Category: Thyroid

Monitor: 16

16 - High intensity focused ultrasound (HIFU) in the treatment of thyroid nodules. Efficacy, side-effects and predictive factors of clinical outcome

Saturday, Apr 27
11:30 AM – 12:00 PM

Objective :

Background: Currently, few small trials on heterogeneous series of cases reported clinical outcomes of HIFU ablation of thyroid nodules. Aim of our study was to assess clinical results and tolerability of this procedure in solid non functioning nodules.


Methods :

Material and methods: Twenty-three non functioning thyroid nodules with a mean volume of 16.3 ml ( range 4.3-68.8 ml) associated with cosmetic signs and/or compressive symptoms were treated from October 2016 to September 2018 by HIFU according to the previously described procedure. Ten nodules were completely solid and 13 had spongiform areas. All patients were euthyroid and had two benign cytological reports. Ablation was performed in Interventional Radiology department with last generation equipment (EchoPulse, Theraclion, France) with an energy delivery of 3.9-14.6 KJ during a single session and a median effective requested power per pulse of 41.0 Watt ( range 34-45 W). Tolerability was assessed with a visual analogue scale and side-effects and complications were registered. Clinical and US examination were blindly performed in the Endocrinology department after 1, 3 and 6 months.


Results :


Results: The mean duration of treatment was 41.6 ± 18.0 minutes. After treatment, US examination showed an ill-defined hypoechoic area of ablation with marked decrease of vascular signals. Fifteen nodules (65.2%) showed a 18.2% ( range 2.5%-41.8%) volume reduction at one-month and a 31.5%( range 8.8%-53.6%) volume decrease at six-month controls. Four nodules (17.3%) showed a not significant volume decrease and four (17.3%) had a 10.0% volume increase ( range 4.2%-13.4%) at one month followed by a not significant change at 6 months. Treatment was reported as unpleasant or painful by the majority of patients and some of them required analgesic drugs by mouth for 1 to 3 days. No major complications were observed.


Discussion :


Discussion: In comparison with data reported for laser or radiofrequency ablation procedures, time expenditure for HIFU treatment was longer, the mean volume reduction of the nodules at 6 months was lower and the outcomes were less consistent, especially in larger or deep-placed lesions. HIFU procedure was safe, as no cervical bleeding, thyroid function changes or major complications were observed.


Conclusion :


Conclusion: Advantages of HIFU for the treatment of thyroid nodules are the positive reception of patients for a completely noninvasive procedure, the absence of any cosmetic damage and the lack of complications related to needles insertion. However the reduction in size of the nodules is lower and less predictable than with mini-invasive thermal ablation techniques.

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Enrico Papini

Edocrinologist
“Regina Apostolorum”, Albano Laziale
Rome, Lazio, Italy

Enrico Papini is head of the Thyroid Unit, Regina Apostolorum Hospital in Albano, Rome, and is Scientific Director of the hospital.
Professor of Endocrinology at the Postgraduate Medical School of the Catholic University of Rome.
President of the Italian AACE Chapter and Past President of the Italian Association of Clinical Endocrinologists. Dean of the College of the Presidents of Italian Association of Clinical Endocrinologists.
Italian Representative at the European Board of Endocrinology (UEMS).
Fellow, American College of Endocrinology.
The scientific contributions, covering >100 original manuscripts, textbook chapters and Italian and International Guidelines, fall in the following areas:
1. Ultrasound (US) assessment of thyroid gland
Fromthe early 1990s, EPproposed this technique as a major diagnostic tool for thyroid nodules and defined the main US risk features for thyroid malignancy. He also provided relevant contributes to the diagnosis and therapy of nodular goiter.

2. Minimally invasive treatments for thyroid lesions and endocrine tumors
EP pioneered thyroid interventional procedures and his work has been pivotal in image-guided ethanol and thermal therapy of benign thyroid nodules and non surgical management of thyroid cancer recurrences and microcarcinomas.

Agnese Persichetti

Endocrinologist
Regina Apostolorum, Albano Laziale, Roma
Rome

E

Antonio Bianchini

radiologist
regina apostolorum hospital

...

Carmela Coccaro

consultant endocrinologist
Regina Apostolorum Hospital Albano Laziale

Biosketch for Carmela Coccaro
Born in Vallo Della Lucania (SA), 18.03.1982
Degree in Medicine and Surgery 110/110 cum laude, “La Sapienza” University of Rome Medical
School, March 2009
Specialist cum laude in Endocrinology & Metabolism “La Sapienza” University of Rome Medical
School, July 2016
Consultant Endocrinologist, Department of Endocrinology and Metabolism, Regina Apostolorum Hospital
Scientific contributes in the field of diagnostic thyroid ultrasound, ultrasound-guided fine-needle aspiration biopsy, and minimally invasive procedures for the treatment of thyroid nodules.

Marco Chianelli

Consultant Physician
Endocrinology Unit, Regina Apostolorum Hospital, Albano, Rome Italy

Born in Rome on 2nd August 1963. MD in Rome, Italy and PhD in London, UK

Rinaldo Guglielmi

Chief of Endocrine and Metabolism Unit
Regina Apostolorum Hospital

Rinaldo Guglielmi is the Chief of Endocrine and Metabolism Unit of the Regina Apostolorum Hospital in Albano, Rome.
Professor of Endocrinology at the Postgraduate Medical School of the Catholic University of Rome.
Past President of the Italian Association of Clinical Endocrinologists.

The scientific contributions, covering >50 original manuscripts, textbook chapters and Italian and International Guidelines, fall in the following areas:
1. Ultrasound (US) assessment of thyroid gland

2. Minimally invasive treatments for thyroid lesions and endocrine tumors

Giancarlo Bizzarri

Chief
Regina Apostolorum Hospital

**

Enrico Papini

Edocrinologist
“Regina Apostolorum”, Albano Laziale
Rome, Lazio, Italy

Enrico Papini is head of the Thyroid Unit, Regina Apostolorum Hospital in Albano, Rome, and is Scientific Director of the hospital.
Professor of Endocrinology at the Postgraduate Medical School of the Catholic University of Rome.
President of the Italian AACE Chapter and Past President of the Italian Association of Clinical Endocrinologists. Dean of the College of the Presidents of Italian Association of Clinical Endocrinologists.
Italian Representative at the European Board of Endocrinology (UEMS).
Fellow, American College of Endocrinology.
The scientific contributions, covering >100 original manuscripts, textbook chapters and Italian and International Guidelines, fall in the following areas:
1. Ultrasound (US) assessment of thyroid gland
Fromthe early 1990s, EPproposed this technique as a major diagnostic tool for thyroid nodules and defined the main US risk features for thyroid malignancy. He also provided relevant contributes to the diagnosis and therapy of nodular goiter.

2. Minimally invasive treatments for thyroid lesions and endocrine tumors
EP pioneered thyroid interventional procedures and his work has been pivotal in image-guided ethanol and thermal therapy of benign thyroid nodules and non surgical management of thyroid cancer recurrences and microcarcinomas.