A propensity‐matched analysis of clinical outcomes between open thyroid lobectomy and high‐intensity focused ultrasound (HIFU) ablation of benign thyroid nodules

Abstract

Background: High‐intensity focused ultrasound is a promising, nonoperative treatment for benign thyroid nodules. Our study aimed to compare treatment outcomes of single‐session high‐intensity focused ultrasound ablation with open lobectomy after propensity score matching. Methods: After propensity matching, we compared treatment‐related morbidity, treatment time, duration of hospitalization, improvement in symptom score, cost, and acoustic parameters of consecutive patients who underwent high‐intensity focused ultrasound ablation or lobectomy. All eligible patients completed the computerized, multidimensional voice program and Voice Handicap Index questionnaire before, and 3 and 6 months after treatment. Results: The matched cohort comprised 154 patients (77 in each group). Although treatment‐related morbidity was comparable between the two groups (P = .368), treatment time (P <.001), duration of hospitalization (P <.001), and medical cost (P <.001) were less in the high‐intensity focused ultrasound group. After high‐intensity focused ultrasound ablation, the 6‐month nodule shrinkage (mean ± SD) was 64% ± 26% and the 6‐month symptom improvement score was comparable with lobectomy (P = .283). At 6 months, none of the acoustic parameters were changed from the baseline in both groups (P >.05), and the Voice Handicap Index questionnaire did not differ between the two groups (P >.05). Conclusion: Despite having similar treatment‐related morbidity and voice outcomes, there were possibly some advantages with high‐intensity focused ultrasound during open lobectomy, including the avoidance of a neck scar, shorter treatment time and duration of hospitalization, and lower medical cost.