Outcomes and Risk Factors for Complications of Laser Ablation for Thyroid Nodules: A Multicenter Study on 1531 Patients.
BACKGROUND
Image-guided laser ablation therapy (LAT) of benign thyroid nodules demonstrated favorable results in randomized trials with fixed modalities of treatment. The aim of this retrospective multicenter study was to assess the effectiveness, tolerability, and complications of LAT in a large consecutive series of patients from centers using this technique in their routine clinical activity.


METHODS
Clinical records of 1534 consecutive laser-treated nodules in 1531 patients from eight Italian thyroid referral centers were assessed. Inclusion criteria were as follows: solid or mixed nodules with fluid component up to 40%; benign cytological findings; and normal thyroid function.


METHODS
LAT was performed with a fixed-power protocol, whereas the number of applicators and illumination times were different according to target size. From one to three illuminations with pullback technique and with a total energy delivery based on the nodule volume were performed during the same session. Patients were evaluated during LAT, within 30 days, and 12 months after the procedure.


RESULTS
Total number of treatments was 1837; 1280 (83%) of nodules had a single LAT session. Mean nodule volume decreased from 27 ± 24 mL at baseline to 8 ± 8 mL 12 months after treatment (P < .001). Mean nodule volume reduction was 72% ± 11% (range 48%-96%). This figure was significantly greater in mixed nodules (79% ± 7%; range 70%-92%) because they were drained immediately before laser illumination. Symptoms improved from 49% to 10% of cases (P < .001) and evidence of cosmetic signs from 86% to 8% of cases (P < .001). Seventeen complications (0.9%) were registered. Eight patients (0.5%) experienced transitory voice changes that completely resolved at the ear-nose-throat examination within 2-84 days. Nine minor complications (0.5%) were reported. No changes in thyroid function or autoimmunity were observed.


CONCLUSIONS
Real practice confirmed LAT as a clinically effective, reproducible, and rapid outpatient procedure. Treatments were well tolerated and risk of major complications was very low.
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
C M
CM
Pacella
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
G
G
Mauri
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
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G
Achille
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
D
D
Barbaro
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
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Bizzarri
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
P
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De Feo
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
E
E
Di Stasio
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
R
R
Esposito
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
G
G
Gambelunghe
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
I
I
Misischi
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
B
B
Raggiunti
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
T
T
Rago
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
G L
GL
Patelli
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
S
S
D'Este
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
P
P
Vitti
Department of Diagnostic Imaging (C.M.P., G.B.), and Department of Endocrinology (I.M., E.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Italy; Department of Diagnostic Imaging and Interventional Oncology Unit (G.M.), Circolo Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy; Cervico-Facial Ultrasound Diagnostic and Interventional Unit (G.A.), Institute of Oncology, 70126 Bari, Italy; Endocrinology Unit (D.B.), Azienda S.L.6 Livorno, 46080 Livorno, Italy; Department of Internal Medicine (P.D.F., G.G.), University of Perugia, 06100 Perugia, Italy; Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Catholic University "Sacro Cuore," 00168 Rome, Italy; Endocrinology Unit (R.E.), S. S. Annunziata Hospital, 50121 Cosenza, Italy; Endocrinology Unit (B.R.), Atri Hospital, 87071 Atri, Italy; Department of Endocrinology (T.R., P.V.), University of Pisa, 56127 Pisa, Italy; and Department of Interventional Radiology (G.L.P., S.D.), Pesenti-Fenaroli Hospital, 24022 Alzano Lombardo, Italy.
E
E
Papini
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013961:Thyroid Gland / Q000601:surgery*; D016606:Thyroid Nodule / Q000601:surgery*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult