Endocrinology and Metabolism

Original Articles

Thyroid
The Diagnostic Role of Repeated Biopsy of Thyroid Nodules with Atypia of Undetermined Significance with Architectural Atypia on Core-Needle Biopsy: Hye Hyeon Moon, Sae Rom Chung, Young Jun Choi, Tae-Yon Sung, Dong Eun Song, Tae Yong Kim, Jeong Hyun Lee, Jung Hwan Baek; Endocrinol Metab. 2024;39(2):300-309. Published online January 3, 2024; DOI: https://doi.org/10.3803/EnM.2023.1818

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Abstract PDF Supplementary Material PubReader ePub: Background
We aimed to evaluate the utility of repeat biopsy of thyroid nodules classified as atypia of undetermined significance with architectural atypia (IIIB) on core-needle biopsy (CNB).
Methods
This retrospective study evaluated patients with thyroid nodules categorized as IIIB on CNB between 2013 and 2015. Demographic characteristics, subsequent biopsy results, and ultrasound (US) images were evaluated. The malignancy rates of nodules according to number of CNBs and the number of IIIB diagnoses was compared. Demographic and US features were evaluated to determine factors predictive of malignancy.
Results
Of 1,003 IIIB nodules on CNB, the final diagnosis was determined for 328 (32.7%) nodules, with 121 of them confirmed as malignant, resulting in a malignancy rate of 36.9% (95% confidence interval, 31.7% to 42.1%). Repeat CNB was performed in 248 nodules (24.7%), with 75 (30.2%), 131 (52.8%), 13 (5.2%), 26 (10.5%), one (0.4%), and two (0.8%) reclassified into categories II, IIIB, IIIA, IV, V, and VI, respectively. Malignancy rates were not significantly affected by the number of CNBs (P=0.291) or the number of IIIB diagnoses (P=0.473). None of the nodules confirmed as category II on repeat CNB was malignant. US features significantly associated with malignancy (P<0.003) included solid composition, irregular margins, microcalcifications, and high suspicion on the US risk stratification system.
Conclusion
Repeat biopsy of nodules diagnosed with IIIB on CNB did not increase the detection of malignancy but can potentially reduce unnecessary surgery. Repeat biopsy should be performed selectively, with US features guiding the choice between repeat biopsy and diagnostic surgery.

Clinical Study
Effectiveness of Injecting Cold 5% Dextrose into Patients with Nerve Damage Symptoms during Thyroid Radiofrequency Ablation: Min Kyoung Lee, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi, Yu-Mi Lee, Tae Yong Kim, Jeong Hyun Lee; Endocrinol Metab. 2020;35(2):407-415. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.407

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Background
Although radiofrequency ablation (RFA) is a safe treatment for thyroid tumors, nerve damage is a frequent complication. A previous retrospective study suggested that an injection of cold 5% dextrose in water (5% DW) can reduce nerve damage during RFA. This study validated the efficacy of injecting cold 5% DW for management of nerve damage during RFA.
Methods
Between November 2017 and December 2018, 242 patients underwent 291 RFA sessions for treatment of benign thyroid nodules or recurrent thyroid cancers. Using a standardized technique, cold (0°C to 4°C) 5% DW was immediately injected around the damaged nerve into patients with any symptoms suggesting nerve damage. The incidence of nerve damage, the volume of 5% DW injected, symptom recovery time and the incidence of permanent nerve damage were evaluated.
Results
Nineteen patients experienced nerve damage symptoms related to 21 RFA sessions, including 17 patients during 19 sessions and two patients on the day after two sessions. Patients with nerve damage symptoms detected during RFA were treated by injection of a mean 41 mL (range, 3 to 260) cold 5% DW, but the two patients who experienced symptoms the next day did not receive cold 5% DW injections. Immediate recovery was observed after 15 RFA sessions in 14 patients. No patient experienced permanent nerve damage.
Conclusion
Injection of cold 5% DW is effective in managing nerve damage during RFA of thyroid lesions.

Citations

Citations to this article as recorded by

The Role of Radiofrequency Ablation in Benign and Malignant Thyroid Nodules
Meghal Shah, Catherine McManus
Surgical Clinics of North America.2024;[Epub] CrossRef
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Hui-hui Chai, Zhan-jing Dai, Bai Xu, Qiao-hong Hu, Hong-feng He, Ying Xin, Wen-wen Yue, Cheng-zhong Peng
Academic Radiology.2023; 30(11): 2647. CrossRef
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Man Him Matrix Fung, Brian Hung Hin Lang
European Radiology.2023; 33(9): 6534. CrossRef
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Shahzad Ahmad, Jules Aljammal, Ian Orozco, Sheharyar Raashid, Fizza Zulfiqar, Sean P Nikravan, Iram Hussain
Journal of the Endocrine Society.2023;[Epub] CrossRef
Radiofrequency ablation of benign thyroid nodules: the value of anterolateral hydrodissection
So Yeong Jeong, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi, Ki-Wook Chung, Tae Yong Kim, Jeong Hyun Lee
Ultrasonography.2023; 42(3): 432. CrossRef
Effective and Safe Application of Radiofrequency Ablation for Benign Thyroid Nodules
Jin Yong Sung
Journal of the Korean Society of Radiology.2023; 84(5): 985. CrossRef
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So Yeong Jeong, Eun Ju Ha, Jung Hwan Baek, Tae Yong Kim, Yu-Mi Lee, Jeong Hyun Lee, Jeonghun Lee
Ultrasonography.2022; 41(1): 204. CrossRef
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Jules Aljammal, Iram Hussain, Shahzad Ahmad
AACE Clinical Case Reports.2022; 8(2): 102. CrossRef
Thermal Ablation for the Management of Papillary Thyroid Microcarcinoma in the Era of Active Surveillance and Hemithyroidectomy
Sae Rom Chung, Jung Hwan Baek, Young Jun Choi, Jeong Hyun Lee
Current Oncology Reports.2022; 24(8): 1045. CrossRef
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Pia Pace-Asciak, Jon O. Russell, Ralph P. Tufano
Frontiers in Surgery.2022;[Epub] CrossRef
Using Intra‐Operative Laryngeal Ultrasonography as a Real‐Time Tool in Assessing Vocal Cord Function During Radiofrequency Ablation of the Thyroid Gland
Matrix Man Him Fung, Brian Hung Hin Lang
World Journal of Surgery.2022; 46(9): 2206. CrossRef
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Jia-Rui Du, Wen-Hui Li, Cheng-Hai Quan, Hui Wang, Deng-Ke Teng
Frontiers in Endocrinology.2022;[Epub] CrossRef
Continuous neuromonitoring during radiofrequency ablation of benign thyroid nodules provides objective evidence of laryngeal nerve safety
Catherine F. Sinclair, Maria J. Téllez, Roberto Peláez-Cruz, Alba Díaz-Baamonde, Sedat Ulkatan
The American Journal of Surgery.2021; 222(2): 354. CrossRef
Future Considerations and Directions for Thermal Ablative Technologies
Jonathon Russell, Catherine F. Sinclair
Current Otorhinolaryngology Reports.2021; 9(2): 210. CrossRef

Clinical Study
Long-Term Results of Thermal Ablation of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis: Se Jin Cho, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi, Jeong Hyun Lee; Endocrinol Metab. 2020;35(2):339-350. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.339

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Abstract PDF Supplementary Material PubReader ePub

Background
Ultrasound-guided thermal ablations have become one of the main options for treating benign thyroid nodules. To determine efficacy of thermal ablation of benign thyroid nodules, we performed a meta-analysis of studies with long-term follow-up of more than 3 years.
Methods
Databases were searched for studies published up to August 25, 2019, reporting patients with benign thyroid nodules treated with thermal ablation and with follow-up data of more than 3 years. Data extraction and quality assessment were performed according to PRISMA guidelines. The analysis yielded serial volume reduction rates (VRRs) of ablated nodules for up to 3 years or more, and adverse effect of ablation during follow-up. Radiofrequency ablation (RFA) and laser ablation (LA) were compared in a subgroup analysis.
Results
The pooled VRRs for ablated nodules showed rapid volume reduction before 12 months, a plateau from 12 to 36 months, and more volume reduction appearing after 36 months, demonstrating long-term maintenance of treatment efficacy. Thermal ablation had an acceptable complication rate of 3.8%. Moreover, patients undergoing nodule ablation showed no unexpected delayed complications during the follow-up period. In the subgroup analysis, RFA was shown to be superior to LA in terms of the pooled VRR and the number of patients who underwent delayed surgery.
Conclusion
Thermal ablations are safe and effective methods for treating benign thyroid nodules, as shown by a long follow-up analysis of more than 3 years. In addition, RFA showed superior VRRs compared with LA for the treatment of benign thyroid nodules, with less regrowth and less delayed surgery.

Citations

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Radioiodine versus radiofrequency ablation to treat autonomously functioning thyroid nodules: a systematic review and comparative meta-analysis
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European Journal of Nuclear Medicine and Molecular Imaging.2024;[Epub] CrossRef
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Radiofrequency ablation and related ultrasound‐guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with
Lisa A. Orloff, Julia E. Noel, Brendan C. Stack, Marika D. Russell, Peter Angelos, Jung Hwan Baek, Kevin T. Brumund, Feng‐Yu Chiang, Mary Beth Cunnane, Louise Davies, Andrea Frasoldati, Anne Y. Feng, Laszlo Hegedüs, Ayaka J. Iwata, Emad Kandil, Jennifer K
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enhanced anarchic society optimization technique for the classification of ultrasound thyroid images using ILBP
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Matrix 3D ultrasound-assisted thyroid nodule volume estimation and radiofrequency ablation: a phantom study
T. Boers, S. J. Braak, M. Versluis, S. Manohar
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Chi-Yu Kuo, Chien-Liang Liu, Chung-Hsin Tsai, Shih-Ping Cheng
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Clinical Study
Does Radiofrequency Ablation Induce Neoplastic Changes in Benign Thyroid Nodules: A Preliminary Study: Su Min Ha, Jun Young Shin, Jung Hwan Baek, Dong Eun Song, Sae Rom Chung, Young Jun Choi, Jeong Hyun Lee; Endocrinol Metab. 2019;34(2):169-178. Published online May 15, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.169

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Abstract PDF Supplementary Material PubReader ePub

Background

To evaluate the clinical feasibility of radiofrequency ablation (RFA) of benign thyroid nodules along with cytomorphological alteration, and any malignant transformation through biopsy.

Methods

The data were retrospectively collected between April 2008 and June 2013 and core needle biopsy (CNB) was performed on 16 benign thyroid nodules previously treated using RFA. The parameters of the patients were compared, between the time of enrollment and the last follow-up examination, using linear mixed model statistical analysis.

Results

No atypical cells or neoplastic transformation were detected in the undertreated peripheral portion of treated benign nodules on the CNB specimen. RFA altered neither the thyroid capsule nor the thyroid tissue adjacent to the treated area. On histopathological examinations, we observed 81.2% acellular hyalinization, which was the most common finding. After a mean follow-up period of over 5 years, the mean volume of thyroid nodule had decreased to 6.4±4.2 mL, with a reduction rate of 81.3%±5.8% (P<0.0001).

Conclusion

RFA is a technically feasible treatment method for benign thyroid nodules, with no carcinogenic effect or tissue damage of the normal thyroid tissue adjacent to the RFA-treated zone.

Citations

Citations to this article as recorded by

Comparison of the Therapeutic Efficacy and Technical Outcomes between Conventional Fixed Electrodes and Adjustable Electrodes in the Radiofrequency Ablation of Benign Thyroid Nodules
Jae Ho Shin, Minkook Seo, Min Kyoung Lee, So Lyung Jung
Korean Journal of Radiology.2024; 25(2): 199. CrossRef
Thermoablation of thyroid nodules reveals excellent results with low morbidity
Robert M. Eisele, Philipp R. Scherber, Monika Schlüter, Thorsten Drews, Matthias Glanemann, Gereon Gäbelein
Technology and Health Care.2022; 30(3): 683. CrossRef
Radiofrequency ablation and related ultrasound‐guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with
Lisa A. Orloff, Julia E. Noel, Brendan C. Stack, Marika D. Russell, Peter Angelos, Jung Hwan Baek, Kevin T. Brumund, Feng‐Yu Chiang, Mary Beth Cunnane, Louise Davies, Andrea Frasoldati, Anne Y. Feng, Laszlo Hegedüs, Ayaka J. Iwata, Emad Kandil, Jennifer K
Head & Neck.2022; 44(3): 633. CrossRef
Thyroid Nodule Radiofrequency Ablation: Complications and Clinical Follow Up
James Y. Lim, Jennifer H. Kuo
Techniques in Vascular and Interventional Radiology.2022; 25(2): 100824. CrossRef
American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions
Sina Jasim, Kepal N. Patel, Gregory Randolph, Stephanie Adams, Roberto Cesareo, Edward Condon, Tara Henrichsen, Malak Itani, Maria Papaleontiou, Leonardo Rangel, John Schmitz, Marius N. Stan
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Efficacy of radiofrequency and laser thermal ablation in solving thyroid nodule-related symptoms and cosmetic concerns. A systematic review and meta-analysis
Roberto Cesareo, Silvia Egiddi, Anda M. Naciu, Gaia Tabacco, Andrea Leoncini, Nicola Napoli, Andrea Palermo, Pierpaolo Trimboli
Reviews in Endocrine and Metabolic Disorders.2022; 23(5): 1051. CrossRef
Comparison of ultrasound-guided radiofrequency ablation versus thyroid lobectomy for T1bN0M0 papillary thyroid carcinoma
Lin Yan, Xinyang Li, Yingying Li, Jing Xiao, Mingbo Zhang, Yukun Luo
European Radiology.2022; 33(1): 730. CrossRef
A systematic review and meta-analysis comparing tumor progression and complications between radiofrequency ablation and thyroidectomy for papillary thyroid carcinoma
Yuan-dong Sun, Hao Zhang, Hai-tao Zhu, Chun-xue Wu, Miao-ling Chen, Jian-jun Han
Frontiers in Oncology.2022;[Epub] CrossRef
RFA and benign thyroid nodules: Review of the current literature
Haris Muhammad, Prasanna Santhanam, Jonathon O. Russell, Jennifer H. Kuo
Laryngoscope Investigative Otolaryngology.2021; 6(1): 155. CrossRef
Radiofrequency ablation and thyroid nodules: updated systematic review
Haris Muhammad, Prasanna Santhanam, Jonathon O. Russell
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Complications of RFA for Thyroid Nodules: Prevention and Management
Rahul K. Sharma, Jennifer H Kuo
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Long-Term Results of Ultrasound-Guided Radiofrequency Ablation of Benign Thyroid Nodules: State of the Art and Future Perspectives—A Systematic Review
Hervé Monpeyssen, Ahmad Alamri, Adrien Ben Hamou
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Long-Term Outcomes of Thermal Ablation for Benign Thyroid Nodules: The Issue of Regrowth
Jung Suk Sim, Jung Hwan Baek, Rosaria Meccariello
International Journal of Endocrinology.2021; 2021: 1. CrossRef
Ultrasound-Guided Radiofrequency Ablation Versus Thyroid Lobectomy for Low-Risk Papillary Thyroid Microcarcinoma: A Propensity-Matched Cohort Study of 884 Patients
Lin Yan, Mingbo Zhang, Qing Song, Yukun Luo
Thyroid.2021; 31(11): 1662. CrossRef
Clinical Effects of Microwave Ablation in the Treatment of Low-Risk Papillary Thyroid Microcarcinomas and Related Histopathological Changes
Chenya Lu, Xingjia Li, Xiaoqiu Chu, Ruiping Li, Jie Li, Jianhua Wang, Yalin Wang, Yang Xu, Guofang Chen, Shuhang Xu, Chao Liu
Frontiers in Endocrinology.2021;[Epub] CrossRef
Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules
Enock Adjei Agyekum, Jian-hua Fu, Fei-Ju Xu, Yong-Zhen Ren, Debora Akortia, Qing Chen, Xiao-Qin Qian, Yuguo Wang, Xian Wang
Frontiers in Oncology.2021;[Epub] CrossRef
Comparison Between Radiofrequency Ablation and Microwave Ablation in the Treatment for Benign Thyroid Nodules: a Meta-analysis
Jing Wu, Junguo Liu, Li Liu
Indian Journal of Surgery.2021;[Epub] CrossRef
2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules
Enrico Papini, Hervé Monpeyssen, Andrea Frasoldati, Laszlo Hegedüs
European Thyroid Journal.2020; 9(4): 172. CrossRef
Response: Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth (Endocrinol Metab 2019;34:117–23, Jung Suk Sim et al.)
Jung Suk Sim, Jung Hwan Baek
Endocrinology and Metabolism.2019; 34(3): 325. CrossRef

Thyroid
A Comparison of Ultrasound-Guided Fine Needle Aspiration versus Core Needle Biopsy for Thyroid Nodules: Pain, Tolerability, and Complications: Eun Ji Jeong, Sae Rom Chung, Jung Hwan Baek, Young Jun Choi, Jae Kyun Kim, Jeong Hyun Lee; Endocrinol Metab. 2018;33(1):114-120. Published online March 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.1.114

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Abstract PDF PubReader ePub

Background

To compare pain, tolerability, and complications associated with fine needle aspiration (FNA) versus core needle biopsy (CNB).

Methods

FNAs were performed using 23-gauge needles and CNBs were performed using 18-gauge double-action spring-activated needles in 100 patients for each procedure. Patients were asked to record a pain score using a 10-cm visual analog scale and procedure tolerability. Complications and number of biopsies were recorded.

Results

The median pain scores were similar for the FNA and CNB approaches during and 20 minutes after the biopsy procedures (3.7 vs. 3.6, P=0.454; 0.9 vs. 1.1, P=0.296, respectively). The procedure was tolerable in all 100 FNA patients and in 97 CNB patients (P=0.246). The mean number of biopsies was fewer in the CNB group (1.4 vs. 1.2, P=0.002). By subgroup analysis (staff vs. non-staff), no significant difference was detected in any parameter. There were no major complications in either group, but three patients who underwent CNB had minor complications (P=0.246).

Conclusion

FNA and CNB show no significant differences for diagnosing thyroid nodules in terms of pain, tolerability, or complications.

Citations

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Growth Hormone-Releaser Diet Attenuates Cognitive Dysfunction in Klotho Mutant Mice via Insulin-Like Growth Factor-1 Receptor Activation in a Genetic Aging Model: Seok Joo Park, Yoon Hee Chung, Jeong Hyun Lee, Duy-Khanh Dang, Yunsung Nam, Ji Hoon Jeong, Yong Sun Kim, Toshitaka Nabeshima, Eun-Joo Shin, Hyoung-Chun Kim; Endocrinol Metab. 2014;29(3):336-348. Published online September 25, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.3.336

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Background

It has been recognized that a defect in klotho gene expression accelerates the degeneration of multiple age-sensitive traits. Accumulating evidence indicates that aging is associated with declines in cognitive function and the activity of growth hormone (GH)/insulin-like growth factor-1 (IGF-1).

Methods

In this study, we examined whether a GH-releaser diet could be effective in protecting against cognitive impairment in klotho mutant mice.

Results

The GH-releaser diet significantly induced the expression of IGF-1 and IGF-1 receptors in the hippocampus of klotho mutant mice. Klotho mutant mice showed significant memory impairments as compared with wild-type mice. In addition, the klotho mutation significantly decreased the expression of cell survival/antiapoptotic factors, including phospho-Akt (p-Akt)/phospho-glycogen synthase kinase3β (p-GSK3β), phospho-extracellular signal-related kinase (p-ERK), and Bcl-2, but significantly increased those of cell death/proapoptotic factors, such as phospho-c-jun N-terminal kinase (p-JNK), Bax, and cleaved caspase-3 in the hippocampus. Treatment with GH-releaser diet significantly attenuated both decreases in the expression of cell survival/antiapoptotic factors and increases in the expression of cell death/proapoptotic factors in the hippocampus of klotho mutant mice. In addition, klotho mutation-induced oxidative stress was significantly attenuated by the GH-releaser diet. Consequently, a GH-releaser diet significantly improved memory function in the klotho mutant mice. GH-releaser diet-mediated actions were significantly reversed by JB-1, an IGF-1 receptor antagonist.

Conclusion

The results suggest that a GH-releaser diet attenuates oxidative stress, proapoptotic changes and consequent dysfunction in klotho mutant mice by promoting IGF-1 expression and IGF-1 receptor activation.

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Review Articles

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