Unfavorable Outcomes in Solid and Spongiform Thyroid Nodules Treated with Laser Ablation. A 5-Year Follow-up Retrospective Study

Author(s): Roberto Negro*, Gabriele Greco

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets
Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders

Volume 19 , Issue 7 , 2019


DOI : 10.2174/1871530319666190206123156

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Graphical Abstract:


Abstract:

Objective: Laser Ablation (LA) is a therapeutic modality for reducing the volume of large benign thyroid nodules. This retrospective study was aimed at assessing the outcome of LA in patients with benign nonfunctioning thyroid nodules in a 5-years follow-up.

Methods: Sixty-two patients (47 females; mean age 54.7±12 yr) with benign cold thyroid nodules underwent LA from July 2009 to March 2012. Nodule volume, thyroid function test, and ultrasound were monitored at baseline, and at 3, 6 and 12 months after the procedure, then annually. After dividing nodules in solid and spongiform, we evaluated unfavourable outcomes: 1) nodule’s volume reduction <50%; 2) need for surgery; 3) need for additive LA session (due to nodule re-growth with persistence of cosmetic concern or compressive symptoms).

Results: Baseline volume did not differ between solid and spongiform nodules as well as energy delivered and the number of needles used. Unfavourable outcomes occurred in 24 patients (38.7%). Nineteen/ 24 (79.2%) patients who experienced unfavourable outcomes belonged to the solid nodules group (P<0.01). When considering only those who benefited from LA, the 5-years reduction was 59.7% for solid and 78.6% for spongiform nodules (P<0.05). One/6 patients who underwent surgery (solid nodules group) had a final diagnosis of Follicular Variant of Papillary Thyroid Cancer (FVPTC).

Conclusion: Large solid nodules, unlike spongiform, submitted to LA are characterized by a long-term unfavourable outcome and entail a potential risk of false negative cytologic results.

Keywords: Thyroid, laser, thermal ablation, nodule, ultrasound, surgery.

[1]
Kim, J.H.; Baek, J.H.; Lim, H.K.; Ahn, H.S.; Baek, S.M.; Choi, Y.J.; Choi, Y.J.; Chung, S.R.; Ha, E.J.; Hahn, S.Y.; Jung, S.L.; Kim, D.S.; Kim, S.J.; Kim, Y.K.; Lee, C.Y.; Lee, J.H.; Lee, K.H.; Lee, Y.H.; Park, J.S.; Park, H.; Shin, J.H.; Suh, C.H.; Sung, J.Y.; Sim, J.S.; Youn, I.; Choi, M.; Na, D.G. (KSThR) and Korean Society of Radiology. Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology. Korean J. Radiol., 2018, 19, 632-655.
[http://dx.doi.org/10.3348/kjr.2018.19.4.632] [PMID: 29962870]
[2]
Cesareo, R.; Palermo, A.; Pasqualini, V.; Cianni, R.; Gaspa, G.; Manfrini, S.; Pacella, C.M. Radiofrequency ablation for the management of thyroid nodules: A critical appraisal of the literature. Clin. Endocrinol. (Oxf.), 2017, 87(6), 639-648.
[http://dx.doi.org/10.1111/cen.13422] [PMID: 28718950]
[3]
Chianelli, M.; Bizzarri, G.; Todino, V.; Misischi, I.; Bianchini, A.; Graziano, F.; Guglielmi, R.; Pacella, C.M.; Gharib, H.; Papini, E. Laser ablation and 131-iodine: a 24-month pilot study of combined treatment for large toxic nodular goiter. J. Clin. Endocrinol. Metab., 2014, 99(7), E1283-E1286.
[http://dx.doi.org/10.1210/jc.2013-2967] [PMID: 24684455]
[4]
Rotondi, M.; Amabile, G.; Leporati, P.; Di Filippo, B.; Chiovato, L. Repeated laser thermal ablation of a large functioning thyroid nodule restores euthyroidism and ameliorates constrictive symptoms. J. Clin. Endocrinol. Metab., 2009, 94(2), 382-383.
[http://dx.doi.org/10.1210/jc.2008-1782] [PMID: 19193913]
[5]
Døssing, H.; Bennedbaek, F.N.; Bonnema, S.J.; Grupe, P.; Hegedüs, L. Randomized prospective study comparing a single radioiodine dose and a single laser therapy session in autonomously functioning thyroid nodules. Eur. J. Endocrinol., 2007, 157(1), 95-100.
[http://dx.doi.org/10.1530/EJE-07-0094] [PMID: 17609407]
[6]
Døssing, H.; Bennedbaek, F.N.; Hegedüs, L. Beneficial effect of combined aspiration and interstitial laser therapy in patients with benign cystic thyroid nodules: a pilot study. Br. J. Radiol., 2006, 79(948), 943-947.
[http://dx.doi.org/10.1259/bjr/40698061] [PMID: 16822801]
[7]
Dietrich, C.F.; Müller, T.; Bojunga, J.; Dong, Y.; Mauri, G.; Radzina, M.; Dighe, M.; Cui, X.W.; Grünwald, F.; Schuler, A.; Ignee, A.; Korkusuz, H. Statement and Recommendations on Interventional Ultrasound as a Thyroid Diagnostic and Treatment Procedure. Ultrasound Med. Biol., 2018, 44(1), 14-36.
[http://dx.doi.org/10.1016/j.ultrasmedbio.2017.08.1889] [PMID: 29126752]
[8]
Sim, J.S.; Baek, J.H.; Lee, J.; Cho, W.; Jung, S.I. Radiofrequency ablation of benign thyroid nodules: depicting early sign of regrowth by calculating vital volume. Int. J. Hyperthermia, 2017, 33(8), 905-910.
[http://dx.doi.org/10.1080/02656736.2017.1309083] [PMID: 28540795]
[9]
Gambelunghe, G.; Bini, V.; Stefanetti, E.; Colella, R.; Monacelli, M.; Avenia, N.; De Feo, P. Thyroid nodule morphology affects the efficacy of ultrasound-guided interstitial laser ablation: a nested case-control study. Int. J. Hyperthermia, 2014, 30(7), 486-489.
[http://dx.doi.org/10.3109/02656736.2014.963701] [PMID: 25289659]
[10]
Negro, R.; Salem, T.M.; Greco, G. Laser ablation is more effective for spongiform than solid thyroid nodules. A 4-year retrospective follow-up study. Int. J. Hyperthermia, 2016, 32(7), 822-828.
[http://dx.doi.org/10.1080/02656736.2016.1212279] [PMID: 27405595]
[11]
Bellantone, R.; Lombardi, C.P.; Bossola, M.; Boscherini, M.; De Crea, C.; Alesina, P.; Traini, E.; Princi, P.; Raffaelli, M. Total thyroidectomy for management of benign thyroid disease: review of 526 cases. World J. Surg., 2002, 26(12), 1468-1471.
[http://dx.doi.org/10.1007/s00268-002-6426-1] [PMID: 12360381]
[12]
Spiezia, S.; Vitale, G.; Di Somma, C.; Pio Assanti, A.; Ciccarelli, A.; Lombardi, G.; Colao, A. Ultrasound-guided laser thermal ablation in the treatment of autonomous hyperfunctioning thyroid nodules and compressive nontoxic nodular goiter. Thyroid, 2003, 13(10), 941-947.
[http://dx.doi.org/10.1089/105072503322511346] [PMID: 14611703]
[13]
Døssing, H.; Bennedbæk, F.N.; Hegedüs, L. Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules. Eur. J. Endocrinol., 2011, 165(1), 123-128.
[http://dx.doi.org/10.1530/EJE-11-0220] [PMID: 21551168]
[14]
Cesareo, R.; Naciu, A.M.; Iozzino, M.; Pasqualini, V.; Simeoni, C.; Casini, A.; Campagna, G.; Manfrini, S.; Tabacco, G.; Palermo, A. Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules. Int. J. Hyperthermia, 2018, 34(5), 617-623.
[http://dx.doi.org/10.1080/02656736.2018.1430868] [PMID: 29357717]
[15]
Wang, B.; Han, Z.Y.; Yu, J.; Cheng, Z.; Liu, F.; Yu, X.L.; Chen, C.; Liu, J.; Liang, P. Factors related to recurrence of the benign non-functioning thyroid nodules after percutaneous microwave ablation. Int. J. Hyperthermia, 2017, 33(4), 459-464.
[http://dx.doi.org/10.1080/02656736.2016.1274058] [PMID: 28081645]
[16]
Ritz, J.P.; Lehmann, K.S.; Zurbuchen, U.; Knappe, V.; Schumann, T.; Buhr, H.J.; Holmer, C. Ex vivo and in vivo evaluation of laser-induced thermotherapy for nodular thyroid disease. Lasers Surg. Med., 2009, 41(7), 479-486.
[http://dx.doi.org/10.1002/lsm.20805] [PMID: 19708069]
[17]
Mertyna, P.; Hines-Peralta, A.; Liu, Z.J.; Halpern, E.; Goldberg, W.; Goldberg, S.N. Radiofrequency ablation: variability in heat sensitivity in tumors and tissues. J. Vasc. Interv. Radiol., 2007, 18(5), 647-654.
[http://dx.doi.org/10.1016/j.jvir.2007.02.033] [PMID: 17494847]
[18]
Papini, E.; Rago, T.; Gambelunghe, G.; Valcavi, R.; Bizzarri, G.; Vitti, P.; De Feo, P.; Riganti, F.; Misischi, I.; Di Stasio, E.; Pacella, C.M. 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., 2014, 99(10), 3653-3659.
[http://dx.doi.org/10.1210/jc.2014-1826] [PMID: 25050903]
[19]
Valcavi, R.; Riganti, F.; Bertani, A.; Formisano, D.; Pacella, C.M. Percutaneous laser ablation of cold benign thyroid nodules: a 3-year follow-up study in 122 patients. Thyroid, 2010, 20(11), 1253-1261.
[http://dx.doi.org/10.1089/thy.2010.0189] [PMID: 20929405]
[20]
Pacini, F.; Basolo, F.; Bellantone, R.; Boni, G.; Cannizzaro, M.A.; De Palma, M.; Durante, C.; Elisei, R.; Fadda, G.; Frasoldati, A.; Fugazzola, L.; Guglielmi, R.; Lombardi, C.P.; Miccoli, P.; Papini, E.; Pellegriti, G.; Pezzullo, L.; Pontecorvi, A.; Salvatori, M.; Seregni, E.; Vitti, P. Italian consensus on diagnosis and treatment of differentiated thyroid cancer: joint statements of six Italian societies. J. Endocrinol. Invest., 2018, 41(7), 849-876.
[http://dx.doi.org/10.1007/s40618-018-0884-2] [PMID: 29729004]
[21]
Rossi, E.D.; Bizzarro, T.; Fadda, G.; Pontecorvi, A.; Bernet, V.; Nassar, A. The cytological diagnosis of a ‘benign thyroid lesion’: is it a real safe diagnosis for the patient? Cytopathology, 2016, 27(3), 168-175.
[http://dx.doi.org/10.1111/cyt.12267] [PMID: 26388423]
[22]
Giles, W.H.; Maclellan, R.A.; Gawande, A.A.; Ruan, D.T.; Alexander, E.K.; Moore, F.D., Jr; Cho, N.L. False negative cytology in large thyroid nodules. Ann. Surg. Oncol., 2015, 22(1), 152-157.
[http://dx.doi.org/10.1245/s10434-014-3952-7] [PMID: 25074665]
[23]
Mehanna, R.; Murphy, M.; McCarthy, J.; O’Leary, G.; Tuthill, A.; Murphy, M.S.; Sheahan, P. False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. Laryngoscope, 2013, 123(5), 1305-1309.
[http://dx.doi.org/10.1002/lary.23861] [PMID: 23293053]
[24]
Kragel, C.; Shattuck, T.M. The follicular variant of papillary thyroid carcinoma as a source of false negative cytopathology: a report of four cases with an emphasis on the multifocality of nuclear changes. Diagn. Cytopathol., 2015, 43(2), 174-177.
[http://dx.doi.org/10.1002/dc.23157] [PMID: 24692359]
[25]
Nikiforov, Y.E.; Nikiforova, M.N. Molecular genetics and diagnosis of thyroid cancer. Nat. Rev. Endocrinol., 2011, 7(10), 569-580.
[http://dx.doi.org/10.1038/nrendo.2011.142] [PMID: 21878896]


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Article Details

VOLUME: 19
ISSUE: 7
Year: 2019
Published on: 11 October, 2019
Page: [1041 - 1045]
Pages: 5
DOI: 10.2174/1871530319666190206123156

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