Interventional procedure overview of percutaneous ultrasound-guided microwave ablation for symptomatic benign thyroid nodules
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Appendix
The following table outlines the studies that are considered potentially relevant to the IP overview but were not included in the summary of the key evidence. It is by no means an exhaustive list of potentially relevant studies.
Article | Number of patients/follow-up | Direction of conclusions | Reasons for non-inclusion in summary of key evidence section |
Aydenizoz D, Selcuk OT, Cetinkaya EA et al. (2021) A case of vocal cord paralysis after thyroid nodule microwave ablation. International Medicine 2(6): 362–5. | Benign nodule | The risk of nerve damage is very low in the microwave ablation technique. In the case of recurrent nerve paralysis, it is important to perform a laryngoscopic examination by the otolaryngologist and to call the patient for monthly outpatient clinic controls to check for temporary or permanent paralysis. | Case report. |
Chen X, Wu W, Gong X et al. (2017) Ultrasound-Guided Percutaneous Microwave Ablation for Solid Benign Thyroid Nodules: Comparison of MWA versus Control Group. International Journal of Endocrinology, 2017: 9724090. | Benign solid nodules | Volume of all 90 benign thyroid nodules obviously decreased after microwave ablation at 3-, 6-, 9-, and 12-month follow-ups (p < 0.01), while that of the control group increased at the follow-up of 12 months ( p < 0.01). The volume reduction rate (VRR) at 3-, 6-, 9-, and 12-month follow-ups was 55.98%, 69.31%, 76.65%, and 84.67% in the MWA group, respectively. The cosmetic problems and clinical symptoms were also improved in the MWA group. All the patients are well tolerated to the procedure. Hoarseness occurred in 2 cases (2.7%) and Horner syndrome in 1 case (1.3%), and 1 patient (1.3%) developed slight burn on cervical skin. | Studies with more patients or longer follow-up are included. |
Cheng Z, Che Y, Yu S et al. (2017) US-Guided Percutaneous Radiofrequency versus Microwave Ablation for Benign Thyroid Nodules: A Prospective Multicenter Study. Scientific Reports 7(1): 9554. | Benign nodules | The results for the nodular MDRR and VRR in the RFA group were significantly better than those in the MWA group at 6 months and later follow-up, and the major complication rates of 4.78% and 6.63% in RFA and MWA groups showed no statistically significant differences. | Included in Zheng (2018) and Guo (2021) systematic reviews |
Cui R, Yu J, Han Z et al. (2019) Ultrasound-Guided Percutaneous Microwave Ablation for Substernal Goiter: Initial Experience. Journal of Ultrasound in Medicine 38(11): 2883–91. | Substernal goitre | The nodule volume was significantly reduced at the 3-month follow-up (17.5 ± 9.5 mL; P < .05). The mean 3-month VRR of the index nodule was 66.7% ± 7.1%. A higher ablated portion-to-nodule ratio 1 day after MWA predicted a higher 3-month VRR (Spearman r = 0.646; P = .044). The mean symptom score (from 4.5 ± 1.7 to 1.5 ± 1.0; P = .005) and cosmetic grade (from 3.3 ± 0.5 to 2.2 ± 0.4; P = .004) declined significantly 3 months after the procedure. No complications or unexpected side effects were observed. | Studies with more patients or longer follow-up are included. |
Dong P, Wu X-L, Sui G-Q et al. (2021) The efficacy and safety of microwave ablation versus lobectomy for the treatment of benign thyroid nodules greater than 4 cm. Endocrine 71(1): 113–21. | Benign nodules | During the 12-month follow-up, the mean nodule volume in the MWA group was reduced from 36.1 +/- 23.1 to 4.0 +/- 4.1 ml, and the mean VRR of the nodules was 90 +/- 5% in the MWA group, which was comparable with that in the surgery group. MWA is safe and effective for the treatment of benign thyroid nodules > 4 cm. Moreover, MWA is associated with a faster recovery, fewer complications, better protection of thyroid function, and superior aesthetic results relative to thyroid lobectomy. | Studies with |
Erturk MS, Cekic B, Celik M (2020) Microwave Ablation of Benign Thyroid Nodules: Effects on Systemic Inflammatory Response. Journal of the College of Physicians and Surgeons Pakistan 30(7): 694–700. | Benign nodules | The nodule volume decreased from 23.89 ±15.44 cc to 11.57 ±8.65 cc at two months and to 7.79 ±5.74 cc at six months. The VRR% increased from 38.65 ±16.82 to 63.16 ±14.19 at three months and to 68.29 ±11.80 at six months. The mean value of NLR decreased from 2.28 ±0.86 to 1.78 ±0.54. | Studies with more patients or longer follow-up are included. |
Erturk MS, Cekic B, Celik M et al. (2021) Microwave ablation of symptomatic benign thyroid nodules: Short- and long-term effects on thyroid function tests, thyroglobulin and thyroid autoantibodies. Clinical Endocrinology 94(4): 677–83. | Benign nodules | The difference between all thyroid hormone levels at pre MWA and 24 h after MWA was statistically significant (p <.001). FT3 (4.62) pmol/L and FT4 (10.81) pmol/L median levels increased significantly (p <.001), while thyrotropin (TSH) levels decreased at 24 h after MWA (p <.001). Thyroid antibodies levels were not statistically different at 6-month (p >.05), whereas Tg levels decreased (p <.001) compared to pre MWA. While no significant effect was observed at 6 month, the effect of MWA on thyroid function tests was prominent at 24 h. | Studies with more patients or longer follow-up are included. |
Fei Y, Xing Z, Li Z et al. (2020) Effects of energy-based ablation on thyroid function in treating benign thyroid nodules: a systematic review and meta-analysis. International Journal of Hyperthermia 37(1): 1090–1102. | Benign nodules | Energy-based ablation was more likely to have negative effects on thyroid function and antibodies and led to transient increase in Tg level in the short term. However, most of the patients would not develop any thyroid dysfunction in the long-term follow-up. | Mixed interventions |
Feng B, Liang P, Cheng Z et al. (2012) Ultrasound-guided percutaneous microwave ablation of benign thyroid nodules: experimental and clinical studies. European Journal of Endocrinology 166(6): 1031–7. | Benign nodules | At the last follow- up, the largest diameter decreased from 2.9±1.0 (range 1.6–4.1) to 1.9±0.7 (range 0.4–3.0) cm | Included in Zheng (2018) systematic review |
Guan SH, Wang H, Teng DK (2020) Comparison of ultrasound-guided thermal ablation and conventional thyroidectomy for benign thyroid nodules: a systematic review and meta-analysis. International Journal of Hyperthermia 37(1): 442–9. | Benign nodules | The incidences of hoarseness [odds ratio (OR) 0.33, 95% confidence interval (95% CI; 0.14, 0.79)], hypothyroidism [risk difference (RD) -0.31, 95% CI -0.34,-0.28)] and postoperative pain [OR 0.35, 95% CI (0.25,0.49)] were lower, and the hospitalization time was shorter [standard mean difference (SMD) -4.01, 95% CI -4.22, -3.81)], in the thermal ablation group than in the conventional thyroidectomy group, and postoperative cosmetic effects were better [relative risk (RR) ratio 1.12, 95% CI (1.01, 1.24)] (p < 0.05). | Mixed interventions |
Wang B, Han ZY, Yu J et al. (2017) Factors related to recurrence of the benign non-functioning thyroid nodules after percutaneous microwave ablation. International Journal of Hyperthermia, 33(4): 459–64. | Benign non-functioning solid nodules | The US-guided MWA results in a satisfactory long-term outcome of the patients with a benign solitary thyroid nodule. We identified three risk factors for recurrence: initial volume, vascularity, and the energy per 1 ml reduction in nodular volume. | Included in Cui (2019) systematic review |
Happel C, Korkusuz H, Koch DA et al. (2015) Combination of ultrasound guided percutaneous microwave ablation and radioiodine therapy in benign thyroid diseases. A suitable method to reduce the 131I activity and hospitalization time?. Nuklearmedizin 54(3): 118–24. | Nodular goitre | Depending on ablated volume by MWA, RIT monotherapy requires on average 31.2% more 131I-activity than the combined therapy. The combined therapy remarkably decreases 131I-dose and hospitalization time. The combined MWA and RIT therapy is a considerable, effective and safer alternative to surgery for the treatment of very large benign nodular goitres. | Combined interventions |
Heck K, Korkusuz Y, Happel C et al. (2016) Percutaneous microwave ablation of thyroid nodules: Efficacy evaluation with 99m Tc-pertechnetate and 99m Tc-MIBI functional imaging. International Journal of Radiation Research 14(2): 91–8. | Benign nodules | The determined results show the effectiveness of MWA as a treatment option for benign thyroid nodules. With functional scintigraphy a significant activity decrease could be detected in the ablation zone; hence a verification of affectivity was possible after a short period of time. | Functional imaging study |
Heck K, Happel C, Grunwald F et al. (2015) Percutaneous microwave ablation of thyroid nodules: effects on thyroid function and antibodies. International Journal of Hyperthermia 31(5): 560–7. | Benign nodules | Serum TSH, T4, T3 and Tg levels did not change significantly at the 3-month or 6-month follow-up (p<0.05); thyroid function was not affected by MWA. Antibody levels did not change significantly either; however, two patients developed antibodies after treatment. A volume reduction of 51.4% or 7.85 mL could be demonstrated after 3 months and a reduction of 55.8% or 14.0 mL after 6 months. Slight complications such as mild pain during the ablation or superficial haematomas emerged. The development of Graves' disease and mild Horner's syndrome were observed as more severe side effects. | Studies with more patients or longer follow-up are included. |
Hu K, Wu J, Dong Y et al. (2019) Comparison between ultrasound-guided percutaneous radiofrequency and microwave ablation in benign thyroid nodules. Journal of Cancer Research and Therapeutics 15(7): 1535–40. | Benign nodules | The mean VRRs of the RFA group vs. the MWA group at 1, 3, 6, and 12 months were 22.7±13.4% vs. 24.0±16.1% (P = 0.681), 56.1±19.5% vs. 54.8±22.8% (P = 0.788), 77.9±21.0% vs. 68.7±19.1% (P = 0.038), and 85.4±18.9% vs. 75.8±19.4% (P = 0.029), respectively. There was no significant difference in the VRRs between the two treatments at 1 and 3 months and the RFA group achieved higher VRRs than MWA group at 6 and 12 months. Moreover, the symptom and cosmetic scores decreased significantly in both groups and all patients succeeded in preserving thyroid function. Of the total patients, 2.8% in the RFA group and 4% in the MWA group experienced voice changes after undergoing thyroid ablation, and one patient in the RFA group had intraoperative haemorrhage of about 10 ml. | Studies with more patients or longer follow-up are included. |
Javadov M, Karatay E, Ugurlu MU (2021) Clinical and functional results of radiofrequency ablation and microwave ablation in patients with benign thyroid nodules. Saudi Medical Journal 42(8): 838–46. | Benign nodules | There were statistically significant differences in pain scores, dysphagia scores, and foreign body sensation scores at 1, 3, and 6 months after therapy in both ablation groups (p=0.0006, p=00004, p=0.0005). At the same time, there were statistically significant reductions in size and volume of the nodules for RFA and MWA (p=0.0004, p=0.0003). There was no significant difference between the RFA and MWA groups' cosmetic scoring and volume changes (p=0.68, p=0.43). | Studies with more patients or longer follow-up are included. |
Jin H, Lin W, Lu L et al. (2021) Conventional thyroidectomy vs thyroid thermal ablation on postoperative quality of life and satisfaction for patients with benign thyroid nodules. European Journal of Endocrinology 184(1): 131–41. | Benign nodules | At the 15th month after randomisation, more patients in the thyroid thermal ablation group were satisfied with the treatment effects compared to those in the conventional thyroidectomy group. More patients in the thyroid thermal ablation group have a QoL score of 410 (QOL scores ranges from 0 to 410) than patients in conventional thyroidectomy. Eight (4%) of the 209 patients in conventional thyroidectomy group and 6 (3%) of the 208 patients in thyroid thermal ablation group had at least one severe postoperative complication. The time to achieve volume reduction was longer in the thermal | Mixed interventions |
Khanh HQ, Hung NQ, Vinh VH et al. (2020) Efficacy of Microwave Ablation in the Treatment of Large (>=3 cm) Benign Thyroid Nodules. World Journal of Surgery 44(7): 2272–9. | Benign nodules | The medians of largest diameter and volume of the nodules were 40 mm and 22 ml. Four (10%) minor complications were observed. The mean VRR was 75.1, 85.2, and 96.4% after 3, 6, and 12 months. The mean symptom and cosmetic scores dropped from 8.0 and 3.8 (before treatment) to 2.8 and 2.3 (at 12 months), respectively. Thirteen nodules (31%) required two MWA sessions. | Studies with more patients or longer follow-up are included. |
Korkusuz H, Happel C, Heck K et al. (2014) Percutaneous thermal microwave ablation of thyroid nodules. Preparation, feasibility, efficiency. Nuklearmedizin 53(4): 123–30. | Benign nodules | The treatment was well tolerated and no severe complications were observed. The preliminary data suggests that MWA is an effective method to treat benign thyroid nodules. | Functional imaging study |
Korkusuz H, Happel C, Koch DA et al. (2016) Combination of Ultrasound-Guided Percutaneous Microwave Ablation and Radioiodine Therapy in Benign Thyroid Disease: A 3-Month Follow-Up Study. Fortschr Röntgenstr 188(1): 60–8. | Nodular goitre, Graves' disease | TSH, T4, T3 and Tg did not change at 3MFU, except for in two patients in whom the initial TSH levels improved to normal thyroid functioning levels at follow-up. One of the patients developed a high TRAb-level that receded back into the normal | Combined interventions |
Korkusuz H, Nimsdorf F, Happel C et al. (2015) Percutaneous microwave ablation of benign thyroid nodules. Functional imaging in comparison to nodular volume reduction at a 3-month follow-up. Nuklearmedizin 54(1): 13–9. | Benign nodules | Mean relative nodular volume reduction after three | Functional imaging study |
Korkusuz Y, Groner D, Raczynski N et al. (2018) Thermal ablation of thyroid nodules: are radiofrequency ablation, microwave ablation and high intensity focused ultrasound equally safe and effective methods?. European Radiology 28(3): 929–35. | Benign nodules | RFA showed a significant volume reduction of nodules of 50 % (p<0.05), MWA of 44 % (p<0.05) and HIFU of | Studies with more patients or longer follow-up are included. |
Korkusuz Y, Mader OM, Kromen W et al. (2016) Cooled microwave ablation of thyroid nodules: Initial experience. European Journal of Radiology 85(11): 2127–32. | Benign nodules, thyroid carcinoma | All patients tolerated cMWA well. Median pain intensity averaged 2.1 ± 0.8 (range: 1–3). Post ablative hematoma was observed in all cases. cMWA led to a significant decrease of blood circulation, nodule echogenicity and a significant increase of elasticity (Δ= 1.1 ± 0.33; 0.8 ± 0.4 and 1.1 ± 0.6 | Studies with more patients or longer follow-up are included. |
Li S, Yang M, Guo H et al. (2021) Microwave Ablation Vs Traditional Thyroidectomy for Benign Thyroid Nodules: A Prospective, Non-Randomized Cohort Study. Academic Radiology. | Benign nodules | The VRR was 80.70 ± 18.60%, and TSR was 91.70% at 6-months. Furthermore, the VRR increased to 90.45 ± 11.51%, and TSR increased to 100% at 12-months. C-reactive protein levels were significantly higher in group B on the first postoperative day (POD) (3.89 ± 0.86 mg/mL vs 3.39 ± 0.56 mg/mL, p = 0.002). Visual analogue scale scores were significantly lower in group A on the first and second POD. | Studies with more patients or longer follow-up are included. |
Liu SY, Guo WH, Yang B et al. (2019) Comparison of stress response following microwave ablation and surgical resection of benign thyroid nodules. Endocrine 65(1): 138–43. | Benign nodules | The effects of MWA are more tolerable than those of surgical resection and the physiological function of the thyroid is preserved, which has high clinical value. | Studies with more patients or longer follow-up are included. |
Liu YJ, Qian LX, Liu D et al. (2017) Ultrasound-guided microwave ablation in the treatment of benign thyroid nodules in 435 patients. Experimental Biology and Medicine 242(15): 1515–23. | Benign nodules | The volume of all thyroid nodules significantly decreased after ultrasound-guided microwave ablation. The average volume was 13.07±0.95 ml before treatment, and 1.14±0.26 ml at 12-months follow-up. The mean volume reduction rate was 90% and the final volume reduction rate was 94%. The volume reduction rate of mainly cystic nodules was significantly higher than that of simple solid and mainly solid | Included in Zheng (2018) systematic review |
Mader OM, Tanha NF, Mader A et al. (2017) Comparative study evaluating the efficiency of cooled and uncooled single-treatment MWA in thyroid nodules after a 3-month follow up. European Journal of Radiology Open 4: 4–8. | Benign nodules | Cooled MWA was better tolerated than uncooled MWA. A significant reduction of thyroid nodule volume was observed in all cases. The reduction after cMWA was higher (40%) than after uMWA (29%). Pain intensity during cMWA was significantly lower than after uMWA. CMWA and uMWA led to a significant decrease of nodule blood circulation and echogenicity and to a significant increase of nodule | Studies with more patients or longer follow-up are included. |
Mo HS, Wei L, Ye H et al. (2022) Microwave Ablation of Visible Benign Thyroid Nodules with Different Internal Characteristics: A Comparative Study with Follow-up Results. Journal of Investigative Surgery 35(2): 347-53. | Benign nodules | The average volume of the nodules was 11.68 ± 10.16 ml, the volume reduction rates (VRR) at 1st, 3rd, 6th, 12th, and 18th | Studies with more patients or longer follow-up are included. |
Su C, Liu YJ, Qian LX (2021) Modified percutaneous ethanol injection method combined with microwave ablation for the treatment of symptomatic, predominantly cystic, benign thyroid nodules: a retrospective study of 201 cases. International Journal of Hyperthermia 38(1): 995–1001. | Benign cystic nodules | No major complications were observed during or after the treatment. Ten patients (4.8%) experienced temporary voice change, which resolved within 3 months. Of 200 (97.6%) out of 205 nodules showed significant volume reduction at the final follow-up. Recurrence occurred for only 5 (2.4%) nodules. The mean thyroid nodule volume decreased from 17.40 ± 3.21 mL at baseline to 1.17 ± 0.37 mL at 12 months. The greatest VRR was observed within the first 3 months after treatment. | Combined interventions |
Vorlander C, David Kohlhase K, Korkusuz Y et al. (2018) Comparison between microwave ablation and bipolar radiofrequency ablation in benign thyroid nodules: differences in energy transmission, duration of application and applied shots. International Journal of Hyperthermia 35(1): 216–25. | Benign nodules | Mean initial volume (MWA: 23.90 ± 17.35 ml; RFA: 29.44 ± 30.09 ml), energy transmission (MWA: 13.56 ± 10.17 kJ; RFA: 15.12 ± 13.45 kJ), energy transmission per ml (MWA: 0.85 ± 1.01 kJ/ml; RFA: 0.65 ± 0.32 kJ/ml), power (MWA: 22.69 ± 12.32 J/s; RFA: 20.97 ± 7.86 J/s) and duration of ablation (MWA: | Studies with more patients or longer follow-up are included. |
Wei Y, Qian L, Liu JB et al. (2018) Sonographic measurement of thyroid nodule changes after microwave ablation: relationship between multiple parameters. International Journal of Hyperthermia 34(5): 660–8. | Benign nodules | All of the thyroid nodules underwent a significant decrease in size after MWA. The mean decrease in the volume of the thyroid nodules was from 17.40 ± 22.52 mL to 1.31 ± 2.71 mL, with a mean percent decrease of 0.90 ± 0.15% after 12 months. Index R increased over time from 2.55 ± 1.08 | Included in Cui (2019) systematic review |
Wu W, Gong X, Zhou Q et al. (2017) US-guided percutaneous microwave ablation for the treatment of benign thyroid nodules. Endocrine Journal 64(11): 1079–85. | Benign nodules | Microwave ablation was associated with a significant decrease in nodule volume {1.05±1.05mL (0.08~4.33mL) vs 8.56±4.21mL(4.05~22.66mL), p<0.001} at 12-month follow-up. The largest diameter was also decreased {1.36±0.53cm(0.60~3.73cm) vs 2.94±0.55cm(2.00~4.40cm), p<0.001}. The symptom score and cosmetic score were decreased significantly after the procedure(1.71±0.68 vs 3.31±1.13, p<0.001; 1.16±0.37 vs 2.37±0.94, p<0.001). The VRR was 57.66±22.95%,.70.23±20.07%, 85.97±14.04% at 3-, 6- and 12-month follow-up after ablation, respectively. Two patients(2.0%) experienced hoarseness and recovered within 2 months. Two patients(2.0%) developed slight burn on cervical skin. One case(1%) developed Horner Syndrome, recovered within 2 months.. | Studies with more patients or longer follow-up are included. |
Xia B, Yu B, Wang X et al. (2021) Conspicuousness and recurrence related factors of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules. BMC Surgery 21(1): 317. | Benign nodules | The VRR at 1 month, 3 months, 6 months and 12 months were 40.79%, 60.37%, 74.59% and 85.60%, respectively. In addition, MWA had a better ablation effect for small nodules (initial volume≤10 mL). In recurrent studies, we found that the energy volume ratio was an independent risk factor for benign thyroid nodules (P<0.05). | Included in Zheng (2018) systematic review |
Yue WW, Wang SR, Lu F et al. (2017) Radiofrequency ablation vs. microwave ablation for patients with benign thyroid nodules: a propensity score matching study. Endocrine 55(2): 485-95. | Benign nodules | Between the well-matched groups, no significant differences were found in all nodule volume-related endpoints at 6 months (volume reduction ratio: 79.4 vs. 77.2 %, P = 0.108; symptom score: 2.1 vs. 1.9, P = 0.456; cosmetic score: 2.1 vs. 2.3, P = 0.119; therapeutic success rate: 99 vs. 97 %, P = 0.621) and 12 months (volume reduction ratio: 83.6 vs. 81.6 %, P = 0.144; symptom score: 1.5 vs. 1.5, P = 0.869; cosmetic score: 1.6 vs. 1.7, P = 0.409; therapeutic success rate: 100 vs. 100 %, P > 0.99) after treatment. No major complications occurred in either group (P > 0.99). | Included in Guo (2021) systematic review |
Yue W, Wang S, Wang B et al. (2013) Ultrasound guided percutaneous microwave ablation of benign thyroid nodules: safety and imaging follow-up in 222 patients. European Journal of Radiology 82(1): e11-6. | Benign nodules | All thyroid nodules significantly decreased in size after microwave ablation. A 6-month follow-up | Included in Zheng (2018) systematic review |
Zhi X, Zhao N, Liu Y et al. (2018) Microwave ablation compared to thyroidectomy to treat benign thyroid nodules. International Journal of Hyperthermia 34(5): 644–52. | Benign nodules | MWA reduced mean nodule volume by 72.3% at 3 months, 84.5% at 6 months and 92.4% at 12 months as effective as surgery in inactivating nodules, and thyroid dysfunction did not occur during 12-month follow-up for those receiving MWA. Although both MWA and surgery were safe, patients | Studies with more patients or longer follow-up are included. |
Zhou B, Yan X, Wang X et al. (2018) Clinical study of ultrasonic guided percutaneous microwave ablation in the treatment of benign thyroid nodules with a one-year follow-up. International Journal of Clinical and Experimental Medicine, 11(10): 10903–9. | Benign nodules | Thyroid nodules were significantly decreased in size after MWA. Preoperative maximum diameter of the nodules was 2.95 ± 0.54 cm and the volume was 5.32 ± 2.08 cm3. Values were 1.47 ± 0.61 cm and 1.12 ± 0.67 cm3 twelve months after the operation (P < 0.01, respectively). At postoperative 1, 3, 6, and 12 months, VRRs were 11.85%, 29.07%, 60.23%, and 78.86% (P < 0.01). Thyroid function status was normal at postoperative 1, 3, and 6 months (P > 0.05). | Studies with more patients or longer follow-up are included. |
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