Efficacy and safety of single-session radiofrequency ablation for intrathoracic goiter: preliminary results and short-term evaluation

• Main Authors: Pi-Ling Chiang, Wei-Che Lin, Hsiu-Ling Chen, Sheng-Dean Luo, Meng-Hsiang Chen, Wei-Chih Chen, Yen-Hsiang Chang, Chen-Kai Chou, Yan-Ye Su, Yu-Cheng Tung, Wen-Chieh Chen, Shun-Yu Chi, Jung Hwan Baek
• Format: Article
• Language: English
• Published: Taylor & Francis Group 2021-01-01
• Series: International Journal of Hyperthermia
• Subjects: intrathoracic goiter; ultrasound; ablation technique
• Online Access: http://dx.doi.org/10.1080/02656736.2021.1942241
• ISSN: 0265-6736; 1464-5157

Background An intrathoracic goiter (ITG) is defined as a thyroid extension below the sternal notch. Compared to cervical goiters, surgery for ITG is more challenging, with a higher risk of an extracervical approach. Ultrasound (US)-guided radiofrequency ablation (RFA) is a minimally invasive treatment modality. The purpose of this study was to prospectively evaluate the safety and efficacy of RFA in patients with ITG. Methods From a total of 324 patients who underwent thyroid RFA at a single medical center, 15 patients (mean age 52.2 years; 73.3% female) with 16 ITGs were included and classified into three grades and three types using the cross-section imaging CT system. Clinical features and demographics, degree of extension, RFA details, goiter volume, and complications were analyzed. Results Mean pre- and post-RFA goiter volumes as measured by US were 106.62 ± 61.82 and 25.09 ± 14.22 mL respectively, with a volume reduction rate (VRR) of 75.5% (p < 0.001) at 6 months. The VRR as measured by CT/MRI was 57.0 ± 10.0% (p < 0.001) at 6 months. The intrathoracic length reduction rate at 6 months was 44.9 ± 39.2% (p = 0.001). In addition, 4 (25%) ITGs had total regression of the intrathoracic extension, with a downgrade from grade 1 to cervical goiter. Mean pre- and post-RFA symptom and cosmetic scores were 1.53 and 0.15 (p = 0.001), and 2.67 and 2.00 (p = 0.001), respectively. One patient had transient vocal cord palsy and another had perithyroidal and mediastinal hemorrhage. Conclusion US-guided RFA is an effective treatment for ITG in terms of both cervical and intrathoracic reductions with an acceptable complication rate.