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    Interventional procedure overview of percutaneous ultrasound-guided microwave ablation for symptomatic benign thyroid nodules

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    Efficacy summary

    Nodule volume reduction

    A systematic review of 1,461 patients with benign thyroid nodules reported a pooled reduction in mean nodule volume of 89% (95% confidence interval [CI] 85% to 92%), n=1,845 nodules, I2=93%) 12 months after microwave ablation (MWA) from an initial mean nodule volume of 15.0 ml after MWA (Zheng 2018).

    A systematic review of 1,146 patients with benign thyroid nodules (BTNs) or papillary thyroid microcarcinomas reported that in benign nodule subgroup analysis, the volume reduction rate (VRR) after MWA treatment (follow-up range 3 to 12 months) was 75% (standard mean difference [SMD]: 0.99, 95% CI 0.91 to 1.08; 5 studies, n=1,159 nodules; I2=0%; Cui 2019).

    A systematic review of 1,768 patients reported that after 12-month follow up, the VRR in patients who had MWA was 80% (95% CI 77% to 83%; 3 studies, n=938 nodules; I2=74%; Guo 2021).

    A non-randomised comparative study of 267 patients reported that after 15 months of follow up, the mean VRR was 93±1.8% and the mean nodule area decreased to 0.16±0.07 cm2 from a baseline of 5.28±3.63 cm2. When split by nodule type, the VRR was 92%±2.4% and the mean nodule area decreased to 0.18±0.06 cm2 from a baseline of 4.7±3.51 cm2 in nodular goitres, and in thyroid cystadenomas the VRR was 94%±1% and the mean nodule area decreased to 0.22±0.09 cm2 from a baseline of 5.87±3.75 cm2 (Honglei 2021).

    A non-randomised comparative study of 578 propensity matched patients reported that after 18 months of follow up, the mean VRR in patients who had MWA was 92% (range 89% to 95%; Jin 2021).

    A case series of 171 patients reported that after 3 years of follow up, the mean VRR was 93.2%. When split by nodule diameter, the mean VRR was 85%±13% for nodules ≤10 ml, 86%±15% for nodules 10 ml to 30 ml, and 87%±15% for nodules ≥30 ml at 12-month follow-up. When split by nodule component, the mean VRR was 83%±16% for solid nodules, 87%±14 % for predominantly solid nodules, and 89%±10% for cystic nodules at 12-month follow up (Luo 2021).

    A non-randomised comparative study of 318 patients reported a VRR at last follow up (mean 14.3±6.5 months) of 83%±32% across all nodules (Shi 2019).

    A non-randomised comparative study of 212 patients reported a decrease in nodule volume from a baseline volume of 2.5 cm3 to 0.51 cm3 after 12-month follow up, and a VRR of 80%±10% after 12 months (Jin 2018).

    A case series of 115 patients reported a decrease in nodule volume from a baseline mean volume of 5.30±8.56 ml to 0.58±1.32 ml after 12-month follow up, and a VRR of 91%±10% after 12 months (Fu 2021).

    A case series of 53 patients reported a decrease in nodule volume from a baseline mean volume of 7.8±11.42 ml to 1.49±4.00 ml after 3-year follow up, and a VRR of 85%±18% (Zhao 2021).

    Pressure symptoms

    A systematic review of 1,146 patients with BTNs or papillary thyroid microcarcinomas reported that across 2 studies looking at benign nodules, the pooled changes in symptom score gave an SMD of 1.51 (95% CI -0.40 to 3.42; 2 studies, n=766 nodules; I2=100%) at 12-month follow up (Cui 2019).

    A systematic review of 1,768 patients reported that after 12-month follow up, there was a decrease in symptom score with an SMD of 1.45 (95% CI 0.34 to 2.56; 3 studies, n=866 nodules; I2=98%; Guo 2021).

    A non-randomised comparative study of 318 patients reported a decrease in symptom score (scored 1 to 10 with 10 being the most severe) from a mean value of 5.8±2.5 to 3.5±1.6 at last follow up (mean 14.3±6.5 months; Shi 2019).

    A case series of 53 patients reported a decrease in symptom score (scored 110 with 10 being the most severe) from a baseline of 4.93±2.16 to 0.85±1.52 after 3‑year follow up (Zhao 2021).

    Cosmetic appearance

    A systematic review of 1,146 patients with BTNs or papillary thyroid microcarcinomas reported that across 3 studies looking at benign nodules, the pooled changes in cosmetic score gave an SMD of 1.20 (95% CI 0.87 to 1.52; 3 studies, n=876 nodules; I2=83%; Cui 2019).

    A systematic review of 1,768 patients reported that after 12-month follow up, there was a decrease in cosmetic score with an SMD of 1.15 (95% CI 0.83 to 1.47; 3 studies, n=866 nodules; I2=81%; Guo 2021).

    A non-randomised comparative study of 318 patients reported a decrease in cosmetic score (scored 1 to 4 with 4 being the most severe) from a mean value of 3.0±0.8 to 1.5±0.8 at last follow up (mean 14.3±6.5 months; Shi 2019).

    A case series of 53 patients reported a decrease in cosmetic score (scored 1 to 4 with 4 being the most severe) from a baseline of 2.94±1.03 to 0.99±1.01 after 3‑year follow up (Zhao 2021).

    Thyroid function

    A non-randomised comparative study of 267 patients reported that all thyroid function tests at baseline and post-ablation showed no statistically significant difference in thyroid function following MWA (Honglei 2021).

    Quality of life

    A non-randomised comparative study of 578 propensity matched patients reported that after 18‑month follow up, quality of life (scored from 0 to 410) increased from an average of 271/410 to 373/410 (range 360 to 386; Jin 2021).