Patient-reported symptom relief from percutaneous benign thyroid nodule radiofrequency ablation in routine clinical care.

Abstract

Background and purpose: We investigated patient-reported symptom relief from percutaneous ultrasound-guided radiofrequency ablation of benign thyroid nodules in routine clinical care, given that prior studies have reported efficacy based on size reduction and specific symptom scores but not patient-reported effectiveness.

Materials and methods: This retrospective cohort study included all consecutive adults treated 5/12/2021-8/7/2024 with ultrasound-guided radiofrequency ablation for symptomatic benign thyroid nodules at a quaternary care hospital. Procedures were performed by a single board certified neuroradiologist utilizing a trans-isthmus moving shot technique. Patient-reported symptom relief (symptoms resolved yes/no) was assessed at 6-month routine clinical follow-up. Descriptive statistics were performed. Pre-ablation nodule size associations with symptom resolution were assessed with Wilcoxon tests.

Results: 49 patients (mean age 56.6±13.1 years; 45 females) had average pre-ablation nodule volume of 30.6±31.0 mL, higher than 20.1±22.4 mL reported in a recent meta-analysis of efficacy studies. Common pre-ablation symptoms were cosmetic deformity (37/49, 77.1%), dysphagia (28/49, 58.3%), and dysphonia (15/49, 30.6%). Thirty-six patients (73.0%) completed at least one follow-up visit. Post-ablation symptom resolution was 78.0% (28/36, 95%CI 61.9%-88.3%) among those with follow-up, higher than the 64.4% reported in the single study included in the meta-analysis that assessed subjective symptom relief. Relative mean volume reduction was 52.3±27.4% in those with follow-up and was associated with symptom resolution (59% reduction with symptom resolution vs. 30% without, p=0.035). One patient experienced a minor bleeding complication.

Conclusions: Patient-reported symptom relief from percutaneous ultrasound-guided thermal ablation of benign thyroid nodules in our clinic has resulted in approximately 80% clinically-relevant effectiveness based on patient-reported symptom relief, with a slightly lower volume reduction rate compared to those reported in efficacy studies. Our clinic patients had larger nodule volumes than typical in published studies and many patients opted to forgo post-treatment follow-up. This likely led to underestimation of our effectiveness and volume reduction measurements.

Abbreviations: RFA＝ radiofrequency ablation; BTN＝ benign thyroid nodule; VAS＝ visual analog scale; VRR＝ volume reduction ratio; TSH = thyroid stimulating hormone; LA＝ laser ablation; MWA＝ microwave ablation.