March 04, 2022
2 minute read
According to data from a study published in Thyroid.
“Radiofrequency ablation has been effective in reducing the volume of benign, non-functioning thyroid nodules in children, providing significant symptom relief with a good safety profile during short- and long-term follow-up,” xinguang Qiu, MD, from department of thyroid surgery at the First Affiliated Hospital of Zhengzhou University in China, and colleagues wrote. “Radiofrequency ablation should be considered a beneficial, minimally invasive treatment modality for some pediatric patients.”
Researchers reviewed data from 62 patients aged 18 or younger with benign thyroid nodules treated with radiofrequency ablation at the First Affiliated Hospital of Zhengzhou University from July 2014 to August 2017 (75.8% female; age average, 14.4 years). Participants underwent ultrasound before the procedure to assess the composition and symptoms of thyroid nodules and were followed up 3, 6 and 12 months after treatment. After 1 year, follow-up visits were performed annually. Ultrasound and laboratory tests were repeated at each follow-up visit. The volume reduction ratio was calculated to assess the extent of nodule volume reduction.
In the study cohort, 54 children had one thyroid nodule requiring treatment and eight had two thyroid nodules. At 3 months, the mean rate of volume reduction was 65.1% and increased to 74.7% at 6 months and 77.5% at 1 year. The average rate of volume reduction was 60.3% at 2 years, 68.5% at 3 years and 55.1% at 4 years. Thirty-six nodules had strong echogenicity or hyperechogenicity at 3 months, and six retained these features at 6 months.
Sixteen of the 70 nodules began to regrow after the initial treatment. Of the nodules that regrow, 56.3% have a volume reduction rate of less than 50%, indicating a loss of treatment efficacy. Among those who lost the effectiveness of the treatment, 66.7% became larger than before the treatment. Three nodules underwent a second radiofrequency ablation and surgery was performed on two other nodules.
Children requiring treatment for bilateral nodules had a lower volume reduction rate (13.6% versus 74.1%; P < 0.001), lower technical efficiency (56.3% vs. 90.7%; P = 0.001) and a higher regrowth rate (68.8% versus 9.3%; P < 0.001) compared to unilateral nodules.
“We found that bilateral nodules requiring treatment had lower rates of volume reduction, lower therapeutic efficacy and higher regrowth rates, and the presence of bilateral nodules was an independent factor related to efficacy and to regrowth,” the researchers wrote. “The precise reason for these associations is unclear. Additionally, such results have not been reported in adult studies. Thus, radiofrequency ablation may not be appropriate for the treatment of bilateral thyroid nodules in children.
Nodules with a higher cystic component had a higher volume reduction ratio than those with a lower cystic component (72.4% vs. 46.7%; P = 0.001). Nodules with higher vascularity had a lower regrowth rate than those with low vascularity (12.1% versus 32.4%; P = 0.043). In total, 4.8% of the patients presented complications following the intervention.
The researchers wrote that radiofrequency ablation offers benefits for many patients, but those who undergo the procedure require long-term follow-up, and the lack of pathological examination means providers cannot rule out malignancy.
“This treatment requires specialized treatment centers, specialized equipment, and highly skilled and experienced physicians, so access to radiofrequency ablation may also be a barrier to its use,” the researchers wrote. “Therefore, we believe that radiofrequency ablation is more likely to be a complementary treatment modality to surgical treatment.”