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Comparison of the Therapeutic Efficacy and Technical Outcomes between Conventional Fixed Electrodes and Adjustable Electrodes in the Radiofrequency Ablation of Benign Thyroid Nodules

  • Jae Ho Shin (Department of Radiology, Anam Hospital, Korea University College of Medicine) ;
  • Minkook Seo (Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Min Kyoung Lee (Department of Radiology, Yeouido St. Mary's Hospital, The Catholic University of Korea) ;
  • So Lyung Jung (Department of Radiology, Yeouido St. Mary's Hospital, The Catholic University of Korea)
  • 투고 : 2023.06.21
  • 심사 : 2023.11.19
  • 발행 : 2024.02.01

초록

Objective: This study aimed to compare therapeutic efficacy and technical outcomes between adjustable electrode (AE) and conventional fixed electrode (FE) for radiofrequency ablation (RFA) of benign thyroid nodules. Materials and Methods: Between 2013 and 2021, RFA was performed on histologically proven benign thyroid nodules. For the AE method, AE length ≥ 1 cm with higher power and < 1 cm with lower power were utilized for ablating feeding vessels and nodules, especially those near anatomical structures, respectively. The therapeutic efficacy (volume reduction rate [VRR], complication rate, and regrowth rate) and technical outcomes (total energy delivery, ablated volume/energy, RFA time, and ablated volume/time) of FE and AE were compared. Continuous parameters were compared using a two-sample t-test or Mann-Whitney U test, and categorical parameters were compared using a chi-squared test or Fisher's exact test. Results: A total of 182 nodules (FE: 92 vs. AE: 90) in 173 patients (mean age ± standard deviation, 47.0 ± 14.7 years; female, 90.8% [157/173]; median follow-up, 726 days [interquartile range, 441-1075 days]) were analyzed. The therapeutic efficacy was comparable, whereas technical outcomes were more favorable for AE. Both electrodes demonstrated comparable overall median VRR (FE: 92.4% vs. AE: 84.9%, P = 0.240) without immediate major complications. Overall regrowth rates were comparable between the two groups (FE: 2.2% [2/90] vs. AE: 1.1% [1/90], P > 0.99). AE demonstrated a shorter median RFA time (FE: 811 vs. AE: 627 seconds, P = 0.009). Both delivered comparable median energy (FE: 42.8 vs. AE: 29.2 kJ, P = 0.069), but AE demonstrated higher median ablated volume/energy and median ablated volume/time (FE: 0.2 vs. AE: 0.3 cc/kJ, P < 0.001; and FE: 0.7 vs. AE: 1.0 cc/min, P < 0.001, respectively). Conclusion: Therapeutic efficacy between FE and AE was comparable. AE demonstrated better technical outcomes than FE in terms of RFA time, ablated volume/energy, and ablated volume/time.

키워드

참고문헌

  1. Park HS, Baek JH, Park AW, Chung SR, Choi YJ, Lee JH. Thyroid radiofrequency ablation: updates on innovative devices and techniques. Korean J Radiol 2017;18:615-623 
  2. Wong KP, Lang BH. Use of radiofrequency ablation in benign thyroid nodules: a literature review and updates. Int J Endocrinol 2013;2013:428363 
  3. Kim JH, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, et al. 2017 thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology. Korean J Radiol 2018;19:632-655 
  4. Sim JS, Baek JH. Long-term outcomes following thermal ablation of benign thyroid nodules as an alternative to surgery: the importance of controlling regrowth. Endocrinol Metab (Seoul) 2019;34:117-123 
  5. Kim YS, Rhim H, Tae K, Park DW, Kim ST. Radiofrequency ablation of benign cold thyroid nodules: initial clinical experience. Thyroid 2006;16:361-367 
  6. Sim JS, Baek JH, Lee J, Cho W, Jung SI. Radiofrequency ablation of benign thyroid nodules: depicting early sign of regrowth by calculating vital volume. Int J Hyperthermia 2017;33:905-910 
  7. Ha EJ, Baek JH, Lee JH. The efficacy and complications of radiofrequency ablation of thyroid nodules. Curr Opin Endocrinol Diabetes Obes 2011;18:310-314 
  8. Ha SM, Shin JY, Baek JH, Song DE, Chung SR, Choi YJ, et al. Does radiofrequency ablation induce neoplastic changes in benign thyroid nodules: a preliminary study. Endocrinol Metab (Seoul) 2019;34:169-178 
  9. Huh JY, Baek JH, Choi H, Kim JK, Lee JH. Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session--prospective randomized study. Radiology 2012;263:909-916 
  10. Kim YJ, Baheti A, Huber TC. Radiofrequency ablation of solid benign thyroid nodules. Tech Vasc Interv Radiol 2022;25:100819 
  11. Lim HK, Lee JH, Ha EJ, Sung JY, Kim JK, Baek JH. Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients. Eur Radiol 2013;23:1044-1049 
  12. Lee J, Shin JH, Hahn SY, Park KW, Choi JS. Feasibility of adjustable electrodes for radiofrequency ablation of benign thyroid nodules. Korean J Radiol 2020;21:377-383 
  13. Cha J, Kim YS, Rhim H, Lim HK, Choi D, Lee MW. Radiofrequency ablation using a new type of internally cooled electrode with an adjustable active tip: an experimental study in ex vivo bovine and in vivo porcine livers. Eur J Radiol 2011;77:516-521 
  14. Sim JS, Baek JH. Unresolved clinical issues in thermal ablation of benign thyroid nodules: regrowth at long-term follow-up. Korean J Radiol 2021;22:1436-1440 
  15. Sim JS, Baek JH. Long-term outcomes of thermal ablation for benign thyroid nodules: the issue of regrowth. Int J Endocrinol 2021;2021:9922509 
  16. Jung SL. Advanced techniques for thyroid nodule radiofrequency ablation. Tech Vasc Interv Radiol 2022;25:100820 
  17. Lee MK, Na DG, Joo L, Lee JY, Ha EJ, Kim JH, et al. Standardized imaging and reporting for thyroid ultrasound: Korean Society of Thyroid Radiology consensus statement and recommendation. Korean J Radiol 2023;24:22-30 
  18. Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, et al. 2021 Korean thyroid imaging reporting and data system and imaging-based management of thyroid nodules: Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol 2021;22:2094-2123 
  19. Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 2005;235:728-739 
  20. Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. Radiology 2014;273:241-260 
  21. Kim HJ, Baek JH, Cho W, Sim JS. Long-term follow-up of the radiofrequency ablation of benign thyroid nodules: the value of additional treatment. Ultrasonography 2022;41:661-669 
  22. Chen MH, Lin WC, Luo SD, Chiang PL, Chen YS, Chen WC, et al. Residual, regrowth, and new growth of radiofrequency ablation for benign thyroid nodules of different volumes: two-year follow-up results. Int J Hyperthermia 2022;39:1172-1178 
  23. Deandrea M, Trimboli P, Garino F, Mormile A, Magliona G, Ramunni MJ, et al. Long-term efficacy of a single session of RFA for benign thyroid nodules: a longitudinal 5-year observational study. J Clin Endocrinol Metab 2019;104:3751-3756 
  24. Mauri G, Pacella CM, Papini E, Solbiati L, Goldberg SN, Ahmed M, et al. Image-guided thyroid ablation: proposal for standardization of terminology and reporting criteria. Thyroid 2019;29:611-618 
  25. Neizert CA, Do HNC, Zibell M, Rieder C, Sinden D, Niehues SM, et al. Three-dimensional assessment of vascular cooling effects on hepatic microwave ablation in a standardized ex vivo model. Sci Rep 2022;12:17061 
  26. Dessie MA. Variations of the origin of superior thyroid artery and its relationship with the external branch of superior laryngeal nerve. PLoS One 2018;13:e0197075 
  27. Pillai K, Akhter J, Chua TC, Shehata M, Alzahrani N, Al-Alem I, et al. Heat sink effect on tumor ablation characteristics as observed in monopolar radiofrequency, bipolar radiofrequency, and microwave, using ex vivo calf liver model. Medicine (Baltimore) 2015;94:e580 
  28. Jeong SY, Baek JH, Chung SR, Choi YJ, Chung KW, Kim TY, et al. Radiofrequency ablation of benign thyroid nodules: the value of anterolateral hydrodissection. Ultrasonography 2023;42:432-439