Comparison of ultrasound-guided thermal ablation and conventional thyroidectomy for benign thyroid nodules: a systematic review and meta-analysis

Figures & data

Figure 1. Flow diagram. Search and selection process for clinical trials.

Table 1. Characteristics of the included studies.

Study	Nation	N (ablation/ thyroidectomy)	Study type	Ablation	Safety			Efficiency
					Hoarseness	Hypothyroidism	Postoperative pain	Symptom improvement	Cosmetic effect	Hospitalization time
Jin et al. [5]	China	212 (106/106)	Cohort study	MWA	+	+	−	−	−	+
Yue et al. [18]	China	216 (108/108)	Cohort study	RFA	−	−	+	−	−	+
Che et al. [19]	China	400 (200/200)	Cohort study	RFA	+	+	−	−	−	+
Bernardi et al. [20]	Italy	111 (37/74)	Cohort study	RFA	+	+	+	+	+	−
Zhi et al. [21]	China	52 (28/24)	RCT	MWA	+	+	+	+	+	+
Lang et al. [22]	China	154 (77/77)	Cohort study	HIFU	+	+	−	+	−	+
Liu et al. [23]	China	144 (72/72)	Cohort study	MWA	−	+	+	−	−	+

RCT: randomized controlled trial; MWA: microwave ablation; RFA: radiofrequency ablation; HIFU: high-intensity focused ablation; −: data with this indicator have been excluded, +: data with this indicator have been included.

Table 2. Patients’ characteristics at baseline.

	Thermal ablation (n = 628)	Conventional thyroidectomy (n = 661)	p Value
Age (years)	46.3 ± 12.3	50.0 ± 12.6	0.000
Sex (M/F)	172/456	185/476	0.322
Nodule diameter (cm)	3.5 ± 2.2	3.7 ± 1.9	0.081
Nodule volume (ml)	8.6 ± 9.8	8.9 ± 9.8	0.583

M: male; F: female.

Except for sex (M/F) and p-values, data are reported as mean ± standard deviations.

Table 3. Risk of bias of randomized controlled trial.

Study	Random sequence generation (selection bias)	Allocation concealment (selection bias)	Blinding of participants and personnel (performance bias)	Blinding of outcome assessment (detection bias)	Incomplete outcome data (attrition bias)	Selective reporting (reporting bias)	Other bias
Zhi et al. [21]	Low risk	Low risk	High risk	Low risk	Low risk	Low risk	Unclear

Table 4. Quality assessment of cohort studies.

Study	Selection	Comparability	Outcome	Score
Jin et al. [5]	★★★★	★	★★★	8
Yue et al. [18]	★★★	★	★★★	7
Che et al. [19]	★★★★	★	★★★	8
Bernardi et al. [20]	★★★★	★	★★★	8
Lang et al. [22]	★★★★	★	★★	7
Liu et al. [23]	★★★★	★	★★	7

Figure 2. (A) Forest plot of hoarseness. Forest plot of hoarseness analyzed by odds ratio (OR) with 95% confidence intervals. The size of the data markers indicates the weight in the analysis. (B) Forest plot of hypothyroidism. Forest plot of hypothyroidism analyzed by risk difference (RD) with 95% confidence intervals. The size of the data markers indicates the weight in the analysis. (C) Forest plot of postoperative pain. Forest plot of postoperative pain analyzed by odds ratio (OR) with 95% confidence intervals. The size of the data markers indicates the weight in the analysis.

Figure 3. (A) Forest plot of symptom improvement. Forest plot of symptom improvement analyzed by relative risk (RR) ratio with 95% confidence intervals. The size of the data markers indicates the weight in the analysis. (B) Forest plot of postoperative cosmetic effect. Forest plot of postoperative cosmetic effect analyzed by relative risk (RR) ratio with 95% confidence intervals. The size of the data markers indicates the weight in the analysis. (C) Forest plot of hospitalization time. Forest plot of hospitalization time analyzed by standard mean difference (SMD) with 95% confidence intervals. The size of the data markers indicates the weight in the analysis.

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