Prevalence and Management of Complications of Laser Ablation for Benign Thyroid Nodules: A Systematic Review of Literature and Meta-analysis

Abstract Context Percutaneous laser ablation (LA) is today regarded as a valuable therapy for symptomatic, benign solid (non-cystic) thyroid nodules. Objective We assessed the prevalence of complications from laser ablation (LA) for benign and solid thyroid nodules (STNs) and their management. Methods We conducted a systematic review with meta-analysis of data from published studies on LA of STNs, in addiction to author’s institution. A random effects meta-analysis was performed on the prevalence rates. Results The literature search yielded 1351 studies, of which 38 studies were included, in addition to our institutional experience (4745 STNs in total). The overall quality of each included study was judged as fair. The prevalence of “Overall” complications of LA was 23% ([CI 17–30%], I2 93.7%, 1208 of 4702 thyroid nodules [TNs]). The prevalence of “Minor” complications of LA was 21% ([CI 15–27%], I2 93.7%, 1159 of 4702 TNs). The prevalence of “Major” complications of LA was 2% ([CI 1–3%], I2 54.0%, 49 of 4745 TNs). Sensitivity analyses did not modify the results, except for dysphonia whose pooled prevalence was higher when using local anesthesia (2%, CI [1-3], I2 25.2, p-value 0.010) or conscious sedation (2%, CI [1-4], I2 27.2, p-value 0.014). The pooled prevalence rate of local pain was 15% (CI [12-20], I2 89.3). Local pain was transient and typically mild to moderate, sometimes severe requiring analgesics for 1-5 days up to one month. The pooled prevalence rate of dysphonia was 2% (CI [1-2], I2 30.3). All cases of dysphonia were transient except for one permanent case. Conclusion LA for benign and solid (non-cystic) thyroid nodules could be considered a generally safe technique. Major complications were rare.