Lee Yun-Ju, Lin An-Ni, Chen Yueh-Sheng, Lee Chih-Ying, Chiang Pi-Ling, Lu Chia-Yin, Wang Cheng-Kang, Lin Wei-Che
Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Diagnostic Radiology, Kaohsiung Municipal Fong Shan Hospital-Under the management of Chang Gung Medical Foundation, Kaohsiung, Taiwan.
Eur Radiol. 2025 Jul 14. doi: 10.1007/s00330-025-11791-y.
This study aimed to compare the efficacy and safety of radiofrequency ablation (RFA) and transarterial embolization (TAE) in managing large benign thyroid nodules (BTNs), particularly those exceeding 100 mL, where established guidelines are limited.
This retrospective multicenter study, conducted from January 2018 to May 2022, included 70 patients with a total of 76 large BTNs. Of these, 53 underwent RFA and 17 underwent TAE. Nodules were categorized by initial volume (< 50 mL, 50-100 mL, > 100 mL) and diameter (< 6 cm, 6-9 cm, > 9 cm). Treatment efficacy was evaluated using the volume reduction rate (VRR) at 6 months. Complications, as well as improvements in symptoms and cosmetic scores, were documented and analyzed.
At 6 months, TAE demonstrated a significantly higher mean VRR than RFA (p = 0.007), especially for nodules larger than 100 mL (TAE: 63.34% vs. RFA: 49.71%; p = 0.035). The complication rate in the TAE group (5.26%) was lower than that in the RFA group (14.03%), where transient hoarseness and hematoma were common complications. Both treatments resulted in significant improvements in symptom and cosmetic scores (p < 0.001), with TAE providing greater improvements in larger nodules.
TAE is more effective and has fewer complications than RFA for the treatment of large BTNs exceeding 100 mL. These findings suggest that TAE may serve as a minimally invasive alternative to surgery for patients with large thyroid nodules.
Question What are the optimal minimally invasive treatment strategies for large benign thyroid nodules considering efficacy and safety? Findings Transarterial embolization (TAE) achieved a higher volume reduction rate with fewer complications compared to radiofrequency ablation (RFA) for large thyroid nodules exceeding 100 mL. Clinical relevance TAE offers a safer and more effective minimally invasive alternative to RFA for large thyroid nodules, improving patient outcomes with fewer risks.
本研究旨在比较射频消融（RFA）和经动脉栓塞（TAE）治疗大型良性甲状腺结节（BTN），特别是那些超过100毫升的结节的疗效和安全性，目前既定指南对此类情况的指导有限。
这项回顾性多中心研究于2018年1月至2022年5月进行，纳入了70例患者，共76个大型BTN。其中，53例行RFA，17例行TAE。结节按初始体积（<50毫升、50 - 100毫升、>100毫升）和直径（<6厘米、6 - 9厘米、>9厘米）进行分类。使用6个月时的体积缩小率（VRR）评估治疗效果。记录并分析并发症以及症状和美容评分的改善情况。
6个月时，TAE的平均VRR显著高于RFA（p = 0.007），尤其是对于大于100毫升的结节（TAE：63.34% vs. RFA：49.71%；p = 0.035）。TAE组的并发症发生率（5.26%）低于RFA组（14.03%），RFA组常见的并发症为短暂性声音嘶哑和血肿。两种治疗方法均使症状和美容评分有显著改善（p < 0.001），TAE对较大结节的改善更明显。
对于治疗超过100毫升的大型BTN，TAE比RFA更有效且并发症更少。这些发现表明，TAE可能是大型甲状腺结节患者手术的一种微创替代方法。
问题：考虑到疗效和安全性，大型良性甲状腺结节的最佳微创治疗策略是什么？研究结果：对于超过100毫升的大型甲状腺结节，经动脉栓塞（TAE）与射频消融（RFA）相比，实现了更高的体积缩小率且并发症更少。临床意义：对于大型甲状腺结节，TAE为RFA提供了一种更安全、有效的微创替代方法，以更低风险改善患者预后。
