Radiofrequency Ablation for Thyroid Nodules (RATED Study)-Analysis of a Learning Curve and Predictors of Success.

IF 5.1 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Manon M D van der Meeren, Tim Boers, Pim de Graaf, Katya M Duvivier, Koen M A Dreijerink, Laura N Deden, Peter Veendrick, Paul Cernohorsky, Frank B M Joosten, Angelique B M C Savelberg, Sicco J Braak, Sean H P P Roerink, Michel Versluis, Srirang Manohar, Wim J G Oyen
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Abstract

Context: Radiofrequency ablation (RFA) is used as treatment for symptomatic thyroid nodules. Factors influencing the volume reduction ratio (VRR) at 12 months are not yet fully understood.

Objective: The primary objective of this work was evaluating the VRR at 12 months after RFA. Secondary objectives were the assessment of a learning curve and factors influencing the VRR at 12 months.

Methods: A retrospective observational cohort study was conducted at 3 Dutch referral hospitals of patients who underwent RFA for symptomatic thyroid nodules with available ultrasound (US) follow-up. Main outcome measures included US-based VRR at 12 months and chronologically numbered RFA procedures. All patients' baseline, treatment, and early follow-up factors were assessed for correlation with VRR at 12 months.

Results: A total of 337 patients with 356 nodules were included in the learning curve analysis. VRR at 12 months increased for the first 20 treatments per center and stabilized thereafter, indicating a plateau phase after a learning curve. These initial cases were removed from further analysis. In the remaining 299 nodules, median VRR at 3, 6, and 12 months was 57.1%, 65.6%, and 70.8%. Baseline nodule volume negatively correlated with VRR at 12 months but VRR was high for every volume category. Energy delivered per volume did not correlate with VRR.

Conclusion: In RFA for thyroid nodules, a stable treatment efficacy is achieved after 20 treatments, with a median VRR of 70.8%. Baseline nodule volume, energy delivered, and prolonged follow-up 6 months after treatment may not be clinically relevant to predict treatment success.

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射频消融治疗甲状腺结节(RATED研究)-学习曲线分析和成功的预测因素。
背景:射频消融(RFA)用于治疗症状性甲状腺结节。影响12个月体积缩小比(VRR)的因素尚未完全了解。目的:主要目的是评估RFA后12个月的VRR。次要目标是评估12个月时的学习曲线和影响VRR的因素。设计:回顾性观察队列研究。环境:三家荷兰转诊医院。患者和干预措施:接受射频消融治疗有症状甲状腺结节的患者,超声随访。主要观察指标:12个月时基于超声的VRR和按时间顺序编号的RFA手术。在12个月时评估所有患者的基线、治疗和早期随访因素与VRR的相关性。结果:337例患者356个结节被纳入学习曲线分析。在每个中心前20次治疗中,12个月的VRR增加,此后趋于稳定,表明学习曲线后的平台期。这些最初的病例从进一步的分析中删除。在剩余的299个结节中,3,6和12个月的中位VRR分别为57.1,65.6和70.8%。基线结节体积与12个月时的VRR呈负相关,但每个结节类型的VRR都很高。单位体积的能量传递与VRR无关。结论:甲状腺结节RFA治疗20次后疗效稳定,中位VRR为70.8%。基线结节体积、能量输送和治疗后6个月的延长随访可能与预测治疗成功没有临床相关性。
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来源期刊
Journal of Clinical Endocrinology & Metabolism
Journal of Clinical Endocrinology & Metabolism 医学-内分泌学与代谢
CiteScore
11.40
自引率
5.20%
发文量
673
审稿时长
1 months
期刊介绍: The Journal of Clinical Endocrinology & Metabolism is the world"s leading peer-reviewed journal for endocrine clinical research and cutting edge clinical practice reviews. Each issue provides the latest in-depth coverage of new developments enhancing our understanding, diagnosis and treatment of endocrine and metabolic disorders. Regular features of special interest to endocrine consultants include clinical trials, clinical reviews, clinical practice guidelines, case seminars, and controversies in clinical endocrinology, as well as original reports of the most important advances in patient-oriented endocrine and metabolic research. According to the latest Thomson Reuters Journal Citation Report, JCE&M articles were cited 64,185 times in 2008.
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