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

Nodule rupture

Nodule rupture was reported in <1% (4/1461) of patients who had MWA in a systematic review of 1,461 patients (Zheng 2018). Nodule rupture was reported in <1% (6/1226) of nodules in patients who had MWA in a systematic review of 1,146 patients with BTNs or papillary thyroid microcarcinomas (Cui 2019).

Nodule rupture was reported in <1% (4/869) of patients who had MWA in a systematic review of 1,768 patients (Guo 2021).

Nodule rupture was reported in 2% (3/171) of patients in a case series of 171 patients, with symptoms improving within 1 to 2 weeks after treatment with non-steroidal anti-inflammatory drugs (Luo 2021).

Voice change and vocal cord palsy

Transient voice change was reported in 4% (54/1461) of patients who had MWA, and transient hoarseness was reported in <1% (3/1461) of patients who had MWA in a systematic review of 1,461 patients. In the same study, 1 patient experienced ipsilateral vocal cord palsy (Zheng 2018).

Transient or permanent voice change was reported in 5% (58/1146) patients who had MWA in a systematic review of 1,146 patients with BTNs or papillary thyroid microcarcinomas (Cui 2019).

Transient voice change was reported in 5% (44/869) of patients who had MWA in a systematic review of 1,768 patients (Guo 2021). Transient voice change was reported in <1% (2/267) of patients who had MWA in a non-randomised comparative study of 267 patients (Honglei 2021).

Hoarseness was reported in 1 patient in the MWA group in a non-randomised comparative study of 578 propensity matched patients (Jin 2021).

Hoarseness was reported in 2% (4/171) of patients in a case series of 171 patients, with all patients recovering within 1 month (Luo 2021).

Voice change was reported in 1% (2/160) of patients who had MWA in a non-randomised comparative study of 318 patients (Shi 2019).

Vocal cord paralysis was reported in 1 patient who had MWA in a non-randomised comparative study of 212 patients. The patient recovered from this complication within 3 months of the procedure (Jin 2018).

Hoarseness was reported in 3% (4/115) of patients in a case series of 115 patients. Three of these resolved within 1 day of the procedure and 1 resolved 3 months after procedure (Fu 2021).

Hoarseness was reported in 1 patient in a case series of 53 patients (Zhao 2021).

Haemorrhage or haematoma

Haemorrhage was reported in 2% (27/1461) of patients who had MWA in a systematic review of 1,461 patients. In the same study haematomas were reported in <1% (2/1461) of patients. Superficial haematomas were also reported across 'almost all patients' in 1 included study of 30 patients within the systematic review but the exact number was not specified (Zheng 2018).

Haematoma was reported in 4% (46/1146) of patients who had MWA in a systematic review of 1,146 patients with BTNs or papillary thyroid microcarcinomas (Cui 2019).

Haemorrhage, haematoma, or both, were reported in 4% (33/869) of patients who had MWA in a systematic review of 1,768 patients (Guo 2021). In a non-randomised comparative study of 578 propensity matched patients, haemorrhage and haematoma was reported in 1 patient (Jin 2021).

Haematoma was reported in 3% (5/160) of nodules in patients who had MWA in a non-randomised comparative study of 318 patients (Shi 2019).

Haematoma was reported in 3% (4/115) of patients in a case series of 115 patients; this resolved 2 to 7 days after the procedure in all patients affected (Fu 2021).

Nerve injury

Horner's syndrome was reported in <1% (2/1461) of patients who had MWA in a systematic review of 1,461 patients, and sympathetic nerve injury was reported in 1 patient in the same study (Zheng 2018).

Sympathetic nerve injury was reported in <1% (2/869) of patients in a systematic review of 1,768 patients (Guo 2021).

Thyroid dysfunction

Thyroid dysfunction was reported in <1% (6/1461) of patients who had MWA in a systematic review of 1,461 patients. In the same study, hyperthyroidism was reported in <1% (2/1461) of patients and Graves' disease was reported in 1 patient (Zheng 2018).

Hyperthyroidism was reported in 1 patient who had MWA in a systematic review of 1,768 patients (Guo 2021).

Burns

First-degree burn was reported in 2% (25/1461) of patients who had MWA in a systematic review of 1,461 patients, and in the same study skin burn was reported in <1% (3/1,461) of patients (Zheng 2018).

Skin burns were reported in 1 patient who had MWA in a systematic review of 1,146 patients with BTNs or papillary thyroid microcarcinomas (Cui 2019).

Skin burns were reported in 1 patient who had MWA in a systematic review of 1,768 patients (Guo 2021).

Skin burns were reported in 1% (4/267) of patients who had MWA in a comparative study of 267 patients (Honglei 2021).

Skin burns were reported in <1% (2/289) of patients who had MWA in a non-randomised comparative study of 578 propensity matched patients (Jin 2021).

Skin burns were reported in 1 patient who had MWA in a non-randomised comparative study of 212 propensity matched patients (Jin 2018).

Skin burn was reported in 1 patient and oesophageal burn was reported in 1 patient in a case series of 115 patients (Fu 2021).

Pain and swelling

Pain was reported in 9% (130/1461) of patients who had MWA in a systematic review of 1,461 patients (Zheng 2018).

Unbearable pain was reported in 2% (28/1146) of patients who had MWA in a systematic review of 1,146 patients with BTNs and papillary thyroid microcarcinomas (Cui 2019).

Slight pain at the site of ablation was reported by most patients on the first day after MWA (exact numbers unspecified) in a case series of 171 patients (Luo 2021).

Pain was reported in 13% (20/160) of patients who had MWA in a comparative study of 318 patients (Shi 2019).

Neck pain was reported in 10% (11/115) of patients in a case series of 115 patients, which resolved within 5 days of procedure (Fu 2021).

Pain was reported in 60% (32/53) of patients in a case series of 53 patients, and in the same study swelling was reported in 49% (26/53) of patients (Zhao 2021).

Fever

Fever was reported in <1% (13/1461) of patients who had MWA in a systematic review of 1,461 patients (Zheng 2018).

Fever was reported in 2% (2/115) of patients in a case series of 115 patients, and in all cases was resolved 3 days after the procedure (Fu 2021).

Fever was reported in 1 patient in a case series of 53 patients (Zhao 2021).

Vomiting or nausea

Vomiting was reported in 1 patient in a systematic review of 1,461 patients (Zheng 2018), and in 1 patient in a systematic review of 1,768 patients (Guo 2021).

In a comparative study of 267 patients, nausea was reported in 2% (5/267) of patients and vomiting was reported in <1% (2/267) of patients who had MWA (Honglei 2021).

Anecdotal and theoretical adverse events

In addition to safety outcomes reported in the literature, professional experts are asked about anecdotal adverse events (events which they have heard about) and about theoretical adverse events (events which they think might possibly occur, even if they have never happened). For this procedure, the professional expert did not list any adverse events that had not been described in the literature.