1st Propaedeutic Department of Surgery, AHEPA University Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Vascular Surgery, AHEPA University Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Thyroid. 2023 Aug;33(8):950-964. doi: 10.1089/thy.2022.0671. Epub 2023 Jul 10.
Image-guided thermal ablation interventions are novel thermal-based modalities used for the treatment of benign thyroid nodules. We conducted a systematic review and a Bayesian network meta-analysis, examining studies using thermal ablation interventions in the treatment of benign nodular thyroid disease (PROSPERO CRD42022367680). The primary endpoints included volume reduction rate (VRR), and symptomatic score and cosmetic score improvement. Secondary endpoints included vocal disturbances, laryngeal nerve palsy, hypothyroidism, and nodular regrowth (defined by increased nodular volume of >50% for thermal ablation or new nodules arising in remaining thyroid tissue conventional surgery [CS]). We included 16 studies (3 randomized controlled trials [RCTs] and 13 comparative case series), describing radiofrequency ablation (RFA), laser ablation (LA), microwave ablation (MWA), high-intensity focus ultrasound (HIFU), and CS, respectively. The review included data from 4112 patients followed for a mean of 11.9 months. Meta-analyses showed no significant differences among RFA, LA, MWA, HIFU, and CS regarding any of the primary endpoints of VRR, symptomatic score, and cosmetic score. In examining the surface under the cumulative ranking area (SUCRA) ranking, CS (SUCRA, 98.49), LA (SUCRA, 51.58), and MWA (SUCRA, 57.0) were identified as the three interventions that were most likely to result in the largest VRR, symptomatic and cosmetic score reduction. RFA, relative risk (RR) 0.19 [95% credibility interval (CI): 0.06 to 0.48], LA RR 0.23 [CI: 0.06 to 0.79], and MWA RR 0.25 [CI: 0.09 to 0.60] were associated with the greatest reduction in risk for postintervention vocal complications compared with CS, with RFA (SUCRA, 61.62) being ranked as the highest in safety. RFA RR 0.05 [CI: 0.00 to 0.40] and MWA RR 0.16 [CI: 0.02 to 0.73] were associated with a reduced risk of transient laryngeal nerve injury compared with CS. RFA RR 0.00 [CI: 0.00 to 0.00] and MWA RR 0.00 [CI: 0.00 to 0.03] were associated with a reduced risk of hypothyroidism occurrence compared with CS, with RFA (SUCRA, 99.86) yielding the highest safety ranking. RFA was associated with a reduced risk for nodular regrowth RR 0.09 [CI: 0.00 to 0.85], compared with CS. We have comprehensively reviewed the published literature on the efficacy and safety of thermal ablation modalities for benign thyroid nodules. Important research gaps remain regarding a paucity of both long-term data and high-quality RCTs.
图像引导热消融干预是一种新型的基于热的治疗方法，用于治疗良性甲状腺结节。我们进行了系统评价和贝叶斯网络荟萃分析，研究了使用热消融干预治疗良性结节性甲状腺疾病的研究（PROSPERO CRD42022367680）。主要终点包括体积减少率（VRR），以及症状评分和美容评分的改善。次要终点包括声带障碍、喉返神经麻痹、甲状腺功能减退和结节复发（定义为热消融后结节体积增加>50%，或在常规手术[CS]后剩余甲状腺组织中出现新结节）。我们纳入了 16 项研究（3 项随机对照试验[RCT]和 13 项比较病例系列），分别描述了射频消融（RFA）、激光消融（LA）、微波消融（MWA）、高强度聚焦超声（HIFU）和 CS。该综述包括对 4112 名患者进行平均 11.9 个月随访的数据。荟萃分析显示，在 VRR、症状评分和美容评分方面，RFA、LA、MWA、HIFU 和 CS 之间没有显著差异。在考察累积排序面积（SUCRA）排名的表面下（SUCRA）排名时，CS（SUCRA，98.49）、LA（SUCRA，51.58）和 MWA（SUCRA，57.0）被确定为最有可能导致最大 VRR、症状和美容评分降低的三种干预措施。与 CS 相比，RFA（RR，0.19[95%可信区间[CI]：0.06 至 0.48]）、LA（RR，0.23[CI：0.06 至 0.79]）和 MWA（RR，0.25[CI：0.09 至 0.60]）与术后声带并发症风险降低相关，RFA（SUCRA，61.62）的安全性最高。与 CS 相比，RFA（RR，0.05[CI：0.00 至 0.40]）和 MWA（RR，0.16[CI：0.02 至 0.73]）与短暂性喉返神经损伤风险降低相关。与 CS 相比，RFA（RR，0.00[CI：0.00 至 0.00]）和 MWA（RR，0.00[CI：0.00 至 0.03]）与甲状腺功能减退发生风险降低相关，RFA（SUCRA，99.86）的安全性最高。与 CS 相比，RFA（RR，0.09[CI：0.00 至 0.85]）与结节复发风险降低相关。我们全面回顾了有关良性甲状腺结节热消融治疗效果和安全性的已发表文献。关于长期数据和高质量 RCT 的缺乏仍然存在重要的研究空白。
