C.CHEONG1, J.X.Y.AU1, M.Y.LIM2, E.W.Z.FU2, L.HAO2, J.Y.J.GAN2
National University of Singapore1, Tan Tock Seng Hospital2
There have only been 2 systematic reviews and 1 combined systematic review meta-analysis on High-Intensity Focused Ultrasound (HIFU) as a treatment for benign thyroid nodules to date. This systematic review and meta-analysis seeks to evaluate the efficacy and safety of HIFU in the treatment of benign thyroid nodules.
Pubmed, Embase and Cochrane databases were searched for relevant studies from 1990 to 2021. This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Meta-analytic pooling was performed using the inverse variance method for calculating weights, and random-effects modelling was utilised to determine the pooled proportions and 95% confidence intervals (CI). Chi-square statistics for pooled estimates and the inconsistency index I2 were used to determine heterogeneity. Pooled Volume Reduction Rate (VRR) at three, six and twenty-four months after HIFU were assessed.
Nine studies were included in the systematic review and six in the meta-analysis. The pooled VRR at 3, 6, and 24 months after HIFU were 43.11 (95% CI= 25.63 to 60.59, I2= 95%), 53.49 (95% CI= 36.83 to 70.15, I2= 97%) and 46.9 (95% CI= 18.52-46.71, I2=99%), indicating significant heterogeneity. Common side effects included pain, skin changes and edema, vocal cord paresis and Horner’s syndrome.
HIFU may be an effective and safe alternative treatment modality. Larger clinical trials with longer follow up are needed to evaluate the effectiveness of this treatment and assess the risks and benefits of using different combinations of energy depending on the size, type and location of the nodule.