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

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. (C) 2018 Elsevier Inc. All rights reserved.