Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Eur Thyroid J. 2024 May 13;13(3). doi: 10.1530/ETJ-24-0020. Print 2024 Jun 1.
Radiofrequency ablation (RFA) is effective in the treatment of thyroid nodules, leading to a 50-90% reduction with respect to baseline. Current guidelines indicate the need for a benign cytology prior to RFA, though, on the other side, this procedure is also successfully used for the treatment of papillary microcarcinomas. No specific indications are available for nodules with an indeterminate cytology (Bethesda III/IV).
To evaluate the efficacy of RFA in Bethesda III nodules without genetic alterations as verified by means of a custom panel.
We have treated 33 patients (mean delivered energy 1069 ± 1201 J/mL of basal volume) with Bethesda III cytology, EU-TIRADS 3-4, and negative genetic panel. The mean basal nodular volume was 17.3 ± 10.7 mL.
Considering the whole series, the mean volume reduction rate (VRR) was 36.8 ± 16.5% at 1 month, 59.9 ± 15.5% at 6 months, and 62 ± 15.7% at 1-year follow-up. The sub-analysis done in patients with 1 and 2 years follow-up data available (n = 20 and n = 5, respectively) confirmed a progressive nodular volume decrease. At all-time points, the rate of reduction was statistically significant (P < 0.0001), without significant correlation between the VRR and the basal volume. Neither cytological changes nor complications were observed after the procedure.
RFA is effective in Bethesda III, oncogene-negative nodules, with reduction rates similar to those obtained in confirmed benign lesions. This procedure represents a good alternative to surgery or active surveillance in this particular class of nodules, regardless of their initial volume. A longer follow-up will allow to evaluate further reduction or possible regrowth.
射频消融（RFA）在治疗甲状腺结节方面非常有效，可使结节基线体积减少 50-90%。目前的指南表明，在进行 RFA 之前需要进行良性细胞学检查，但另一方面，该程序也成功地用于治疗甲状腺微小乳头状癌。对于细胞学不确定（Bethesda III/IV）的结节，尚无具体的适应证。
评估经定制 panel 证实无基因改变的 Bethesda III 结节接受 RFA 的疗效。
我们治疗了 33 例（平均基础体积的实际输送能量为 1069 ± 1201 J/mL）具有 Bethesda III 细胞学、EU-TIRADS 3-4 和阴性基因 panel 的患者。平均基础结节体积为 17.3 ± 10.7 mL。
考虑到整个系列，在 1 个月、6 个月和 1 年随访时，平均体积缩小率（VRR）分别为 36.8 ± 16.5%、59.9 ± 15.5%和 62 ± 15.7%。在有 1 年和 2 年随访数据（n = 20 和 n = 5）的患者中进行的亚分析证实了结节体积的逐渐减小。在所有时间点，减少率均具有统计学意义（P < 0.0001），VRR 与基础体积之间无显著相关性。治疗后未观察到细胞学变化或并发症。
RFA 对无致癌基因的 Bethesda III 结节有效，其缩小率与经证实的良性病变相似。对于这类结节，无论其初始体积如何，该程序是手术或主动监测的良好替代方法。更长的随访时间将允许进一步评估体积缩小或可能的复发。
