Urgent need to apply a common language in image-guided thermal ablations

Dear Sir,

We thank Dr. Pacella for his letter [1], which pointed out some important limitations of our previous study [2]. His clarifications are extremely important in providing a clearer message to the readers.

First of all, Pacella [1] highlights the lack of a precise definition and a homogeneous way of reporting complications after thyroid ablations. Even though many efforts have been made to provide common classifications and definitions of complications after thermal ablations [3, 4], distinctly different classifications are used in the literature [5]. Particularly, the definition of pain during/after an ablation procedure might be defined as a minor complication by some authors and as a side effect by others. This discrepancy in definitions could lead to, as it did in our paper, apparent significant differences in the rates of minor complications, which are determined by the definition of pain, in the literature on laser and radiofrequency ablation. Clearly, this might convey a misleading message to the readers. On the one hand, clearly, different systems used to report complications in the original papers cannot be imputed to authors performing literature reviews; on the other hand, this fact should stimulate the scientific community to more consistently apply the provided indications in their reporting of criteria in scientific papers.

Furthermore, image-guided interventions are facing a massive increase in the treatment of thyroid diseases, expanding the field of application to hyperfunctioning nodules and malignant diseases [6–10]. Thus, it becomes even more important to precisely apply common terminology and reporting criteria to correctly report scientific evidence in this field for a wider and more appropriate clinical application.

Regarding the other points raised by Pacella…

1. The data in Tables 1 and 2 refer to the number of treated nodules, not to the number of treated patients, as a patient treated in two different sessions for two different nodules might experience complications deriving from the treatment being administered twice.

2. The data reported in Table 1 refer to the 584 cases that were analyzed. We agree that the subsequent relevant data [11] significantly modify the picture in the comparison of the two methods. Furthermore, other recent papers did not find significant differences between laser and radiofrequency approaches in the treatment of benign thyroid nodules [12, 13].

3. We thank Dr. Pacella for his table with recent data, which provides a more precise picture of the comparison between the two techniques.

4. We acknowledge the reference mistake on page 15. The correct citation would be ref 32, not ref 34, although the subsequent citation of ref 32 is correct. In the cited paper [14], the authors report a comprehensive analysis of both radiofrequency and laser techniques. We have submitted a request for erratum in this regard.

In conclusion, the data regarding different treatment modalities for benign thyroid disease have been significantly modified by the recent literature, and we thank Dr. Pacella for providing more updated tables. Moreover, a strong need for a more precise application of standard terminology and reporting criteria is evident, as different definitions might determine relevant differences in the clinical data.

Compliance with ethical standards

Conflict of interest

G.M: consultant for Elesta srl. The other authors declare that they have no competing interests.

Ethical approval

No human or animal subjects were included in the present study.

Informed consent

For this type of study, formal consent is not required.