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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