Five-year results of radiofrequency and laser ablation of benign thyroid nodules: a multicenter study from the Italian minimally-invasive treatments of the thyroid group

Background: Radiofrequency and laser ablation (RFA and LA) are effective treatments for benign thyroid nodules. Due to their relatively recent introduction into clinical practice, there are limited long-term follow-up studies. This study aimed to evaluate technique efficacy, rate of regrowth and retreatment over 5 years following RFA or LA and to identify predictive factors of outcome. Methods: In this multicenter retrospective study, the rate of technique efficacy, regrowth, and retreatment were evaluated in 406 patients treated with either RFA or LA and followed for 5 years after initial treatment. Propensity score matching was used to compare treatments. Cumulative incidence studies with hazard models were used to describe regrowth and retreatment trends and to identify prognostic factors. Logistic regression models and receiver operating characteristics analyses were used for risk factors and their cut-offs. Results: RFA and LA significantly reduced benign thyroid nodule volume, and this reduction was generally maintained for 5 years. Technique efficacy (defined as a reduction ≥ 50% after 1 year from the treatment) was achieved in 74% of patients (85% in the RFA and 63% in the LA group). Regrowth occurred in 28% of patients (20% in the RFA and 38% in the LA group). In the majority of cases, further treatment was not required as only 18% of patients were retreated (12% in the RFA and 24% in the LA group). These data were confirmed by propensity score matching. Cumulative incidence studies showed that RFA was associated with a lower risk of regrowth and a lower risk of requiring retreatment over time. Overall, technique inefficacy and regrowth were associated with low energy delivery. Retreatments were more frequent in young patients, in large nodules, in patients with lower volume reduction at 1-year, and in cases of low energy delivery (optimal cut-off was 918 J/mL for RFA). Conclusions: Both thermal ablation techniques result in a clinically significant and long-lasting volume reduction of benign thyroid nodules. The risk of regrowth and needing retreatment was lower after RFA. The need for retreatment was associated with young age, large baseline volume, and treatment with low energy delivery.