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Huh J.Y.,CHA Medical University | Baek J.H.,Thyroid Center | Baek J.H.,University of Ulsan | Choi H.,Thyroid Center | And 2 more authors.
Radiology | Year: 2012

Purpose: To prospectively evaluate the efficacy of additional radiofrequency (RF) ablation by comparing the results of one and two sessions. Materials and Methods: All patients gave written informed consent to participate in this institutional review board-approved prospective study. From September 2007 to February 2008, 30 patients with benign predominantly solid thyroid nodules causing pressure symptoms and/or cosmetic problems were randomly assigned to undergo single-session (group 1, n = 15) or two-session (group 2, n = 15) RF ablation. RF ablation was performed by using an 18-gauge internally cooled electrode with ultrasonographic guidance. Nodule volume and cosmetic and symptom scores were evaluated before ablation and at 1, 3, and 6 months after initial ablation, and quantitative comparisons of these were performed by using the Mann-Whitney and Wilcoxon signed rank tests; the Spearman rank test was used for correlation between nodule volume reduction and applied energy. Results: At 6-month follow-up, there was significant nodule volume reduction, from 13.3 mL ± 12.9 (standard deviation) to 3.8 mL ± 4.4 in group 1 (P = .001), and from 13.0 mL ± 6.8 to 3.0 mL ± 2.2 in group 2 (P = .001). Each group showed significant improvement in cosmetic (P < .0001) and symptom (P = .001) scores. However, there was no significant difference in volume reduction, cosmetic score, and symptom score between two groups (P = .078, P > .99, and P = .259, respectively). In group 1, three of four patients who had a pretreatment nodule volume larger than 20 mL underwent additional RF ablation because of unresolved clinical problems after the first session. Conclusion: Single-session RF ablation showed significant volume reduction and satisfactory clinical response in most patients. Therefore, additional RF ablation should be limited to patients with a large nodule (>20 mL) or unresolved clinical problems. © RSNA, 2012.

Stack Jr. B.C.,University of Arkansas for Medical Sciences | Stack Jr. B.C.,Thyroid Center | Moore E.,University of Arkansas for Medical Sciences | Spencer H.,UAMS | And 2 more authors.
Otolaryngology - Head and Neck Surgery (United States) | Year: 2013

Objective. Describe data from patients undergoing outpatient thyroid surgeries for benign and malignant disease at academic medical centers in the United States. Study Design. Retrospective database search. Setting. The University Health System Consortium (UHC), Oak Brook, Illinois, data compiled from discharge summaries. Subjects and Methods. Discharge data were collected from the first quarter of 2005 through the fourth quarter of 2010. Searching strategy was based on diagnosis of thyroid disease and patients undergoing thyroid surgery across all UHC facilities. Demographic information was collected as well as charges. Complications were also evaluated in this analysis. Results. During the study period, 38,362 outpatient thyroidectomies were performed from our sample, 32% for thyroid cancer. More total thyroidectomies (43%) and fewer hemithyroidectomies (36%) were being performed overall; 64.1% of patients stayed 23 hours. Conclusion. This is one of the largest series reporting outcomes for outpatient thyroid surgery. Since these surgeries appear to be shifting to an outpatient setting, this report reflects the experience with the majority of endocrine surgeries from the UHC database being performed presently. These results are derived from teaching hospitals and their affiliates and may not reflect the entirety of thyroid surgery in the United States. © 2013 American Academy of Otolaryngology-Head and Neck Surgery Foundation.

Lim H.K.,University of Ulsan | Lee J.H.,University of Ulsan | Ha E.J.,University of Ulsan | Sung J.Y.,Thyroid Center | And 3 more authors.
European Radiology | Year: 2013

Objectives: To evaluate the clinical outcomes and safety of radiofrequency (RF) ablation for benign non-functioning thyroid nodules over a 4-year follow-up. Methods: We evaluated 126 benign non-functioning thyroid nodules of 111 patients treated with RF ablation and followed-up more than 3 years. RF ablation was performed using the Cool-Tip RF system and an internally cooled electrode. Nodule volume and cosmetic and symptom scores were evaluated before treatment and during follow-up. Complications and factors related to efficacy were evaluated. Results: The mean follow-up duration was 49.4 ± 13.6 months. Thyroid nodule volume decreased significantly, from 9.8 ± 8.5 ml before ablation to 0.9 ± 3.3 ml (P < 0.001) at final evaluation: a mean volume reduction of 93.4 ± 11.7 %. The mean cosmetic (P < 0.001) and symptom scores (P < 0.001) improved significantly. Factors related to efficacy were initial solidity and volume. The overall recurrence rate was 5.6 % (7/126). The overall complication rate was 3.6 % (4/111). Conclusions: RF ablation was effective in shrinking benign thyroid nodules and in controlling nodule-related problems over a 4-year follow-up. There were no life-threatening complications or sequelae. Therefore, RF ablation can be used as a non-surgical treatment for patients with benign non-functioning thyroid nodules. Key Points: • Radiofrequency (RF) ablation provides a non-surgical option for benign non-functioning thyroid nodules • RF ablation reduced non-functioning thyroid nodular volume by 93.5 % after 49 months • Initial solidity and volume influenced the efficacy of RF ablation • Larger thyroid nodules required more treatment sessions to achieve appropriate volume reduction • Complete treatment of the periphery of the nodule is important in preventing marginal regrowth © 2012 European Society of Radiology.

Sung J.Y.,Thyroid Center | Na D.G.,Intervention Center | Kim K.S.,Thyroid Center | Yoo H.,Thyroid Center | And 3 more authors.
European Radiology | Year: 2012

Objectives To retrospectively compare the accuracy of fineneedle aspiration (FNA) and core-needle biopsy (CNB) for the diagnosis of thyroid malignancy Methods We evaluated the results of FNA and CNB in 555 consecutive thyroid nodules with final diagnoses (malignancy 318, benign 237). All patients underwent FNA and CNB simultaneously for each nodule. We assessed the sensitivity, specificity and accuracy of FNA, CNB and FNA/CNB for the diagnosis of thyroid malignancy. Results The sensitivity of FNA, CNB and FNA/CNB for thyroid malignancy was 68.6%, 86.8% and 90.6%, specificity 100%, 99.2% and 99.2%, and accuracy 82.0%, 92.1% and 94.2%, respectively. The sensitivity and accuracy of CNB or FNA/CNB for thyroid malignancy were significantly higher than those of FNA (P<0.001). Compared with CNB alone, FNA/CNB was more accurate for thyroid malignancy only in small nodules less than 1 cm (P<0.001). Conclusions Our clinical cohort data demonstrated that CNB was more accurate for the diagnosis of thyroid malignancy than FNA, and FNA/CNB was more accurate than CNB alone in small thyroid nodules. CNB will play a complementary role in optimal surgical decision-making and the management of thyroid nodules. Key Points ̇ CNB was more accurate for the diagnosis of malignancy than FNA. ̇ Combined FNA/CNB was more accurate than CNB alone in small thyroid nodules. ̇ CNB should play at least a complementary role in managing thyroid nodules. © European Society of Radiology 2012.

Baek J.H.,Thyroid Center | Baek J.H.,University of Ulsan | Kim Y.S.,Thyroid Center | Lee D.,Thyroid Center | And 2 more authors.
American Journal of Roentgenology | Year: 2010

OBJECTIVE. The purpose of this study was to evaluate the efficacy of radiofrequency ablation of benign predominantly solid thyroid nodules by comparing the findings in treatment and control groups. SUBJECTS AND METHODS. Thirty patients with normal thyroid function, each with a benign predominantly (> 50%) solid thyroid nodule causing pressure symptoms or cosmetic problems, were assigned to a control group (n = 15) or to a group undergoing a single session of radiofrequency ablation (n = 15). Thyroid nodule volume, thyroid function, pressure symptoms, and cosmetic concerns were evaluated before treatment and during follow-up. Sonographically guided radiofrequency ablation was performed with an internally cooled electrode (1-cm active tip) with an output power of 30-80 W. RESULTS. The control group had no resolution of symptoms or cosmetic problems. The mean nodule volume increased slightly after 6 months but without statistical significance (p = 0.46). In the radiofrequency ablation group, the mean symptom score (p = 0.001) and cosmetic grade (p = 0.001) improved significantly. Mean nodule volume decreased significantly from 7.5 ± 4.9 mL (range, 1.7-20.0 mL) to 1.3 ± 0.8 mL (range, 0.2-2.6 mL) 6 months after radiofrequency ablation (p = 0.001). There were no major complications of ablation. CONCLUSION. This study confirmed that radiofrequency ablation is effective for reducing nodule volume and relieving nodule-related clinical problems and that an effect due to spontaneous nodule reduction can be excluded owing to the results of the comparison with a similar control group. Copyright © 2010 by the American Roentgen Ray Society.

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