Three common approach to non-invasive treatment of benign thyroid nodules with thermal ablation profiles have similar efficacy and safety compared with treatment of 200 knots.
Message of this study clearly: thermal ablation for benign thyroid nodules safer than surgery, and has only a few transient side effects. The results presented at the American Association of the thyroid gland (ATA) in 2018.
Minimally invasive thermal ablation small thyroid nodules is regarded as a preferred alternative thyroidectomy operation which is often unnecessary. But few studies have compared several methods of ablation - radiofrequency ablation (RFA), laser ablation (LA) and high-intensity focused ultrasound (HIFU).
Richard J.. Wong, head of service, head and neck surgery department of the Memorial Sloan Kettering Cancer Center in New York, noted that this new research offers a unique comparison technology.
"All three methods have been described previously, mostly small retrospective review, but very few studies have compared them to each other", - said Wong, who coordinated the ATA session.
However, he added that many factors associated with delivery of thermal ablation in the bundle, may complicate the comparison.
To compare these three methods, Ben Hamo and Herve Monpeysen, MD, of the American Hospital of Paris, France, registered 176 patients with benign thyroid nodes cytology or histology, which initially suggested surgery, but they refused.
Of the 200 selected thyroid, have been identified, the average size was 16.8 ± 16.6 ml and 165 (82.5%) were palpable nodules. Among them, 99 (54%) were treated with RFA, 67 (40.5%) were treated with LA, and 10 (5.5%) were treated with HIFU. Most patients (80.7%) were female and the average age of participants was 51 years.
In the first 6 weeks of observation and comparison LA RFA revealed that the decrease in volume of the nodules at baseline was higher with RFA (from 20.4 to 10.7 ml, 51.5%) as compared to LA (13,6 ml - 8 , 5 mL, 40,2%; P <.001). The differences between the two cuts in 12 months of monitoring, though large, were not significant (73.2% vs. 74.3%).
No other differences were observed for 6, 12, or 18 months in terms of reducing the average volume of between RFA and HIFU (66,5% vs. 57.8%, respectively) or between LA and HIFU (68,1% against 57,8% ) after adjusting for factors including age, the initial volume of nodules, thyroid vascularization and evaluation of information and data (TI-RADS).
Complaints of pain were comparable to RFA and LA groups (57.6% vs. 53%), but more frequent in the HIFU group (80%).
On average, in terms of reduction of clinical symptoms, greater than 80% of patients in the three groups have reported the disappearance of symptoms including discomfort (-72%), aesthetic inconveniences (-72%), dysphagia (-26%) and dysphonia (-4% ).
Reported six (3.4%) major adverse events, including two cases of transient recurrent nerve parenteral RFA in the treatment group, a hematoma in the LA group two abscesses that have been successfully treated in the LA group and one spontaneous regression syndrome Horner in HIFU group.
Bin Ham added that he was also one case of Graves' disease and hyperthyroidism are two other cases in the RFA group, but there were no cases of hypothyroidism or hypoparathyroidism during the 18-month follow-up.
"After 18-month follow thermal ablation has been effective in reducing nodule size by 60% (HIFU) to 75% (RFA and LA)», - Ben Ham concluded.
He noted that the restriction includes a small number of clearly HIFU conjugates. "Only a few nodules were treated with HIFU, representing the first nodules treated with HIFU in France and in our center," - he told Medscape Medical News.
"In my opinion, the RFA and LA is clearly more efficient, without differences between the two methods, except for 6 weeks (RFA is better than LA)», - he added.
"Of course, the use of a particular technique depends on the experience of the physician, the node size, structure and location. However, no randomized series was not published. "
In addition, nodule characteristics can determine which method is most appropriate, explained Ben Ham.
"Currently, RFA is considered to be more effective for the treatment of large solid nodules (> 15 ml), whereas LA is considered to be more effective for the treatment of moderate cystic nodes (> 10 ml), but the results of studies comparing the two treatments, are inconsistent", - he said he.
"Indications HIFU is still being discussed and is mainly carried out for the treatment of small nodules (<5 mL), inaccessible to other techniques, or when patients refuse from other mini-invasive techniques."
Wong, session moderator, expanded his comments regarding factors that could affect the results.
"It was interesting to find differences between the three methods [ablation], but there are many variables that can play a role in their effectiveness: these include energy level and how aggressively the modality used on the site - it is difficult to control and make direct comparisons."
And Wong agreed with the authors that the ability of the operator is also a key factor.
"These are the tools that depend on the operator. Imagine comparing surgical laser scalpel, and the result is much better to remove the tumor, "- he said. "All three are equally good methods, depending on the skill of the operating surgeon."
It is important to note that Ben Ham stressed that if the nodules are suspicious, is still recommended surgery.
"We must be very clear with regard to evidence and that these methods should not interfere with the care of suspicious or malignant tumors. In these cases, we know that surgery is still the gold standard, "- he concluded.