Prevalence and Management of Complications of Laser Ablation for Benign Thyroid Nodules

Context: Percutaneous laser ablation (LA) is today regarded as a valuable therapy for symptomatic, benign solid (noncystic) thyroid nodules (STNs). Objective: We assessed the prevalence of complications from LA for benign and STNs and their management. Methods: We conducted a systematic review with meta-analysis of data from published studies on LA of STNs, in addition to author institutions. 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 = .010) or conscious sedation (2%; CI, [1%-4%], I2 27.2; P = .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 to 5 days up to 1 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 noncystic STNs can be considered a generally safe technique. Major complications are rare.