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Radiofrequency superior to laser ablation in large thyroid nodules
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PHOENIX — When compared with laser ablation, radiofrequency ablation yielded greater reductions in volume in large, benign thyroid nodules and allowed more rapid decompression in a single session, according to data presented during a late-breaking session here.
“The bottom line is we want to treat large, benign nodules,” Roberto Valcavi, MD, FACE, of the endocrinology division and thyroid disease center at Arcispedale Santa Maria Nuova in Reggio, Emilia, Italy, said during his presentation. “There have been many papers on reducing nodules with radiofrequency or laser ablation, but so far, there has been no comparison between the two techniques in large nodules.”
To study to the effects of laser vs. radiofrequency ablation in nodules >35 mL, Valcavi and colleagues randomly assigned 108 patients with benign nodules to laser ablation (n=54; mean age, 51 years) or radiofrequency (n=54; mean age, 47 years). Mean nodule volume was approximately 40 mL in both groups.
Results revealed clear differences between the two treatment groups at 1, 3 and 6 months. At 1 month post-procedure, nodule volume was 31.9 mL in patients who underwent laser ablation vs. 28.9 mL in those who underwent radiofrequency ablation (P<.03). At 3 months, compared with the laser ablation group, reductions in nodule volume remained greater in the radiofrequency ablation group (27.8 mL vs. 26.6 mL; P<.04). At 6 months, the difference in nodule reduction became even more apparent (22.6 mL vs. 16.9 mL; P<.01), according to Valcavi.
“We have a faster and greater effect in the radiofrequency group, with a 70% reduction in nodule volume at 6 months vs. a 50% reduction, which is also a lot, with laser ablation,” he said.
A greater decrease in compressive symptoms was also noted in the radiofrequency ablation group, according to the study abstract. Symptoms declined from 5.1 at baseline to 2.5 at 6 months post-procedure in patients who underwent laser vs. from 5.3 to 0.8 in those who underwent radiofrequency ablation (P<.01).
Additionally, the researchers observed tissue carbonization in patients treated with laser ablation, but they found none in patients treated with a cool-tip radiofrequency ablation device.
“This is extremely important because we think the absence of carbonization may speed up nodule reabsorption, which is, on the other hand, ‘foxilized’ by the extremely high temperatures achieved by laser ablation,” Valcavi said.
He also noted that radiofrequency ablation is less expensive than laser ablation in which you need the proper equipment.
“We demonstrated that, in a single, well-done session, we can shrink the nodule and potentially cure the patient,” Valcavi said. “My final message is that, if you are confident enough with finding aspirates on ultrasound, you may have a new, very effective instrument to cure your patients.”
For more information:
Valcavi R. Late-breaking plenary/clinical trials. Presented at: the AACE Annual Scientific and Clinical Congress; May 1-5, 2013; Phoenix.