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Laser Ablation of Benign Thyroid Nodules: A Prospective Pilot Study With a Preliminary Analysis of the Employed Energy
Author(s) -
Freitas Ricardo Miguel Costa,
Miazaki Aline Paterno,
Tsunemi Miriam Harumi,
Araujo Filho Vergilius José Furtado,
Marui Suemi,
Danilovic Debora Lucia Seguro,
Buchpiguel Carlos Alberto,
Chammas Maria Cristina
Publication year - 2020
Publication title -
lasers in surgery and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.888
H-Index - 112
eISSN - 1096-9101
pISSN - 0196-8092
DOI - 10.1002/lsm.23144
Subject(s) - ablation , medicine , nodule (geology) , thyroid nodules , nuclear medicine , euthyroid , receiver operating characteristic , laser ablation , thyroid , laser , radiology , surgery , paleontology , physics , optics , biology
Background and Objectives To assess the effectiveness of ultrasound (US)‐guided laser ablation of benign thyroid nodules (TNs) under different amounts of applied energy. Study Design/Materials and Methods Thirty‐four euthyroid patients with 5–18 ml TNs were enrolled: 21 (laser ablation) and 13 (clinical follow up) patients with a mean age of 56.2 ± 12.0 and 54.7 ± 14.7 years, respectively. The laser ablation protocol used a 1.064 mm wavelength diode laser source; 3.5 W output power; 1,100–1,500 J and 5–8 min/illumination; and one or two fibers/session. Clinical, laboratory, and US data were obtained immediately before treatment and at 6 and 12 months follow‐up and were analyzed by Student's t test and Fisher's exact test. Low‐ and high‐energy subgroups were subsequently defined, and the receiver operating characteristic (ROC) curves were calculated. Results Laser ablation follow‐up showed an overall nodule volume reduction of more than 50%; improvement of symptoms and cosmetic complaints ( P = 0.001); and stable laboratory data compared with the baseline and control groups. Minor complications were 9.5% ( n = 2). One or two fibers/session resulted in a similar nodule volume reduction among 10–18 ml nodules. Analysis of the applied energy suggested a 398.8 J/ml inferior cutoff (ROC curve: 0.889 sensitivity; 0.545 specificity) for the high‐energy subgroup ( n = 14, mean 599.9 ± 136.5 J/ml) to reduce the nodule volume over time (−55.1% vs. −58.4%, P = 0.55). The low‐energy subgroup ( n = 7, mean 240.2 ± 74.6 J/ml) did not show a persistent volume reduction ( P < 0.05) from the 6‐ to 12‐month follow‐ups (−56.6% vs. −53.7%). Conclusions Laser ablation of benign TNs achieved technique efficacy at 12 months posttreatment, with clinical improvement and few minor side effects. A single fiber in a single session with a high deployed energy (>398.8 J/ml) may be associated with improved results, a finding to be confirmed with a larger series. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.