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Published in: European Radiology 3/2019

01-03-2019 | Ultrasound

Role of second high-intensity focused ultrasound (HIFU) treatment for unsatisfactory benign thyroid nodules after first treatment

Authors: Brian Hung-Hin Lang, Yu-Cho Woo, Keith Wan-Hang Chiu

Published in: European Radiology | Issue 3/2019

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Abstract

Background

We aimed to assess the efficacy and safety of second high-intensity focused ultrasound (HIFU) ablation treatment in benign thyroid nodules that had failed to shrink by > 50% 6 months after the first treatment.

Methods

Twenty-eight patients who did not achieve 50% volume reduction at 6 months after the first HIFU treatment underwent a second HIFU treatment. Nodule volume was measured on ultrasound at baseline, 3 months and 6 months. Extent of nodule shrinkage (by volume reduction ratio) (VRR) = [Baseline volume – volume at 6 months]/[Baseline volume] * 100. Treatment success was defined as VRR > 50%. Obstructive symptom score (by 0–10 visual analogue scale, VAS) was evaluated for 6 months after treatment.

Results

No complications occurred after the second treatment. The mean 6-month VRR was 21.78 ± 16.87% with a median (range) of 16.16 (1.63–54.07)%. At 6 months, only two (7.1%) patients achieved treatment success, while nine (32.1%) patients had VRR < 10%. However, relative to baseline (3.96 ± 1.04), the mean VAS significantly improved at 3 and 6 months (2.96 ± 1.43, p<0.001 and 2.58 ± 1.39, p<0.001, respectively). There was a significant correlation between VRR and improvement in VAS score at 6 months (ρ=0.438, p=0.025). Greater nodule volume before the second treatment (OR=1.169, 95% CI=1.004–1.361, p=0.045) was a significant factor for greater VRR after the second treatment.

Conclusions

Although subjective obstructive symptoms continued to improve after the second treatment, the actual extent of nodule shrinkage was small. Larger-volume nodules tended to shrink more significantly than smaller-volume nodules in the second treatment.

Key Points

Second treatment resulted in small shrinkage in unsatisfactory nodules after first treatment.
• Obstructive symptoms tended to continue to improve after second treatment.
• Larger-size nodules tended to respond better in the second treatment.
Literature
1.
go back to reference Gharib H, Papini E, Garber JR et al (2016) P. AACE/ACE/AME Task Force on Thyroid Nodules. 2016 American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the diagnosis and management of thyroid nodules - 2016 Update. Endocr Pract 22(5):622–639PubMed Gharib H, Papini E, Garber JR et al (2016) P. AACE/ACE/AME Task Force on Thyroid Nodules. 2016 American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the diagnosis and management of thyroid nodules - 2016 Update. Endocr Pract 22(5):622–639PubMed
2.
go back to reference Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26:1–133CrossRefPubMedPubMedCentral Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26:1–133CrossRefPubMedPubMedCentral
3.
go back to reference Durante C, Costante G, Lucisano G et al (2015) The natural history of benign thyroid nodules. JAMA 313(9):926–935CrossRefPubMed Durante C, Costante G, Lucisano G et al (2015) The natural history of benign thyroid nodules. JAMA 313(9):926–935CrossRefPubMed
4.
go back to reference Korkusuz Y, Gröner D, Raczynski N et al (2018) Thermal ablation of thyroid nodules: are radiofrequency ablation, microwave ablation and high intensity focused ultrasound equally safe and effective methods? Eur Radiol 28(3):929–935 Korkusuz Y, Gröner D, Raczynski N et al (2018) Thermal ablation of thyroid nodules: are radiofrequency ablation, microwave ablation and high intensity focused ultrasound equally safe and effective methods? Eur Radiol 28(3):929–935
5.
go back to reference Pacella CM, Mauri G, Cesareo R et al (2017) A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis. Int J Hyperthermia 33(8):911–919PubMed Pacella CM, Mauri G, Cesareo R et al (2017) A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis. Int J Hyperthermia 33(8):911–919PubMed
6.
go back to reference Dietrich CF, Müller T, Bojunga J et al (2018) Statement and Recommendations on Interventional Ultrasound as a Thyroid Diagnostic and Treatment Procedure. Ultrasound Med Biol 44(1):14–36CrossRefPubMed Dietrich CF, Müller T, Bojunga J et al (2018) Statement and Recommendations on Interventional Ultrasound as a Thyroid Diagnostic and Treatment Procedure. Ultrasound Med Biol 44(1):14–36CrossRefPubMed
7.
go back to reference Mauri G, Sconfienza LM (2016) Percutaneous ablation holds the potential to substitute for surgery as first choice treatment for symptomatic benign thyroid nodules. Int J Hyperthermia 33(3):301–302CrossRefPubMed Mauri G, Sconfienza LM (2016) Percutaneous ablation holds the potential to substitute for surgery as first choice treatment for symptomatic benign thyroid nodules. Int J Hyperthermia 33(3):301–302CrossRefPubMed
9.
go back to reference Kovatcheva RD, Vlahov JD, Stoinov JI, Zaletel K (2015) Benign Solid Thyroid Nodules: US-guided High-Intensity Focused Ultrasound Ablation-Initial Clinical Outcomes. Radiology 276(2):597–605CrossRefPubMed Kovatcheva RD, Vlahov JD, Stoinov JI, Zaletel K (2015) Benign Solid Thyroid Nodules: US-guided High-Intensity Focused Ultrasound Ablation-Initial Clinical Outcomes. Radiology 276(2):597–605CrossRefPubMed
10.
go back to reference Lang BH, Woo YC, Wong CKH (2017) High-Intensity Focused Ultrasound for Treatment of Symptomatic Benign Thyroid Nodules: A Prospective Study. Radiology 284(3):897–906 Lang BH, Woo YC, Wong CKH (2017) High-Intensity Focused Ultrasound for Treatment of Symptomatic Benign Thyroid Nodules: A Prospective Study. Radiology 284(3):897–906
12.
go back to reference Bini F, Trimboli P, Marinozzi F, Giovanella L (2018) Treatment of benign thyroid nodules by high intensity focused ultrasound (HIFU) at different acoustic powers: a study on in-silico phantom. Endocrine 59(3):506–509CrossRefPubMed Bini F, Trimboli P, Marinozzi F, Giovanella L (2018) Treatment of benign thyroid nodules by high intensity focused ultrasound (HIFU) at different acoustic powers: a study on in-silico phantom. Endocrine 59(3):506–509CrossRefPubMed
13.
go back to reference Lang BH, Woo YC, Chiu KW (2017) Single-Session High-Intensity Focused Ultrasound Treatment in Large-Sized Benign Thyroid Nodules. Thyroid 27(5):714–7214CrossRefPubMed Lang BH, Woo YC, Chiu KW (2017) Single-Session High-Intensity Focused Ultrasound Treatment in Large-Sized Benign Thyroid Nodules. Thyroid 27(5):714–7214CrossRefPubMed
14.
go back to reference Lang BHH, Woo YC, Chiu KW (2018) Significance of hyperechoic marks observed during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Eur Radiol 28(6):2675–2681CrossRefPubMed Lang BHH, Woo YC, Chiu KW (2018) Significance of hyperechoic marks observed during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Eur Radiol 28(6):2675–2681CrossRefPubMed
15.
go back to reference Lim HK, Lee JH, Ha EJ, Sung JY, Kim JK, Baek JH (2013) Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients. Eur Radiol 23(4):1044–1049CrossRefPubMed Lim HK, Lee JH, Ha EJ, Sung JY, Kim JK, Baek JH (2013) Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients. Eur Radiol 23(4):1044–1049CrossRefPubMed
16.
go back to reference Huh JY, Baek JH, Choi H, Kim JK, Lee JH (2012) Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session--prospective randomized study. Radiology 263(3):909–916CrossRefPubMed Huh JY, Baek JH, Choi H, Kim JK, Lee JH (2012) Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session--prospective randomized study. Radiology 263(3):909–916CrossRefPubMed
17.
go back to reference Cibas ES, Ali SZ, NCI Thyroid FNA State of the Science Conference (2009) The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol 132(5):658–665 Cibas ES, Ali SZ, NCI Thyroid FNA State of the Science Conference (2009) The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol 132(5):658–665
18.
go back to reference Zimmermann M, Saad A, Hess S, Torresani T, Chaouki N (2000) Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency. Eur J Endocrinol 143(6):727–731CrossRefPubMed Zimmermann M, Saad A, Hess S, Torresani T, Chaouki N (2000) Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency. Eur J Endocrinol 143(6):727–731CrossRefPubMed
19.
go back to reference Wong KP, Lang BH, Ng SH, Cheung CY, Chan CT, Lo CY (2013) A prospective, assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surgery 154(6):1158–1164CrossRefPubMed Wong KP, Lang BH, Ng SH, Cheung CY, Chan CT, Lo CY (2013) A prospective, assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surgery 154(6):1158–1164CrossRefPubMed
21.
go back to reference Piana S, Riganti F, Froio E, Andrioli M, Pacella CM, Valcavi R (2012) Pathological findings of thyroid nodules after percutaneous laser ablation: a series of 22 cases with cyto-histological correlation. Endocr Pathol 23(2):94–100CrossRefPubMed Piana S, Riganti F, Froio E, Andrioli M, Pacella CM, Valcavi R (2012) Pathological findings of thyroid nodules after percutaneous laser ablation: a series of 22 cases with cyto-histological correlation. Endocr Pathol 23(2):94–100CrossRefPubMed
22.
go back to reference Negro R, Salem TM, Greco G (2016) Laser ablation is more effective for spongiform than solid thyroid nodules. A 4-year retrospective follow-up study. Int J Hyperthermia 32(7):822–828CrossRefPubMed Negro R, Salem TM, Greco G (2016) Laser ablation is more effective for spongiform than solid thyroid nodules. A 4-year retrospective follow-up study. Int J Hyperthermia 32(7):822–828CrossRefPubMed
23.
go back to reference Papini E, Rago T, Gambelunghe G et al (2014) Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules. Results of a three-year multicenter prospective randomized trial. J Clin Endocrinol Metab 99(10):3653–3659CrossRefPubMed Papini E, Rago T, Gambelunghe G et al (2014) Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules. Results of a three-year multicenter prospective randomized trial. J Clin Endocrinol Metab 99(10):3653–3659CrossRefPubMed
24.
go back to reference Spiezia S, Garberoglio R, Milone F et al (2009) Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid 19(3):219–225CrossRefPubMed Spiezia S, Garberoglio R, Milone F et al (2009) Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid 19(3):219–225CrossRefPubMed
Metadata
Title
Role of second high-intensity focused ultrasound (HIFU) treatment for unsatisfactory benign thyroid nodules after first treatment
Authors
Brian Hung-Hin Lang
Yu-Cho Woo
Keith Wan-Hang Chiu
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5671-0

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