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Radiofrequency Ablation for Thyroid Nodules (RATED Study)-Analysis of a Learning Curve and Predictors of Success
Manon M D van der Meeren1,2,3, Tim Boers4, Pim de Graaf5
1Rijnstate, Department of Radiology and Nuclear Medicine, 6815 AD Arnhem, the Netherlands.
Context:
Radiofrequency ablation (RFA) is used as treatment for symptomatic thyroid nodules. Factors influencing the volume reduction ratio (VRR) at 12 months are not yet fully understood.
Objective:
The primary objective of this work was evaluating the VRR at 12 months after RFA. Secondary objectives were the assessment of a learning curve and factors influencing the VRR at 12 months.
Methods:
A retrospective observational cohort study was conducted at 3 Dutch referral hospitals of patients who underwent RFA for symptomatic thyroid nodules with available ultrasound (US) follow-up. Main outcome measures included US-based VRR at 12 months and chronologically numbered RFA procedures. All patients' baseline, treatment, and early follow-up factors were assessed for correlation with VRR at 12 months.
Results:
A total of 337 patients with 356 nodules were included in the learning curve analysis. VRR at 12 months increased for the first 20 treatments per center and stabilized thereafter, indicating a plateau phase after a learning curve. These initial cases were removed from further analysis. In the remaining 299 nodules, median VRR at 3, 6, and 12 months was 57.1%, 65.6%, and 70.8%. Baseline nodule volume negatively correlated with VRR at 12 months but VRR was high for every volume category. Energy delivered per volume did not correlate with VRR.
Conclusion:
In RFA for thyroid nodules, a stable treatment efficacy is achieved after 20 treatments, with a median VRR of 70.8%. Baseline nodule volume, energy delivered, and prolonged follow-up 6 months after treatment may not be clinically relevant to predict treatment success.
