Thermal ablation compared to surgery for symptomatic benign thyroid nodules: a systematic review

Area of Science:

• Endocrinology
• Minimally Invasive Surgery
• Interventional Radiology

Background:

• Symptomatic benign thyroid nodules (SBTN) are common and can cause discomfort and cosmetic concerns.
• Treatment options for SBTN include surgical excision and thermal ablation (TA).
• Evidence comparing the efficacy and safety of TA versus surgery for SBTN is evolving.

Purpose of the Study:

• To systematically review and critically appraise the scientific evidence comparing thermal ablation and surgical management of SBTN.
• To assess and compare the efficacy and safety outcomes of both treatment modalities.

Main Methods:

• A systematic review adhering to PRISMA guidelines.
• Comprehensive literature search of PubMed, EMBASE, and Cochrane CENTRAL databases up to July 2024.
• Primary outcomes included procedural success and safety, with secondary outcomes on procedural time, hospital stay, and costs.

Main Results:

• Three studies indicated comparable efficacy between TA and surgery; four studies showed higher efficacy for surgery.
• Thermal ablation (TA) was associated with significantly lower complication rates, shorter procedural times, and reduced hospital stays compared to surgery.
• Global costs favored TA, though not reaching statistical significance.

Conclusions:

• Image-guided thermal ablation is a safe and effective treatment for SBTN, offering advantages in complication rates, procedure duration, and hospital stay.
• While surgery may offer higher efficacy in volume reduction, further research is warranted due to diverse and conflicting findings.
• TA presents a viable therapeutic option for SBTN management.