The long-term effects of thermal ablation for benign thyroid nodules: a systematic review and meta-analysis.

Summary

Across studies with 3-year follow-up, thermal ablation for benign thyroid nodules achieved a pooled volume reduction rate of 71.6%, a regrowth rate of 7.4%, and a major complication rate of 2.0%, with significant improvements in symptom and cosmetic scores. Subgroup analysis suggests microwave ablation may offer greater long-term volume reduction and lower regrowth than RFA or LA, with comparable safety.

Key Findings

• Pooled 3-year volume reduction rate was 71.59% with thermal ablation.
• Regrowth and major complication rates were 7.41% and 1.96%, respectively.
• Microwave ablation showed higher VRR (89.68%) and lower regrowth (1.96%) than RFA and LA, with similar safety.

Clinical Implications

Thermal ablation can be offered to patients with symptomatic or cosmetically concerning benign nodules as a durable, low-complication option; microwave ablation may be preferred when maximal volume reduction is prioritized.

Limitations

• Underlying studies were largely non-randomized with potential heterogeneity in protocols and patient selection
• Publication bias and inconsistent reporting of regrowth definitions may affect pooled estimates

Future Directions

Head-to-head randomized trials comparing MWA, RFA, and LA with standardized regrowth definitions and patient-centered outcomes; cost-effectiveness and quality-of-life analyses.