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September 26, 2025The long-term effects of thermal ablation for benign thyroid nodules: a systematic review and meta-analysis
| Background | Ultrasound-guided thermal ablation has become an option for treating benign thyroid nodules. To evaluate the long-term safety and efficacy of thermal ablation for benign thyroid nodules (BTNs), cases involving 3 years of follow-up were studied via a systematic review and meta-analysis. |
| Authors | Zhao X, Xue J, Yu W, Dong R, Liu S, Wang P, Wang J, Guo F, Teng DK. |
| Journal | Eur Radiol. 2025 Oct;35(10):6089-6100. doi: 10.1007/s00330-025-11543-y. |
| Methods | Studies published up to January 2024 were searched in the MEDLINE, Embase, and Cochrane Library databases; these studies included 3 years of follow-up data on patients with BTNs who underwent thermal ablation therapy. The reduction in the mean nodule volume, volume reduction rate (VRR), rate of regrowth during follow-up, compression symptoms, postoperative cosmetic effects, and ablation complications during follow-up were analyzed over 3 years. In a subgroup analysis, laser ablation (LA), radiofrequency ablation (RFA), and microwave ablation (MWA) were compared. |
| Results | After 3 years of follow-up, the volumes of BTNs decreased significantly after thermal ablation (p < 0.00001). The VRR was 71.59%. The regrowth rate was 7.41%. The major complication rate was 1.96%. The symptom scores and cosmetic scores significantly decreased (p < 0.00001). According to our subgroup analysis, the combined VRR was 53.27% in the LA group, 79.51% in the RFA group and 89.68% in the MWA group. The regrowth rate in the MWA-treated patients was lower (1.96%) than that in the other groups. Although the rate of the major complication was slightly greater (1.96%), there were no statistically significant differences compared with those in the LA and RFA groups. |
| Conclusions | Long-term follow-up analysis indicated that thermal ablation is a safe and effective method for treating benign thyroid nodules. In addition, compared with RFA and LA, MWA may be more effective at treating benign thyroid nodules.
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| Key Points | Thermal ablation is safe and effective in the long-term for benign thyroid nodules. Laser ablation, radiofrequency ablation, and microwave ablation showed no difference in safety, but microwave ablation may be more effective in treating benign thyroid nodules.
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| Link (DOI) | https://dx.doi.org/10.1007/s00330-025-11543-y |
| Ultrasound speciality | Interventional US, Thyroid US |
Short-Review by:
Prof. Dr. Jose Luis del Cura
Department of Radiology
Donostia University Hospital
Spain
Strengths:
Systematic review and metanalysis including the relevant evidence regarding thyroid ablation of benign nodules. The review has gathered a relevant number of cases: 2763 nodules from 2735 patients. The study includes a comparative analysis of the three methods of ablation used up till now. All included studies had a follow-up span of more than 3 years.
Weaknesses:
A general problem in any metanalysis is that they frequently include studies with different designs, diagnostic criteria and data collection, as in this case. Although the systematic review has gathered a big number of cases, most of the studies included were retrospective, with a small number of prospective studies. Both, prospective and retrospective were included in the metanalysis with the same weight in the results. Some articles included came from the same group of researchers and this cast doubts about the possibility of having duplicated cases.
Personally thinking:
As US-guided ablation of thyroid benign nodules is gaining traction in the clinical practice, it has started to be included in the thyroid guidelines. However, the lack of enough high-level evidence has left this treatment as a subsidiary resource when other treatments are not possible or are refused. This metanalysis provide a significant body of evidence to demonstrate that ablation can also be considered a first-choice treatment just like surgery, with a significant volume reduction rate, a low regrowth rate and few complications. Laser ablation appears as the less effective technique and MW ablation shows better volume reduction and regrowth rate than RF ablation although requires more experience to avoid complications.
