School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
Eur Radiol. 2024 Apr;34(4):2310-2322. doi: 10.1007/s00330-023-10253-7. Epub 2023 Oct 4.
Thyroid nodules are common and sometimes associated with cosmetic issues. Surgical treatment has several disadvantages, including visible scarring. High-intensity focused ultrasound (HIFU) is a recent noninvasive treatment for thyroid nodules. The present study aims to evaluate the effectiveness and safety of HIFU for the treatment of benign thyroid nodules.
We searched PubMed, Embase, and Cochrane Library for studies evaluating the outcomes of HIFU for patients with benign thyroid nodules. We conducted a meta-analysis by using a random effects model and evaluated the volume reduction ratio, treatment success rate, and incidence of treatment-related complications.
Thirty-two studies were included in the systematic review. Only 14 studies were used in the meta-analysis because the other 18 involved data collected during overlapping periods. The average volume reduction ratios at 3, 6, and 12 months after treatment were 39.02% (95% CI: 27.57 to 50.47%, I: 97.9%), 48.55% (95% CI: 35.53 to 61.57%, I: 98.2%), and 55.02% (95% CI: 41.55 to 68.48%, I: 99%), respectively. Regarding complications, the incidences of vocal cord paresis and Horner's syndrome after HIFU were 2.1% (95% CI: 0.2 to 4.1%, I: 14.6%) and 0.7% (95% CI: 0 to 1.9%, I: 0%), respectively.
HIFU is an effective and safe treatment option for patients with benign thyroid nodules. However, the effects of HIFU on nodules of large sizes and with different properties require further investigation. Additional studies, particularly randomized controlled trials involving long-term follow-up, are warranted.
Surgical treatment for thyroid nodules often results in permanent visible scars and is associated with a risk of bleeding, nerve injury, and hypothyroidism. High-intensity focused ultrasound may be an alternative for patients with benign thyroid nodules.
• The success rate of HIFU treatment for thyroid nodules is 75.8% at 6 months. Average volume reduction ratios are 48.55% and 55.02% at 6 and 12 months. • The incidence of complications such as vocal fold paresis, Horner's syndrome, recurrent laryngeal nerve palsy, hypothyroidism, and skin redness is low. • HIFU is both effective and safe as a treatment for benign thyroid nodules.
甲状腺结节很常见，有时会影响美观。手术治疗有几个缺点，包括可见的疤痕。高强度聚焦超声（HIFU）是一种治疗甲状腺结节的新的非侵入性方法。本研究旨在评估 HIFU 治疗良性甲状腺结节的有效性和安全性。
我们检索了 PubMed、Embase 和 Cochrane Library 中评估 HIFU 治疗良性甲状腺结节患者结局的研究。我们采用随机效应模型进行荟萃分析，并评估了体积缩小率、治疗成功率和治疗相关并发症的发生率。
系统评价纳入了 32 项研究。只有 14 项研究被纳入荟萃分析，因为其余 18 项研究的数据存在重叠。治疗后 3、6 和 12 个月的平均体积缩小率分别为 39.02%（95%CI：27.57 至 50.47%，I²：97.9%）、48.55%（95%CI：35.53 至 61.57%，I²：98.2%）和 55.02%（95%CI：41.55 至 68.48%，I²：99%）。关于并发症，HIFU 后声带麻痹和霍纳综合征的发生率分别为 2.1%（95%CI：0.2 至 4.1%，I²：14.6%）和 0.7%（95%CI：0 至 1.9%，I²：0%）。
HIFU 是治疗良性甲状腺结节的有效且安全的选择。然而，HIFU 对大结节和不同性质结节的疗效仍需要进一步研究。需要更多的研究，特别是包括长期随访的随机对照试验。
甲状腺结节的手术治疗常导致永久性可见疤痕，且有出血、神经损伤和甲状腺功能减退的风险。高强度聚焦超声可能是良性甲状腺结节患者的另一种选择。
• HIFU 治疗甲状腺结节的成功率为 6 个月时 75.8%。6 个月和 12 个月时的平均体积缩小率分别为 48.55%和 55.02%。• 声带麻痹、霍纳综合征、喉返神经麻痹、甲状腺功能减退和皮肤发红等并发症的发生率较低。• HIFU 治疗良性甲状腺结节安全且有效。
