ECE2014 Poster Presentations Thyroid (non-cancer) (125 abstracts)
Long-term efficacy of ultrasound-guided laser ablation for solid thyroid nodules. A three-year multicenter prospective randomized trial
Enrico Papini 1 , Teresa Rago 3 , Giovanni Gambelunghe 4 , Roberto Valcavi 2 , Giancarlo Bizzarri 1 , Paolo Vitti 3 , Pierpaolo De feo 4 , Irene Misischi 1 , Enrico Di Stasio 5 & Claudio Maurizio Pacella 1
1Regina Apostolorum Hospital, Department of Endocrinology, Albano Laziale, Italy; 2Thyroid Disease Center, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; 3Department of Endocrinology, University of Pisa, Pisa, Italy; 4Department of Internal Medicine and Endocrine and Metabolic Sciences, Perugia, Italy; 5Institute of Biochemistry and Clinical Biochemistry, Catholic University School of Medicine, Roma, Italy.
Background: Thermal ablation techniques are reported to significantly decrease thyroid nodule volume in several single-center short-term series. The present trial on ultrasound (US)-guided laser ablation (LAT) of solid thyroid nodules is addressed to assess long-term clinical efficacy, side-effects and variability of outcomes in different centers operating with the same LAT procedure.
Patients: Two hundred and one consecutive patients were randomly assigned to a single LAT session (Group 1) or follow-up (Group 2) at four thyroid referral centers. Entry criteria were: solid thyroid nodule with volume >5 and <18 ml, repeat benign cytological findings, normal thyroid function, no autoimmunity, no thyroid gland treatment.
Methods: Group 1: LAT was performed in a single session with two optical fibers, a 1.064 nm neodymium yttrium-aluminum garnet laser source, and an output power of 3 watts. Energy delivery was 3,600 joules for nodules up to 13 ml and 7,200 Joules for nodules larger than 13 ml. Volume and local symptoms changes were evaluated 1, 6, 12, 24 and 36 months after LAT. Side effects and tolerability of treatment were registered. Group 2: follow-up with no treatment.
Results: Group 1: Volume decrease after LAT was −49±%, −59±%, −60±%, and −58±% at 6, 12, 24 and 36 months respectively (P<0.001 vs baseline). LAT resulted in a nodule reduction >50% in 67.3% of cases (P<0.001). Pressure symptoms decreased from 31 to 5% of cases (P=0.002) and cosmetic signs from 74 to 12% of cases. The procedure was well tolerated in most (92%) of cases. One case of vocal cord paresis self-resolved in two weeks. No changes in thyroid function were observed. In Group 2 nodule volume increased at 36 months (25±42%; P=0) and local symptoms worsened not significantly.
Discussion: A single LAT treatment of solid thyroid nodules results in a significant volume reduction with improvement of local symptoms and signs. These effects are persistent on the long-term in absence of relevant side-effects or thyroid function changes.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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