Endocrine Abstracts

Background: In the last decades mini-invasive techniques have been proposed to reduce costs and complications of emithyroidectomy and thyroidectomy, both for benign nodular goiter and thyroid microcarcinoma, and image-guided laser and radiofrequency ablation are the most used.

Purpose: To investigate short and long-term efficacy of image-guided laser and radiofrequency ablation as therapy options for benign nodular goiter.

Methods: For this prospective monocentric, single-operator study 41 consecutive patients who underwent either ultrasound-guided laser (USG-L) (25 cases) or radiofrequency (USG-RF) (16 cases) ablation were enrolled. All patients had large, predominantly solid nodules with previous benign, THY2 cytological diagnosis. Subsequently, they underwent follow-up assessment with B-mode, color-Doppler and contrast-enhanced sonography at 1-2 months (first follow-up) and 1-, 2- and 3 years after ablation, with evaluation of the volume reduction ratio (VRR).

Results: The median volume (MV) of the nodules undergone USG-L was 15.7 ml (range 0.75–91.58 ml). At the first follow-up the MV was 10.08 ml, with a median VRR of 44.06% (P< 0.05: 34.17-53.94%), while at the 3-year follow-up the MV was 4.08 ml and the median VRR 88.09% (P< 0.05: 80.83-95.36%), with positive correlation between patients′ age and 3-year VRR (θ=0.43, P=0.031). In the cohort treated with USG-RF, the MV of nodules was 28.65 ml (range 9.81-109.89 ml) before ablation, and 13.89 ml at the first follow-up, with median VRR of 46.80% (P< 0.05; 38.44-55.17%). At 3-year follow-up the MV was 5.17 ml, and the median VRR 80.84% (P< 0.05: 73.60-88.08%). The difference in number of cases and pre-ablation size between the two groups do not allow to perform statistically significant comparisons. No immediate or late complications occurred, apart from a moderate local discomfort immediately at the end of the procedure, lasting 24-48 h, in almost all patients. No nodular regrowth was detected and no replacement therapy had to be administered to any patient during the 3-year follow-up.

Conclusion: In accordance with the literature, our study confirms that both USG-L and USG-RF can safely achieve significant and long-lasting size reduction of large benign thyroid nodules. Further studies are needed to evaluate if specific features, such as nodular volume and shape, can affect the procedure outcomes and to compare the effectiveness of the two modalities of treatment.