Effect of ultrasound parameters of benign thyroid nodules on radiofrequency ablation efficacy

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Abstract
Background and aim Ultrasound-guided radiofrequency ablation (RFA) is a minimally invasive therapy for thyroid
nodules (TNs). Understanding the determinants of RFA efficacy can improve treatment and prognosis. This study aims
to investigate the relationship between ultrasound parameters of benign TNs and the efficacy of RFA.
Methods A pretest–posttest interventional study was conducted in 2021 on 250 randomly sampled patients with
benign TNs, receiving RFA. For this purpose, the volume reduction (VR) and the VR ratio (VRR) of the nodules were
measured at the 1-, 3-, 6-, and 12-month follow-up periods after the RFA completion. The technical success rate (TSR)
of this procedure was then categorized into four states, including low (VRR < 25%), moderate (VRR = 25–49%), high
(VRR = 50–74%), and very high (VRR ≥ 75). Ordered logistic regression (OLR) was further utilized to investigate the
effect of the ultrasound parameters of TNs on the TSR. The analyses were notably performed using Stata 14.2.
Results The VRR at the 1-, 3-, 6-, and 12-month follow-up periods were 38.7%, 53.6%, 59.3%, and 59.9%, respectively.
The mean VR was also statistically significant at all follow-ups (p < 0.001). At the 1-, 3-, and 6-month follow-up periods,
the VR of over 50% was observed in 28.2%, 52.1%, and 65.2% of the nodules, respectively. The odds ratios (ORs) of the
RFA success were found to be 4.3 times higher for the nodules in the left lobe compared to the right lobe (OR: 4.31,
p = 0.002), 6.3 times greater for isoechoic nodules compared to hyperechoic nodules (OR: 6.39, p < 0.001), 6.2 times
higher for hyper-vascular nodules compared to hypo-vascular nodules (OR: 6.25, p = 0.005), and 2.3 times greater for
mixed nodules compared to solid ones (OR: 2.37, p = 0.049).
Conclusion The ultrasound parameters of TNs had a statistically significant effect on the efficacy of RFA. Small-sized,
isoechoic, and hyper-vascular nodules, as well as those with mixed tissue, were observed to respond better to RFA,
leading to a better prognosis in terms of VR after treatment.
Keywords Interventional Radiology, Radiofrequency Ablation, Thyroid Nodule, Treatment Outcome