NASHVILLE – Ultrasound-guided laser ablation therapy was found to be a clinically safe, effective, and well-tolerated option for the treatment of benign thyroid nodules, both solid and mixed, in a retrospective, multicenter study presented at the annual meeting of the American Association of Clinical Endocrinologists.
“We know that image-guided laser ablation of solid thyroid nodules has demonstrated favorable results in several prospective randomized trials,” said Dr. Enrico Papini of Regina Apostolorum Hospital in Rome. “However, these results were obtained in selected patients, with single treatments and fixed modalities of treatment; so the question is, what happens in a real. clinical practice?”
Dr. Papini explained that the aim of the study was to assess clinical efficacy and side effects of laser ablation therapy (LAT) in a large series of unselected benign thyroid nodules of variable structure and size, using data from centers who use LAT as a standard operating technique. Patients with solid or mixed nodules with up to 40% fluid composition, benign cytological findings, and normal thyroid function were included.
Clinical records of 1,534 thyroid nodules in 1,531 patients, all of whom were treated in the last 10 years, was collected from eight Italian thyroid referral centers. A total of 1,837 LAT procedures were performed on these nodules, of which 1,280 (83% of 1,534) were treated in a single session. All nodules were treated in no more than three consecutive sessions, with a fixed output power of 3 watts. According to Dr. Papini, the laser is only fired for up to 10 minutes.
Mean nodule volume significantly decreased following LAT from 27 ± 24 mL at baseline to 8 ± 8 mL at 12 months after treatment (P < .001), and mean nodule volume reduction was 72% ± 11%, with an overall range of 48%-100%. Mixed nodules experienced significantly larger decreases than solid ones. On average, mixed nodule volume decreased 79% ± 7%, versus 72% ± 11% for solid nodules (P < .001) because of fluid components being drained prior to LAT.
Symptoms decreased from 49% at baseline to 10% at 12 months post-treatment. Similarly robust reductions were also seen in cosmetic signs, which decreased 86% to 8% over 12 months. Only 17 patients experienced a complication, including 8 with a “major” complication of dysphonia, which resolved within 2-84 days, and 9 with “minor” complications, such as skin burn and hematoma.
“Laser ablation was performed in outpatient setting, with no hospital admission after treatment,” said Dr. Papini. “It was well-tolerated, and severe pain – requiring more than 3 days of analgesics – occurred in less than 2% of patients.”
Dr. Papini did not report any relevant financial disclosures.