Li Yi, Li Wen, Jiang Bo, Zhao Jiahang, Zhang Yan, Luo Yukun
Department of Ultrasound, Medical School of Chinese PLA, Beijing, China.
Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
Eur Radiol. 2023 Aug;33(8):5615-5624. doi: 10.1007/s00330-023-09481-8. Epub 2023 Mar 23.
To evaluate the 5-year follow-up results of radiofrequency ablation (RFA) for benign thyroid nodules (BTNs), and construct pre- and postablation nomogram models to predict regrowth in BTNs undergoing RFA.
According to the occurrence of regrowth, BTNs were divided into two subgroups, the regrowth group and the nonregrowth group, and the variables were compared between these two subgroups. Then, univariate and multivariate Cox regression analyzes were utilized to filter the independent prognostic factors of regrowth, which then were introduced into the pre- and postablation prognostic nomograms, respectively. The discrimination powers and prediction performances of the nomograms were appraised by receiver operating characteristic (ROC) curves and calibration charts.
The 5-year mean volume reduction rate was 88.80%, with a complication rate of 0.35% (7/200). Within 5 years of follow-up, the regrowth rate was 19% (38/200). Pre- and postablation prognostic nomograms were established to predict the probability of nonregrowth at 1, 3, and 5 years after RFA. The preablation nomogram included initial volume, perinodular vascularity, and high enhancement ring. The postablation nomogram incorporated total volume, perinodular vascularity, and energy applied per volume. The area under the ROC curves and concordance index values of these models were all above 0.7, indicating that the prognostic nomograms achieved satisfactory discrimination powers and prediction performances.
RFA for BTNs has long-term efficacy and safety under the influence of key techniques. The pre- and postablation nomograms constructed in the present study might facilitate clinical decision-making before RFA and for the follow-up management after RFA.
• Perinodular vascularity, rather than intranodular vascularity was an independent predictor of regrowth, both before and after the RFA procedure. • A high enhancement ring on preablation contrast-enhanced ultrasound was an independent predictor of regrowth. • Pre- and postablation nomograms might facilitate clinical decision-making before RFA and follow-up management after RFA.
评估射频消融（RFA）治疗良性甲状腺结节（BTN）的5年随访结果，并构建消融前后的列线图模型以预测接受RFA治疗的BTN的再生长情况。
根据再生长情况，将BTN分为两个亚组，即再生长组和无再生长组，并比较这两个亚组之间的变量。然后，采用单因素和多因素Cox回归分析筛选再生长的独立预后因素，分别将其纳入消融前和消融后的预后列线图。通过受试者操作特征（ROC）曲线和校准图评估列线图的辨别能力和预测性能。
5年平均体积缩小率为88.80%，并发症发生率为0.35%（7/200）。在5年随访期内，再生长率为19%（38/200）。建立了消融前和消融后的预后列线图，以预测RFA后1年、3年和5年无再生长的概率。消融前列线图包括初始体积、结节周围血管情况和高增强环。消融后列线图纳入了总体积、结节周围血管情况和每体积施加的能量。这些模型的ROC曲线下面积和一致性指数值均高于0.7，表明预后列线图具有令人满意的辨别能力和预测性能。
在关键技术的影响下，RFA治疗BTN具有长期疗效和安全性。本研究构建的消融前和消融后的列线图可能有助于RFA术前的临床决策以及RFA术后的随访管理。
• 结节周围血管情况而非结节内血管情况是RFA手术前后再生长的独立预测因素。• 消融前对比增强超声上的高增强环是再生长的独立预测因素。• 消融前和消融后的列线图可能有助于RFA术前的临床决策以及RFA术后的随访管理。
