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      European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules

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          Objective: Image-guided interventional ultrasound (US) techniques represent diagnostic and therapeutic tools for non-surgical management of thyroid nodular disease. We sought to investigate the attitude of European Thyroid Association (ETA) members towards the use of minimally invasive techniques (MIT) in diagnosis/therapy of symptomatic nodular goitre. Methods: ETA members were invited to participate in an online survey investigating the use of MIT in benign and malignant thyroid nodular disease. Of 865 invited members, 221 (25.5%) completed the survey. The respondents were from 40 countries; 139 (74.7%) were from European countries. Results: Respondents personally performed thyroid US (91.6%), Fine needle aspiration (FNA; 75.3%), ethanol ablation (EA; 22.1%), core needle biopsy (CNB; 11%) and thermal treatments (4.8%). When skills and/or technology were unavailable, only 13.4% referred patients “often” or “always” to other centres with specific expertise in this field. Surgery was the preferred first option in patients with recurrent cysts, 4.0 cm benign nodules, local (radioiodine-avid or non-avid) lymph node metastases, or papillary cancers <1.0 cm. For autonomously functioning nodules radioactive iodine treatment was the preferred choice, followed by surgery. Thermal ablation (TA) was the preferred option only for a 4 cm benign nodule in old patients with comorbidities. Conclusions: US, US-guided FNA and surgery were available to nearly all respondents, while MIT was not. CNB and EA were employed only by about 1/3 of the respondents and TA procedures were available and personally performed only by a minority. For most thyroid lesions, surgery was the preferred option versus thermal therapies. The ETA needs to develop guidelines and establish teaching to overcome geographic inequality and promote the use of MIT as a valid therapy option in appropriate cases.

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          Most cited references 40

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          Clinical review: Nonsurgical, image-guided, minimally invasive therapy for thyroid nodules.

          Nodular thyroid disease is very common. Most nodules are asymptomatic, are benign by fine-needle aspiration, remain stable, and can be followed by observation alone in the majority of the patients. Occasionally, nodules grow or cause symptoms requiring treatment. So far, surgery has been our main option for treatment. In this review, we discuss nonsurgical, minimally invasive approaches for small thyroid masses, including indications, efficacy, side effects, and costs. We selected recent publications related to minimally invasive thyroid techniques, with the focus on large-scale and preferably randomized studies, available via PubMed search in authors' files, using appropriate searches and keywords. In large centers with experienced hands, minimally invasive approaches appear effective and safe. At present, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Either ultrasound-guided laser or radiofrequency ablation can be used for symptomatic solid nodules with normal or abnormal thyroid function. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. These techniques have also been applied to recurrent locoregional cervical thyroid cancer with encouraging initial results, although still limited data. Surgery and radioiodine remain as conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective and can be used to treat symptomatic or enlarging thyroid masses.
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            Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules. Results of a three-year multicenter prospective randomized trial.

            The aim of the present trial on ultrasound (US)-guided laser ablation therapy (LAT) of solid thyroid nodules is to assess long-term clinical efficacy, side effects, and predictability of outcomes in different centers operating with the same procedure.
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              Radiofrequency ablation for autonomously functioning thyroid nodules: a multicenter study.

              The purpose of this study is to validate the generalizability of the efficacy and safety of radiofrequency (RF) ablation for treating autonomously functioning thyroid nodules (AFTN) in a large population multicenter study.

                Author and article information

                European Thyroid Journal
                S. Karger AG
                July 2020
                27 March 2020
                : 9
                : 4
                : 194-204
                aDepartment of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
                bDivision of Endocrinology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
                cDivision of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy
                dDivision of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Italy
                Author notes
                *Roberto Negro, MD, Division of Endocrinology, “V. Fazzi” Hospital, Piazza Muratore, 1, IT–73100 Lecce (Italy), dr.negro@libero.it
                506513 Eur Thyroid J 2020;9:194–204
                © 2020 European Thyroid AssociationPublished by S. Karger AG, Basel

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                Page count
                Figures: 4, Tables: 1, Pages: 11
                Clinical Thyroidology / Research Article


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