High-intensity focused ultrasound (HIFU) is an emerging thermal ablation technique that has been successfully applied to various benign thyroid nodules.
Purpose
To evaluate the efficacy and safety of HIFU for the treatment of benign thyroid nodules.
Material and Methods
The Ovid-MEDLINE and EMBASE databases were searched up to 9 July 2018 for studies describing the use of HIFU to treat benign thyroid nodules. We included studies that have outcomes with sufficient detail to evaluate the volume reduction rate (VRR). The pooled proportions of VRR ≥50% and pooled VRR at one, three, and six months after HIFU were assessed using random-effects modeling. Heterogeneity among studies was determined using Chi-square statistics for pooled estimates and the inconsistency index I2.
Results
Seven studies were included in the systematic review and four in the meta-analysis. The pooled VRR at one, three, and six months after HIFU were 17.59 (95% confidence interval [CI] 12.56–22.62), 48.93 (95% CI 42.20–55.66), and 60.43 (95% CI 51.88–68.98). The pooled proportions of VRR ≥50% at six months after HIFU were 75% (95% CI 53–89; I2=73.6%). There were no major complications of HIFU.
Conclusion
HIFU may be a safe and effective treatment modality for benign thyroid nodules, especially for small nodules.
HaugenBR.2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: what is new and what has changed?Cancer2017;
123:372–381.
2.
GharibHHegedusLPacellaCM, et al.
Nonsurgical, image-guided, minimally invasive therapy for thyroid nodules. J Clin Endocrinol Metab2013;
98:3949–3957.
3.
HegedusL.The thyroid nodule. N Engl J Med2004;
351:1764–1771.
4.
ChoiYJBaekJHBaekSH, et al.
Web-based malignancy risk estimation for thyroid nodules using ultrasonography characteristics: development and validation of a predictive model. Thyroid2015;
25:1306–1312.
5.
ZhiXZhaoNLiuY, et al.
Microwave ablation compared to thyroidectomy to treat benign thyroid nodules. International Journal of Hyperthermia2018;
34:644–652.
6.
BaekJHHaEJChoiYJ, et al.
Radiofrequency versus ethanol ablation for treating predominantly cystic thyroid nodules: A randomized clinical trial. Korean J Radiol2015;
16:1332–1340.
7.
SungJYBaekJHKimKS, et al.
Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation: a prospective randomized study. Radiology2013;
269:293–300.
8.
SungJYKimYSChoiH, et al.
Optimum first-line treatment technique for benign cystic thyroid nodules: ethanol ablation or radiofrequency ablation?AJR Am J Roentgenol2011;
196:W210–214.
9.
HuhJYBaekJHChoiH, et al.
Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session–prospective randomized study. Radiology2012;
263:909–916.
10.
BernardiSDobrinjaCFabrisB, et al.
Radiofrequency ablation compared to surgery for the treatment of benign thyroid nodules. Int J Endocrinol2014;
2014:934595.
11.
KimYSRhimHTaeK, et al.
Radiofrequency ablation of benign cold thyroid nodules: initial clinical experience. Thyroid2006;
16:361–367.
12.
SpieziaSGarberoglioRMiloneF, et al.
Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid2009;
19:219–225.
SpieziaSVitaleGDi SommaC, et al.
Ultrasound-guided laser thermal ablation in the treatment of autonomous hyperfunctioning thyroid nodules and compressive nontoxic nodular goiter. Thyroid2003;
13:941–947.
PacellaCMMauriGAchilleG, et al.
Outcomes and risk factors for complications of laser ablation for thyroid nodules: a multicenter study on 1531 patients. J Clin Endocrinol Metab2015;
100:3903–3910.
17.
WuWGongXZhouQ, et al.
Ultrasound-guided percutaneous microwave ablation for solid benign thyroid nodules: comparison of MWA versus control group. Int J Endocrinol2017;
2017:9724090.
18.
SheWHCheungTTJenkinsCR, et al.
Clinical applications of high-intensity focused ultrasound. Hong Kong Med J2016;
22:382–392.
19.
EsnaultOFrancBMonteilJP, et al.
High-intensity focused ultrasound for localized thyroid-tissue ablation: preliminary experimental animal study. Thyroid2004;
14:1072–1076.
20.
BiniFTrimboliPMarinozziF, et al.
Treatment of benign thyroid nodules by high intensity focused ultrasound (HIFU) at different acoustic powers: a study on in-silico phantom. Endocrine2018;
59:506–509.
21.
ValcaviRRigantiFBertaniA, et al.
Percutaneous laser ablation of cold benign thyroid nodules: a 3-year follow-up study in 122 patients. Thyroid2010;
20:1253–1261.
22.
LangBHHWooYCWongCKH.High-intensity focused ultrasound for treatment of symptomatic benign thyroid nodules: a prospective study. Radiology2017;
284:897–906.
23.
LangBHHWooYCChiuKW.Sequential high intensity focused ultrasound (HIFU) ablation in the treatment of benign multinodular goitre: an observational retrospective study. Eur Radiol2018;
28:3237–3244.
LangBHHWooYCChiuKW.Vocal cord paresis following single-session high intensity focused ablation (HIFU) treatment of benign thyroid nodules: incidence and risk factors. Int J Hyperthermia2017;
33:888–894.
26.
LangBHHWuALH.High intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a systematic review. J Ther Ultrasound2017;
5:11.
27.
WhitingPFRutjesAWWestwoodME, et al.
QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med2011;
155:529–536.
28.
SuhCHParkSH.Successful publication of systematic review and meta-analysis of studies evaluating diagnostic test accuracy. Korean J Radiol2016;
17:5–6.
29.
LeeJKimKWChoiSH, et al.
Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers-part ii. Statistical methods of meta-analysis. Korean J Radiol2015;
16:1188–1196.
30.
HigginsJPTGreenS. Cochrane handbook for systematic reviews of interventions. version 5.1.0. Oxford: The Cochrane Collaboration, 2011. Available at: http://handbook-5-1.cochrane.org/ (accessed 28 September 2018).
31.
KorkusuzHSennertMFehreN, et al.
Local thyroid tissue ablation by high-intensity focused ultrasound: effects on thyroid function and first human feasibility study with hot and cold thyroid nodules. Int J Hyperthermia2014;
30:480–485.
32.
KorkusuzHSennertMFehreN, et al.
Localized thyroid tissue ablation by high intensity focused ultrasound: volume reduction, effects on thyroid function and immune response. Rofo2015;
187:1011–1015.
33.
KorkusuzYGronerDRaczynskiN, et al.
Thermal ablation of thyroid nodules: are radiofrequency ablation, microwave ablation and high intensity focused ultrasound equally safe and effective methods?Eur Radiol2018;
28:929–935.
34.
LangBHHWooYCChiuKW.High-intensity focused ablation (HIFU) of single benign thyroid nodule rarely alters underlying thyroid function. Int J Hyperthermia2017;
33:875–881.
35.
LangBHHWooYCChiuKW.Evaluation of pain during high-intensity focused ultrasound ablation of benign thyroid nodules. Eur Radiol2018;
28:2620–2627.
36.
LangBHHWooYCChiuKW.Two-year efficacy of single-session high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Eur Radiol2019;
29:93–101.
37.
EsnaultOFrancBMenegauxF, et al.
High-intensity focused ultrasound ablation of thyroid nodules: first human feasibility study. Thyroid2011;
21:965–973.
38.
KorkusuzHFehreNSennertM, et al.
Volume reduction of benign thyroid nodules 3 months after a single treatment with high-intensity focused ultrasound (HIFU). J Ther Ultrasound2015;
3:4.
SennertMHappelCKorkusuzY, et al.
Further investigation on high-intensity focused ultrasound (HIFU) treatment for thyroid nodules: effectiveness related to baseline volumes. Acad Radiol2018;
25:88–94.
41.
TrimboliPBiniFMarinozziF, et al.
High-intensity focused ultrasound (HIFU) therapy for benign thyroid nodules without anesthesia or sedation. Endocrine2018;
61:210–215.
42.
GiovanellaLPiccardoAPezzoliC, et al.
Comparison of high intensity focused ultrasound and radioiodine for treating toxic thyroid nodules. Clin Endocrinol (Oxf)2018;
89:219–225.
43.
ZhengBWWangJFJuJX, et al.
Efficacy and safety of cooled and uncooled microwave ablation for the treatment of benign thyroid nodules: a systematic review and meta-analysis. Endocrine2018;
62:307–317.
44.
LimHKLeeJHHaEJ, et al.
Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients. Eur Radiol2013;
23:1044–1049.
45.
CesareoRPalermoAPasqualiniV, et al.
Efficacy and safety of a single radiofrequency ablation of solid benign non-functioning thyroid nodules. Arch Endocrinol Metab2017;
61:173–179.
46.
JungSLBaekJHLeeJH, et al.
Efficacy and safety of radiofrequency ablation for benign thyroid nodules: a prospective multicenter study. Korean J Radiol2018;
19:167–174.
47.
AhnHSKimSJParkSH, et al.
Radiofrequency ablation of benign thyroid nodules: evaluation of the treatment efficacy using ultrasonography. Ultrasonography2016;
35:244–252.
48.
LangBHHWooYCChiuKW.Two sequential applications of high-intensity focused ultrasound (HIFU) ablation for large benign thyroid nodules. Eur Radiol2019;
29:3626–3634.
49.
ChungSRSuhCHBaekJH, et al.
Safety of radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: a systematic review and meta-analysis. Int J Hyperthermia2017;
33:920–930.
