Radiofrequency Ablation for Treatment of Benign Thyroid Nodules: Systematic Review

ObjectiveTo summarize the literature published to date on the use of radiofrequency ablation (RFA) in the treatment of benign thyroid nodules, to evaluate the effectiveness of this treatment, and to attempt an evaluation of factors that may influence treatment outcome. Study DesignSystematic review with meta-analysis. MethodsSystematic literature search was performed by two separate authors in four commonly used literature databases. Trials included in meta-analysis included only those presenting prospective data. Meta-analysis compared pretreatment values to post-treatment outcomes. ResultsOf 46 full-text articles identified, nine articles satisfied inclusion criteria. Two of these articles were randomized controlled trials comparing RFA to placebo or to some other treatment. One article was a randomized controlled trial comparing one RFA treatment to two treatments. The remaining six articles were noncontrolled, prospective observational studies. All analyzed outcomes showed statistically significant improvements from baseline to final follow-up, including reduction in nodule size, improvement of symptom and cosmetic scores, and withdrawal from methimazole. Improvement in nodule size remained significant in both hot and cold nodule subgroups. Twelve adverse events were identified across all studies out of 306 total treatments. Two of these events qualified as significant adverse events. None of these events resulted in hospitalization or death. ConclusionsRadiofrequency ablation is a safe and effective treatment for symptomatic thyroid nodules that are confirmed benign. However, the paucity of level 1 evidence comparing RFA to surgical or to other nonsurgical treatment modalities is concerning. Level of EvidenceNA Laryngoscope, 124:346-353, 2014