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Table 1 A literature summary of HIFU studies adapting different criteria

From: High intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a systematic review

First author (year) Inclusion criteria Exclusion criteria
Esnault (2011) [15] - At least two thyroid nodules, with at least one for surgery
- Nodule targeted for HIFU located at least 3 mm from the trachea, esophagus, recurrent nerve, carotid artery, skin
- Selected nodule for HIFU treatment was different from the one indicated for surgery
- Suspicion of malignancy nodule, neck irradiation, previous surgery, previous radioactive iodine treatment
- Any cystic components ≥ 20% or any large calcifications
- Patient unable to maintain a stable position with hyperextended neck
Korkusuz (2014) [19] At least one benign thyroid nodule with associated thyrotoxicosis, neck pain, throat hoarseness, swallowing disorders, discomfort and/or cost concern. - Malignant nodule
- Close to heat-sensitive structures like the recurrent laryngeal nerve, trachea, esophagus and carotid artery
Korkusuz (2015) [21] - Over 18 years old
- At least one benign thyroid nodule with associated issues (neck pain, hoarseness, swallowing disorders, discomfort, cosmetic concerns and/or thyrotoxicosis
- Refused surgery/RIT
- Malignant nodules
- Target nodules close to sensible structures such as trachea, carotid arteries
- Patients who showed any contraindication to HIFU (recurrent nerve anomalies, target volumes not)
Korkusuz (2015) [22] - Patient with symptomatic nodule
- Cosmetic concerns
- Refused surgery or contraindicated
- Patients with asymptomatic nodules
- Nodule volume ≥ 10 mL
- Histological evidence for malignancy
Kovatcheva (2015) [23] - Over 18 years old
- Presence of one or more thyroid nodules without signs of malignancy
- A nodule measured on US ≥10 mm in three orthogonal dimensions
- ≤30% of the targeted nodule is cystic
- HIFU accessibility of the targeted nodule
- Normal thyrotropin concentrations
- Absence of vocal cord immobility at laryngoscopy
- Head and/or neck disease which prevents hyperextension of neck
- Past medical history of thyroid cancer or other malignant tumors in the neck region
- History of neck irradiation
- Intra-nodular macro-calcifications which precludes treatment with HIFU
- Nodules next to posterior margin of the thyroid lobe with anteroposterior diameter less than 15 mm
- Pregnancy/lactation
- Any contraindications related to intravenous moderate sedation
Lang (2017) [24] - Benign cytology and low to very low suspicion sonographic pattern
- Nodule believed to be causing pressure symptoms
- All 3 dimensions between 10 and 40 mm
- Nodule ≥ 70% solidity
- Nodule within 5–30 mm from skin
- Normal thyroid function and calcitonin levels
- Age ≤ 18 years old
- Pregnant or lactating women
- Indeterminate or malignant nodules
- Intra-nodular macro-calcifications
- History of head and neck irradiation
- History of non-medullary thyroid carcinoma
- Pre-existing vocal cord palsy