Fung Man Him Matrix, Luk Yan, Lang Brian Hung Hin
Division of Endocrine Surgery, Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Eur Radiol. 2025 Sep 12. doi: 10.1007/s00330-025-11985-4.
The comparative efficacy of single-session radiofrequency ablation (RFA) versus microwave ablation (MWA) for benign solid thyroid nodules remains unclear because existing literature consists of heterogenous baseline and wide range of nodule volumes. This study identified the predictors of volume reduction rate (VRR) of RFA versus MWA, and compared the efficacy between the two treatments.
Consecutive benign nodules ≥ 80% solid, treated with a single session of RFA or MWA in a tertiary endocrine surgery center, with at least 12-month follow-up, were included. Propensity score matching (PSM) for baseline characteristics was performed to compare RFA vs MWA. The primary outcome was 12-month VRR.
From 2021 to 2023, 208 nodules were analyzed (RFA: 142, MWA: 66). Maximum nodule diameter and initial nodule volume correlated with 12-month VRR (p < 0.001, correlation coefficient -0.360 and -0.322, respectively) of RFA but not MWA. PSM analysis for age, sex and maximum nodule diameter; or age, sex and initial nodule volume showed comparable overall 12-month VRR between RFA and MWA. In subgroup analysis, MWA achieved greater 3-month and 12-month (78.0% ± 15.5 vs 67.3% ± 17.6, p = 0.028) VRR for nodules with a maximum diameter ≥ 3.5 cm; and greater 6-month VRR for nodules with volume ≥ 20 mL (71.4% ± 16.7 vs 57.2% ± 16.1, p = 0.030). No significant complications occurred in either ablation modality.
Larger nodule diameter and volume negatively correlated with the treatment efficacy of single-session RFA, but not MWA. Single-session MWA achieved greater VRR for nodules with maximum diameter ≥ 3.5 cm, or volume ≥ 20 mL. The results of this study prompt confirmation by future randomized controlled trials with stratification by nodule volume.
Question The comparative efficacy of single-session radiofrequency ablation (RFA) versus microwave ablation (MWA) for benign solid thyroid nodules remains unclear and so are factors affecting treatment efficacy. Findings Larger nodule diameter and volume negatively correlated with efficacy of RFA. For smaller nodules, RFA and MWA were comparable. MWA may have better efficacy for larger nodules. Clinical relevance For smaller nodules (max diameter < 3.5 cm or volume < 20 mL), RFA and MWA were equally effective and safe. For larger nodules (max diameter ≥ 3.5 cm or volume ≥ 20 mL), MWA may be more efficacious. Verification with prospective trials that account for baseline nodule volumes is needed.
单疗程射频消融（RFA）与微波消融（MWA）治疗良性实性甲状腺结节的疗效比较仍不明确，因为现有文献的基线情况各异，且结节体积范围广泛。本研究确定了RFA与MWA的体积缩小率（VRR）预测因素，并比较了两种治疗方法的疗效。
纳入在三级内分泌外科中心接受单疗程RFA或MWA治疗的连续良性结节，其实性成分≥80%，并至少随访12个月。对基线特征进行倾向评分匹配（PSM）以比较RFA与MWA。主要结局为12个月的VRR。
2021年至2023年，共分析了208个结节（RFA：142个，MWA：66个）。最大结节直径和初始结节体积与RFA的12个月VRR相关（p<0.001，相关系数分别为-0.360和-0.322），但与MWA无关。对年龄、性别和最大结节直径；或年龄、性别和初始结节体积进行PSM分析显示，RFA和MWA的总体12个月VRR相当。在亚组分析中，对于最大直径≥ 3.5 cm的结节，MWA在3个月和12个月时的VRR更高（78.0%±15.5对67.3%±17.6，p=0.028）；对于体积≥20 mL的结节，MWA在6个月时的VRR更高（71.4%±16.7对57.2%±16.1，p=0.030）。两种消融方式均未发生显著并发症。
较大的结节直径和体积与单疗程RFA的治疗效果呈负相关，但与MWA无关。对于最大直径≥3.5 cm或体积≥20 mL的结节，单疗程MWA的VRR更高。本研究结果有待未来按结节体积分层的随机对照试验进行验证。
问题 单疗程射频消融（RFA）与微波消融（MWA）治疗良性实性甲状腺结节的疗效比较仍不明确，影响治疗效果的因素也不明确。 发现 较大的结节直径和体积与RFA的疗效呈负相关。对于较小的结节，RFA和MWA相当。MWA对较大结节可能有更好的疗效。 临床意义 对于较小的结节（最大直径<3.5 cm或体积<20 mL），RFA和MWA同样有效且安全。对于较大的结节（最大直径≥3.5 cm或体积≥20 mL），MWA可能更有效。需要进行考虑基线结节体积的前瞻性试验来验证。
