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Searching for optimized follow-up timing after radiofrequency ablation of benign thyroid nodules: Systematic review
Sium Wolde Sellasie1, Maurilio Deandrea2, Stefano Amendola3
1Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, Department of Surgical Sciences, University of Rome Tor Vergata, Rome 00133, Italy; PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Rome 00133, Italy.
Objective:
The primary objective of this study was to determine the optimal ultrasound(US) follow-up timing after radiofrequency ablation(RFA) for benign thyroid nodules(BTNs),conducting a systematic review and meta-analysis of published data on volume reduction rate(VRR) outcomes across different follow-up intervals.
Design And Methods:
A systematic search of articles published up to January 17, 2025 identified studies reporting RFA treatment for BTNs. Characteristics of the study design, BTNs cohorts, and outcomes of interest(VRR at 1,3,6 and 12 months of follow up) were extracted. Statistical analysis included a random-effects meta-analysis, assessment of heterogeneity with use of the I2 statistic, and meta-regression and subgroup analyses to explore potential sources of heterogeneity.
Results:
Twenty-nine studies comprising 3033 BTNs were included.The pooled VRRs at 1,3,6, and 12 months post-RFA were 42.96 %(95 %CI:35.06-50.87),61.80 %(95 %CI:57.66-65.95),69.89 %(95 %CI:67.08-72.69), and 77.86 %(95 %CI:75.89-79.67),respectively. Meta-regression analysis using baseline mean BTN volume revealed an inverse correlation with VRR at both 6 and 12 months(p < 0.01).Small-volume group(<15 mL):Significant changes in VRR were observed between 1-[45.76 %(95 %CI:38.22-53.29)],3-[63.91 %(95 %CI:58.84-68.99)], 6-[74.59 %(95 %CI:71.08-78.11)], and 12-month[81.42 %(95 %CI:78.56-84.29)] follow-ups.Medium-volume group(15-30 mL):Significant changes were noted between 1[47.09 %(95 %CI:40.84-53.34)] and 3 months[63.05 %(95 %CI:60.14-65.96)],and between 6[67.91 %(95 %CI:65.13-70.70)] and 12 months[75.61 %(95 %CI:71.79-79.45)].Large-volume group(≥30 mL):A significant change in VRR was observed only between the 6-[59 %(95 %CI:54.20-63.81)] and 12-month[69.32 %(95 %CI:64.97-73.68)]follow-ups.
Conclusion:
A streamlined follow-up schedule consisting of two US assessments-an early evaluation at 1-3 months and a final evaluation at 12 months-can be sufficient for most patients. These strong findings can guide clinical decision-making, provide a benchmark for RFA efficacy, and support the optimization of healthcare resources.
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