Proficiency in performing radiofrequency ablation procedure for non-functioning benign thyroid nodules: a qualitative...

Area of Science:

• Endocrinology
• Minimally Invasive Surgery
• Medical Technology

Background:

• Radiofrequency ablation (RFA) is a minimally invasive, non-surgical treatment for benign thyroid nodules (BTN).
• While RFA demonstrates a good safety profile for BTN, the learning curve (LC) for operators to achieve proficiency is not well-defined.
• Understanding the LC is crucial for optimizing patient outcomes and standardizing RFA procedures.

Purpose of the Study:

• To define the learning curve (LC) for radiofrequency ablation (RFA) in treating benign thyroid nodules (BTN).
• To assess the impact of nodule size on the operator's learning curve and treatment efficacy.
• To identify factors influencing the success rate of RFA for BTN.

Main Methods:

• Retrospective analysis of 179 RFA procedures performed by a single operator on patients with non-functioning BTN.
• Proficiency defined as achieving a 6-month nodule volume reduction rate (VRR) ≥ 50%.
• Cumulative sum (CUSUM) charts used to evaluate LCs, stratified by basal nodule size (small <10 ml, intermediate 10-25 ml, large >25 ml).

Main Results:

• The overall LC comprised three phases: initial learning (1-39), consolidation (40-145), and experienced (146-179 procedures).
• Proficiency was achieved earlier for small and intermediate nodules (by the 37th and 116th procedures overall, respectively).
• Operator proficiency was not demonstrated for large nodules (>25 ml), with suboptimal volume reduction rates expected.

Conclusions:

• The learning curve for RFA in benign thyroid nodules is significantly influenced by basal nodule size.
• Suboptimal volume reduction rates should be anticipated for large nodules (>25 ml) treated with RFA.
• Experience gained from treating smaller nodules does not appear to enhance RFA efficacy for larger nodules, suggesting other factors are critical.