Department of Thyroid surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, PR China.
Thyroid. 2022 May;32(5):525-535. doi: 10.1089/thy.2021.0454. Epub 2022 Jan 17.
Image-guided radiofrequency ablation (RFA) for benign nonfunctional thyroid nodules in adults has been shown to be effective and safe, but few trials address the use of RFA in children. Therefore, this study was designed to assess the efficacy and safety of RFA application to benign nonfunctional thyroid nodules in children. A retrospective study of RFA for 70 benign nonfunctional thyroid nodules in 62 children with four-year follow-up was conducted. Volume reduction ratio (VRR), technique efficacy, regrowth rate, symptom score, and cosmetic score were calculated to evaluate the efficacy. Complications and side effects were recorded. Logistic regression analysis was performed to identify risk factors, and subgroup analyses were performed. Patients were followed up for at least four years (59.1 ± 10.5 months, range 48-85 months). After RFA treatment, the VRR and technique efficacy rates were highest at the first year (77.5% and 91.4%, respectively) but decreased by four years (55.1% and 81.4%, respectively). The symptom score decreased from 4.0 ± 2.1 to 0.8 ± 1.6 ( = -6.82, < 0.001), and the cosmetic score decreased from 3.3 ± 0.7 to 1.3 ± 0.9 ( = -7.0, < 0.001). The nodule regrowth rate was 22.9%, of which 56.3% of cases represented loss of efficacy. In the cases of loss of efficacy, 66.7% had greater volume than their initial presentation. Patients who received a second RFA treatment due to loss of efficacy lost efficacy again. Bilateral nodules, low vascularity, and low cystic components were independent risk factors correlating with technique efficacy. Bilateral nodules correlated with low VRR, low efficacy rate, and high regrowth rate. Nodules with a higher proportion of cystic components had higher VRR. The overall complication rate was 4.8%. RFA was effective in reducing the volume of benign nonfunctional thyroid nodules in children, providing significant symptomatic relief with a good safety profile during short- and long-term follow-up. RFA is a good minimally invasive treatment modality for selected pediatric patients, and it may not be appropriate for the treatment of bilateral thyroid nodules in children.
图像引导下射频消融术（RFA）治疗成人良性非功能性甲状腺结节已被证实是有效且安全的，但很少有研究探讨 RFA 在儿童中的应用。因此，本研究旨在评估 RFA 治疗儿童良性非功能性甲状腺结节的疗效和安全性。
对 62 例儿童的 70 个良性非功能性甲状腺结节进行了 RFA 的回顾性研究，随访时间为 4 年。通过计算体积减少率（VRR）、技术疗效、复发率、症状评分和美容评分来评估疗效。记录并发症和不良反应。采用 logistic 回归分析确定危险因素，并进行亚组分析。
患者随访至少 4 年（59.1±10.5 个月，范围 48-85 个月）。RFA 治疗后，第 1 年的 VRR 和技术疗效最高（分别为 77.5%和 91.4%），但 4 年后下降（分别为 55.1%和 81.4%）。症状评分从 4.0±2.1 降至 0.8±1.6（ = -6.82， < 0.001），美容评分从 3.3±0.7 降至 1.3±0.9（ = -7.0， < 0.001）。结节复发率为 22.9%，其中 56.3%的病例表示疗效丧失。在疗效丧失的病例中，66.7%的病例体积较初次就诊时增大。因疗效丧失而接受第二次 RFA 治疗的患者再次丧失疗效。双侧结节、低血管性和低囊变成分是与技术疗效相关的独立危险因素。双侧结节与低 VRR、低疗效率和高复发率相关。囊变成分比例较高的结节 VRR 较高。总的并发症发生率为 4.8%。
RFA 可有效缩小儿童良性非功能性甲状腺结节的体积，在短期和长期随访中提供显著的症状缓解，具有良好的安全性。RFA 是一种治疗选择合适的儿科患者的微创治疗方法，可能不适合治疗儿童双侧甲状腺结节。
