Meta-analysis Of Efficacy And Safety Of Thermal Ablation For Benign Thyroid Nodules

BackgroundImage-guided thermal ablation,as a new minimally invasive technique,has become one of the treatment methods for benign thyroid nodules,but the efficacy of different ablation methods is still controversial.ObjectiveTo evaluate the efficacy and safety of Laser ablation(LA),Radiofrequency ablation(RFA)and Microwave ablation(MWA)in the treatment of benign thyroid nodules.MethodsIn PubMed,Embase,Web of science,the Cochrane library of medicine,China HowNet(CNKI),VIP database(VIP),a database of ten thousand,and the Chinese biomedical literature database(CBM),a retrieve on clinical randomized controlled trials on benign thyroid nodules and thermal ablation was conducted with time limit for the database as the first time until November 2020.After screening and quality assessment of the obtained literatures based on inclusion and exclusion criteria,relevant data such as the rate of nodule shrinkage and complication rate after thermal ablation were extracted.Meta-analysis was performed using RevMan 5.3 software.ResultsThe study included 12 trials with 3,674 participants.In terms of nodular VRR,compared with MWA,VRR was significantly higher at 6 months[WMD combined mean difference=3.29,95%Confidence interval(CI)(1.07,5.51),P=0.001]and 12 months[WMD combined mean difference=2.91,95%CI(1.11,4.71),P=0.002]after RFA.Compared with RFA and MWA,LA showed no statistically significant difference in VRR 6 and 12 months after ablation.The preferred probability ranking(SCURA)curve showed that VRR was the highest after surgery,followed by LA,RFA,and MWA.In terms of safety,compared with LA,the incidence of major complications after RFA[combined Risk Ratio(RR)=0.41,95%CI(0.18,0.97),P=0.04]was higher,and the difference was statistically significant.Compared with MWA,there was no significant difference in the incidence of major complications after RFA[combined RR=0.72,95%CI(0.46,1.14),P=0.16]and after LA[combined RR=0.67,95%CI(0.19,2.33),P=0.53],indicating no statistical significance.In addition,compared with MWA,LA postoperative[RR value=0.63,95%CI(0.41,0.96),P = 0.03]statistical differences secondary complications,LA secondary complication rates higher than the MWA group.However,in the incidence of secondary complications,LA and RFA[RR value=0.81,95%CI(0.65,1.00),P=0.06],RFA and MWA[RR=0.80,95%CI(0.42,1.52),P=0.50]no statistically significant difference were observed.ConclusionThe results of the Meta-analysis showed that LA,RFA and MWA can significantly reduce the volume of benign thyroid nodules,and there is no significant difference in the overall incidence of complications among the three ablation methods.RFA is better than LA and MWA in reducing the volume of benign thyroid nodules.The incidence of major complications after RFA is slightly higher than LA and MWA,and the incidence of minor complications after LA is slightly higher than RFA and MWA.