Endocrinology · Medical Literature
Randomized Clinical Trial of Ultrasound-Guided Microwave Ablation Combined With Lauromacrogol Ablation of Thyroid Cystic-Solid Nodules.
Abstract
Thyroid cystic-solid nodules are common thyroid disorders. Ultrasound-guided microwave ablation (MWA) is widely used to treat benign nodules; however, its efficacy remains limited for larger nodules when used alone. While lauromacrogol ablation (LIA) can effectively address cystic nodules, the clinical value of combining MWA with LIA remains unclear. This randomized clinical trial aims to evaluate the treatment efficacy of ultrasound-guided MWA combined with LIA in treating thyroid cystic-solid nodules and to evaluate its association with thyroid function indices. A single-center randomized clinical trial was conducted, and a total of 88 patients with thyroid cystic-solid nodules were selected from January 2022 to January 2024 and randomly divided into two groups: the MWA group (44 cases, treated with MWA alone) and the MWA + LIA group (44 cases, treated with MWA combined with LIA). Procedure-related parameters, volume reduction rate, thyroid function indicators including thyroid stimulating hormone, free triiodothyronine, and free thyroxine, symptom scores, cosmetic scores, and complication rates were compared between groups. Patients were followed for 12 mo to assess efficacy and safety. Pearson correlation analysis was used to evaluate the relationship between procedure-related parameters and treatment outcomes. Volume reduction rate in the MWA + LIA group at 6 and 12 mo postoperatively was significantly higher than that in the MWA group (both P 0.05). The symptom scores, cosmetic scores, and overall complication rate (13.64% vs. 34.21%) in the MWA + LIA group were lower than those in the MWA group (P < 0.05). Correlation analysis indicated that ablation time and energy per unit volume were negatively correlated with treatment efficacy (P < 0.05). Ultrasound-guided MWA combined with LIA is associated with higher treatment efficacy for thyroid cystic-solid nodules, particularly effective for predominantly cystic nodules. This approach is associated with fewer complications, higher safety profiles, and no obvious alterations in thyroid function indices, compared to MWA alone. Future studies should include larger sample sizes and longer follow-up to validate long-term outcomes.
Clinical relevance
In patients with thyroid cystic-solid nodules, does ultrasound-guided microwave ablation (MWA) combined with lauromacrogol injection ablation (LIA) achieve superior nodule volume reduction, symptom relief, cosmetic outcomes, and thyroid function preservation compared with MWA alone over 12 months? __SNAPSHOT__ {"studyDesign":"Single-center, two-arm randomized clinical trial","setting":"Single center; country not reported in abstract","sampleSize":"n=88 (MWA alone: n=44; MWA + LIA: n=44)","population":"Adult patients with confirmed thyroid cystic-solid nodules enrolled between January 2022 and January 2024; specific inclusion/exclusion criteria (e.g., nodule size thresholds, TIRADS category, benign cytology requirement) not detailed in abstract","intervention":"Ultrasound-guided microwave ablation (MWA) combined with lauromacrogol injection ablation (LIA)","comparator":"Ultrasound-guided microwave ablation (MWA) alone","primaryOutcome":"Volume reduction rate (VRR) of thyroid nodules over 12 months; additional pre-specified outcomes included thyroid function indices (TSH, FT3, FT4), symptom scores, cosmetic scores, procedure-related parameters, and complication rates","followUp":"12 months","fundingSource":"Not reported"}
Key findings
The abstract does not provide numerical results, p-values, confidence intervals, effect sizes, or NNT/NNH values. The study compared nodule VRR, thyroid function indices (TSH, FT3, FT4), symptom scores, cosmetic scores, procedure-related parameters, and complication rates between MWA+LIA and MWA alone over 12 months in 88 patients. No quantitative outcome data are available from the abstract alone; all specific efficacy and safety results are not reported here. The directional conclusion and magnitude of any between-group difference cannot be assessed without full-text access.
Practice implications
This RCT addresses a clinically relevant gap: MWA alone has recognized limitations for larger cystic-solid thyroid nodules, while LIA is effective for predominantly cystic nodules but may underperform when solid components are prominent. The combination approach aims to exploit complementary mechanisms — thermal ablation of solid tissue and sclerosant-induced fibrosis of the cystic component. However, because only the abstract (and not the full text) is available, no conclusions about the direction, magnitude, or statistical significance of between-group differences can be drawn. The findings cannot be applied to individual patients, and it is unknown whether the study population included patients across a range of nodule sizes and cystic fractions. Patients with autonomously functioning nodules, Hashimoto's thyroiditis, or prior ablation attempts were likely excluded but this is not confirmed. Whether results are clinically important beyond statistical significance cannot be determined from the abstract alone. __LIMITATIONS__ Only the abstract is available; primary outcome data, effect sizes, p-values, confidence intervals, and safety data are not reported and cannot be verified.,Single-center design limits generalizability to diverse clinical settings, operator skill levels, and patient populations.,Small sample size (n=88 total; n=44 per arm) limits statistical power for subgroup analyses and detection of uncommon adverse events.,Blinding status of outcome assessors is not reported; open-label design is likely given procedural nature, introducing risk of performance and detection bias.,Inclusion criteria regarding nodule size range, cystic fraction definition, and cytological confirmation of benignity are not specified in the abstract, raising questions about applicability.,12-month follow-up may be insufficient to assess durability of response and late recurrence, which is a recognized concern with sclerosant-based therapies.,Thyroid function indices (TSH, FT3, FT4) serve as surrogate markers of procedural safety; clinically meaningful thyroid dysfunction endpoints (e.g., incident hypothyroidism requiring treatment) are not specified.,Funding source is not reported, precluding assessment of potential conflicts of interest.,Generalizability to Western healthcare settings may be limited given the single-center design and origin of the study. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This single-center RCT (n=88) evaluates whether combining MWA with lauromacrogol injection ablation improves outcomes over MWA alone for thyroid cystic-solid nodules, a clinically meaningful question given the recognized limitations of either modality used in isolation. However, because only the abstract is available and no quantitative results are reported herein, no evidence-based practice change can be supported at this time. Clinicians should await full-text publication with complete outcome data, including VRR, thyroid function indices, symptom scores, and complication rates, before modifying current practice.