MINIMAL INVASIVE TREATMENT OF BENIGN THYROID NODULES: A NOVEL PROMISING APPROACH IN THE MANAGEMENT OF THYROID DISEASE

AUTHORS:
A. Chorti (Thessaloniki, Greece) , V. Bontinis (Thessaloniki, Greece) , M. Moysidis (Thessaloniki, Greece) , A. Bontinis (Thessaloniki, Greece) , G. Tzikos (Thessaloniki, Greece) , E. Poulios (Athens, Greece) , I. Pliakos (Thessaloniki, Greece) , T. Papavramidis (Thessaloniki, Greece)
Background:
Image-guided thermal ablation interventions represent a group of novel thermal-based modalities employed for the treatment of benign thyroid nodules. Radiofrequency (RFA), microwave (MWA), laser ablation (LA) and high-intensity focused ultrasound (HIFU) have already been applied in the treatment of hepatic metastases, malignant tumors and superficial vein insufficiency. The aim of the present study is to evaluate the efficacy and safety of the various available techniques.
Methods:
A systematic review and a Bayesian network meta-analysis for studies investigating thermal ablation interventions for the treatment of benign nodular thyroid disease were conducted. Primary endpoints included volume reduction rate (VRR), symptomatic score and cosmetic score improvement by the end of follow-up. Secondary endpoints included overall vocal disturbances, laryngeal nerve palsy, and post-procedural hypothyroidism.
Results:
Sixteen studies comprised of 4112 patients were finally included. Non-statistically significant differences were observed between RFA, LA, MWA HIFU and conventional thyroidectomy regarding any of the primary endpoints. LA and MWA were ranked as the interventions most likely to results in the largest VRR, symptomatic and cosmetic score reduction rates. RFA, LA and MWA decreased the risk for post-intervention vocal complications. Additionally, RFA and MWA decreased the risk for transient laryngeal nerve injury and for hypoparathyroidism
Conclusions:
The present review displayed encouraging results concerning thermal ablation modalities in general and RFA in particular. The non-statistically significant differences regarding efficacy and safety depicted by thermal techniques, produce optimism regarding the present and future of benign nodular thyroid disease treatment.