Division of Endocrinology, "V. Fazzi" Hospital , Lecce, Italy.
Clinic for Nuclear Medicine and Competence Center for Thyroid Disease, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale , Bellinzona, Switzerland.
Electromagn Biol Med. 2020 Oct 1;39(4):347-355. doi: 10.1080/15368378.2020.1809448. Epub 2020 Aug 17.
Thermal ablation (TA) is a therapeutic option for benign, non-functioning thyroid nodules causing symptoms of compression and/or aesthetic concerns. TA was initially introduced as a treatment for patients who refused or were ineligible for surgery. In more recent years, the increase in the positive experiences of TA have paved the way for the idea that TA could be suggested as a first-line treatment. The present review was conceived to summarize the evidence achieved in this field, and to offer a clinical perspective on TA, with particular reference to the comparison between TA and surgery. We searched literature that was focused on two types of TA, laser (LA) and radiofrequency (RFA). The searched literature included short- mid-term prospective and retrospective studies, randomized trials, and meta-analyses that demonstrated a satisfactory volume reduction ratio (VRR), and benefits in cosmetic and symptoms scores. An important drawback of the use of TA, is the regrowth of a certain number of nodules, which necessitate further TA procedures or surgery. Long-term randomized controlled trials to evaluate the cost/effectiveness of TA vs surgery are not currently available. The selection of the nodule, the optimization of interventional techniques, and ultimately, a well-timed second treatment, are all factors that should be considered in a proactive strategy to prevent TA failure.
热消融（TA）是一种治疗良性、无功能甲状腺结节的方法，这些结节会引起压迫和/或美观问题。TA 最初被引入是作为一种治疗拒绝或不适合手术的患者的方法。近年来，TA 的积极经验增加，为 TA 可以被建议作为一线治疗的观点铺平了道路。本综述旨在总结该领域的证据，并提供 TA 的临床观点，特别参考 TA 与手术之间的比较。我们搜索了专注于两种 TA 类型（激光（LA）和射频（RFA））的文献。搜索的文献包括短期、中期前瞻性和回顾性研究、随机试验和荟萃分析，这些研究表明具有令人满意的体积减少率（VRR），并在美容和症状评分方面有获益。TA 使用的一个重要缺点是一定数量的结节会复发，这需要进一步的 TA 程序或手术。目前尚无评估 TA 与手术的成本效益的长期随机对照试验。选择结节、优化介入技术，最终及时进行第二次治疗，这些都是在预防 TA 失败的主动策略中需要考虑的因素。
