Is There a Safer Way for Thyroid Nodule Ablation: Comparative Study of Cooled and Uncooled Systems in Benign Thyroid Nodule Treatment.

Abstract

Background: Ultrasound-guided microwave ablation (MWA) has emerged as a safe and effective nonsurgical treatment option for benign thyroid nodules (BTN), with ongoing debate regarding the comparative performance of cooled (cMWA) and uncooled (uMWA) MWA systems.

Purpose: This study aims to address this debate by comparing the safety and efficacy of cMWA and uMWA and to confirm the effectiveness of both systems in the treatment of BTN.

Material and methods: Data from 73 patients who underwent MWA treatment for BTN between September 2019 and May 2022 were retrospectively evaluated. A total of 24 patients [mean age: 43.87 ± 9.5 years; 15 females (62.5%)] with solid or predominantly solid nodules, who received a single session of cMWA (n = 12) or uMWA (n = 12), were included. Nodule volume reduction, cosmetic scores, clinical symptoms, side effects, and complications were recorded.

Results: Nodule volumes significantly decreased at the third and sixth month follow-ups, with similar volume reduction ratios between cMWA and uMWA (60.30 ± 8 vs 57.29 ± 8.2 at 3 mo and 78.03 ± 6 vs 77.55 ± 10 at 6 mo). Energy power and ablation duration differed significantly between groups (uMWA: 15 watts, 26.92 ± 4.9 min vs cMWA: 30 watts, 14.77 ± 4.79 min). One major and 2 minor complications (nodule rupture and superficial hematoma) occurred only in the cMWA group. Cosmetic concerns and pressure symptoms improved in both groups during follow-up.

Conclusion: uMWA provided similar volume reduction to cooled systems and demonstrated a favorable safety profile. However, observed differences in complications require cautious interpretation because of the limited sample size and the inherent difference in power settings.