Abstract

Objective: To evaluate the effect of operator experience on the treatment outcomes of radiofrequency ablation (RFA) for benign thyroid nodules (BTN).

Methods: Data from the 90 first RFA procedures of a single operator in treating benign thyroid nodules were prospectively collected and retrospectively analyzed. Patients were divided into 3 groups according to their chronological treatment rank: patients 1–30 (G1), 31–60 (G2) and 61–90 (G3). Clinical symptoms, volume reduction ratio (VRR), technique efficacy (TE) defined as a VRR > 50% and ablation ratio (AR) were compared between the three groups at 6 months follow-up. All complications and side effects were recorded.

Results: No significant difference was observed in improvement of clinical symptoms after the RFA procedure between the three groups, with higher satisfaction however for pressure symptoms than for esthetic complaints (complete resolution 87.5% and 52.6%, respectively). In groups 1, 2 and 3, TE was 60%, 93.3%, 76.7%, VRR 54%, 65%, 60% and AR 13.1%, 34%, 34.6%, respectively. Thus, all ultrasound efficacy parameters (TE, VRR, AR) improved significantly between G1 and G2, with no difference between G2 and G3. Solely did AR improve in nodules ≤ 30 mL between G2 and G3 to reach a median value of 94.4% in G3 versus 57.1% in G2 and 13.7% in G1. Maximum values of TE and VRR (95.6% and 68%, respectively) were seen in nodules ≤ 30 mL in G2 at 6 months follow-up, with no improvement in G3 (84.2% and 63%, respectively). Both baseline volume and energy per volume were independently associated with VRR and AR. Three minor complications were recorded which all recovered totally after conservative treatment.

Conclusion: There was a measurable learning curve in RFA for benign thyroid nodules regarding efficacy until 90 patients. VRR and AR can be used as proficiency markers. Only three transient complications occurred confirming the safety of the procedure.

摘要

目的：评估操作者经验对射频消融（RFA）治疗甲状腺良性结节（BTN）的效果。

方法：前瞻性地收集和回顾性分析了90名首次由RFA操作者对甲状腺良性结节进行治疗的数据。根据时间顺序将患者分为三组：患者1–30（G1），患者31–60（G2）和患者61–90（G3）。在随访6个月时比较了三组的临床症状，体积缩小率（VRR），技术功效（TE）（定义为VRR> 50％）和消融率（AR）。记录所有并发症和副作用。

结果：两组之间在RFA手术后的临床症状改善方面没有观察到显着差异，但是压力症状的满意度高于审美诉状（分别为87.5％和52.6％）。在第1、2和3组中，TE分别为60％，93.3％，76.7％，VRR 54％，65％，60％和AR 13.1％，34％，34.6％。因此，G1和G2之间的所有超声功效参数（TE，VRR，AR）均得到显着改善，而G2和G3之间没有差异。G2和G3之间结节≤30 mL时，AR仅有改善，G3的中位值为94.4％，而G2的中位值为57.1％，G1的中位值为13.7％。在随访6个月时，G2结节≤30 mL时，TE和VRR的最大值（分别为95.6％和68％），而G3则无改善（分别为84.2％和63％）。基线体积和单位体积能量均与VRR和AR独立相关。记录了三个轻微并发症，经保守治疗后全部恢复。

结论：直到90例患者，RFA对于甲状腺良性结节的疗效均存在可测量的学习曲线。VRR和AR可以用作熟练程度标记。仅发生了三例短暂并发症，证实了手术的安全性。