Trimboli Pierpaolo, Castellana Marco, Sconfienza Luca Maria, Virili Camilla, Pescatori Lorenzo Carlo, Cesareo Roberto, Giorgino Francesco, Negro Roberto, Giovanella Luca, Mauri Giovanni
Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.
Endocrine. 2020 Jan;67(1):35-43. doi: 10.1007/s12020-019-02019-3. Epub 2019 Jul 20.
Image-guided thermal ablations are commonly used in the treatment of thyroid nodules. Radiofrequency ablation (RFA) and laser ablation are the most commonly used. Here we aimed to obtain solid evidence of the long-term efficacy of RFA and laser ablation in benign non-functioning solid thyroid nodules (BNFSTN).
PubMed, CENTRAL, Scopus, and Web of Science were searched until March 2019. Studies reporting the effectiveness of RFA or laser ablation in patients with BNFSTN in terms of volume reduction rate (VRR), compressive symptoms and cosmetic concerns were included. Complications were also assessed.
Out of 963 papers, 12 studies on RFA and 12 on laser ablation were included, assessing 1186 and 2009 BNFSTNs, respectively. Overall, VRR at 6, 12, 24, and 36 months was 60%, 66%, 62%, and 53%. VRR of RFA was 68%, 75%, and 87%, respectively. VRR of laser ablation was 48%, 52%, 45%, and 44%, respectively. Baseline volume of nodules undergone RFA was significantly smaller compared to laser ablation (20.1 ± 22.4 versus 24.6 ± 23.6 ml; p < 0.01). Nodules smaller than 30 ml obtained better outcomes than larger ones. A significant reduction in compressive symptoms and cosmetic concerns was found after RFA.
This meta-analysis showed that both RFA and laser ablation are able to obtain a significant volume reduction in BNFSTNs. A significant volume reduction is already evident at 6 months after thermal ablation and results are stable over the time.
图像引导下的热消融术常用于甲状腺结节的治疗。射频消融（RFA）和激光消融是最常用的方法。在此，我们旨在获取关于RFA和激光消融治疗良性无功能实性甲状腺结节（BNFSTN）长期疗效的确凿证据。
检索截至2019年3月的PubMed、CENTRAL、Scopus和科学网。纳入报告RFA或激光消融治疗BNFSTN患者的体积缩小率（VRR）、压迫症状和美观问题有效性的研究。同时评估并发症。
在963篇论文中，纳入了12项关于RFA的研究和12项关于激光消融的研究，分别评估了1186个和2009个BNFSTN。总体而言，6个月、12个月、24个月和36个月时的VRR分别为60%、66%、62%和53%。RFA的VRR分别为68%、75%和87%。激光消融的VRR分别为48%、52%、45%和4%。接受RFA的结节基线体积明显小于激光消融（20.1±22.4对24.6±23.6ml；p<0.01）。小于30ml的结节比大结节的治疗效果更好。RFA后压迫症状和美观问题显著减轻。
这项荟萃分析表明，RFA和激光消融均能使BNFSTN的体积显著缩小。热消融术后6个月体积就已明显缩小，且结果随时间稳定。
