Endocrinol Metab.  2020 Jun;35(2):339-350. 10.3803/EnM.2020.35.2.339.

Long-Term Results of Thermal Ablation of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis

• Cho SJ
• Baek JH
• Chung SR
• Choi YJ
• Lee JH

• KMID: 2503264
• DOI: http://doi.org/10.3803/EnM.2020.35.2.339

Abstract

Background
Ultrasound-guided thermal ablations have become one of the main options for treating benign thyroid nodules. To determine efficacy of thermal ablation of benign thyroid nodules, we performed a meta-analysis of studies with long-term follow-up of more than 3 years.
Methods
Databases were searched for studies published up to August 25, 2019, reporting patients with benign thyroid nodules treated with thermal ablation and with follow-up data of more than 3 years. Data extraction and quality assessment were performed according to PRISMA guidelines. The analysis yielded serial volume reduction rates (VRRs) of ablated nodules for up to 3 years or more, and adverse effect of ablation during follow-up. Radiofrequency ablation (RFA) and laser ablation (LA) were compared in a subgroup analysis.
Results
The pooled VRRs for ablated nodules showed rapid volume reduction before 12 months, a plateau from 12 to 36 months, and more volume reduction appearing after 36 months, demonstrating long-term maintenance of treatment efficacy. Thermal ablation had an acceptable complication rate of 3.8%. Moreover, patients undergoing nodule ablation showed no unexpected delayed complications during the follow-up period. In the subgroup analysis, RFA was shown to be superior to LA in terms of the pooled VRR and the number of patients who underwent delayed surgery.
Conclusion
Thermal ablations are safe and effective methods for treating benign thyroid nodules, as shown by a long follow-up analysis of more than 3 years. In addition, RFA showed superior VRRs compared with LA for the treatment of benign thyroid nodules, with less regrowth and less delayed surgery.

Keyword

Radio frequency ablation; Thyroid adenoma; Meta-analysis

Figure

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  Fig. 1 Flow diagram of the study selection process. RFA, radiofrequency ablation; LA, laser ablation.

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  Fig. 2 The trends of pooled volume reduction rates for ablated nodules in the total subjects, total, and separately for the radiofrequency ablation (RFA) and laser ablation (LA) groups.

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  Fig. 3 Quality assessment of the included studies according to risk of bias for nonrandomized studies (RoBANS).

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