 32 : 822-828, 2016

25 Chianelli M, "Laser ablation and 131-iodine : a 24-month pilot study of combined treatment for large toxic nodular goiter" 99 : E1283-E1286, 2014

26 Sim JS, "Initial ablation ratio : quantitative value predicting the therapeutic success of thyroid radiofrequency ablation" 28 : 1443-1449, 2018

27 Mauri G, "Image-guided thyroid ablation : proposal for standardization of terminology and reporting criteria" 29 : 611-618, 2019

28 Sangalli G, "Fine needle aspiration cytology of the thyroid : a comparison of 5469 cytological and final histological diagnoses" 17 : 245-250, 2006

29 Wang B, "Factors related to recurrence of the benign non-functioning thyroid nodules after percutaneous microwave ablation" 33 : 459-464, 2017

30 Trimboli P, "Efficacy of thermal ablation in benign nonfunctioning solid thyroid nodule : a systematic review and meta-analysis" 67 : 35-43, 2020

31 Cesareo R, "Efficacy of radiofrequency ablation in autonomous functioning thyroid nodules. A systematic review and meta-analysis" 20 : 37-44, 2019

32 정소령, "Efficacy and Safety of Radiofrequency Ablation for Benign Thyroid Nodules: A Prospective Multicenter Study" 대한영상의학회 19 (19): 167-174, 2018

33 Ahmed M, "Computer modeling of the combined effects of perfusion, electrical conductivity, and thermal conductivity on tissue heating patterns in radiofrequency tumor ablation" 24 : 577-588, 2008

34 Granchi S, "Characterization of benign thyroid nodules with HyperSPACE(Hyper Spectral Analysis for Characterization in Echography)before and after percutaneous laser ablation : a pilot study" 19 : 172-178, 2017

35 Baek JH, "Benign predominantly solid thyroid nodules : prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition" 194 : 1137-1142, 2010

36 김지훈, "2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology" 대한영상의학회 19 (19): 632-655, 2018