Prediction of Hoarseness Risk After Microwave Ablation for Thyroid Nodules: A Visual Three-Zone Method Combined With a Nomogram.

OBJECTIVE

This study aimed to analyze the risk factors that cause hoarseness after microwave ablation (MWA) and establish a visual zoning approach combined with a nomogram to predict the risk of hoarseness after MWA.

METHODS

Retrospective analysis of the images and clinical data of patients with thyroid nodules who underwent MWA was carried out from January 2021 to September 2024. Patients were divided into benign thyroid nodule and papillary thyroid cancer (PTC) groups. Parameters related to hoarseness were analyzed, including age, sex, multifocality, glandular thickness, nodule components, ablation power, nodule location, maximum nodule diameter and nodule distance from the thyroid capsule and tracheoesophageal groove, as well as a new "three-zone method." Three different prediction models and a nomogram were constructed to predict the risk of hoarseness.

RESULTS

A total of 446 patients (126 males and 320 females; median age 44 years) with a total of 542 nodules were included in this study. The overall incidence rate of hoarseness after MWA was 2.9% (13/446), while it was 2.2% (5/223) in the benign nodule group and 3.6% (8/223) in the PTC group. Multivariate analysis showed that away from anterior capsule distance, close to tracheoesophageal groove distance and location in zone 3 were risk factors of hoarseness after MWA for PTC nodules. The above variables and outcomes were visualized via nomogram (C-index = 0.910).

CONCLUSION

This combined model with the "three-zone method" and established nomogram could be employed to predict the incidence of hoarseness after MWA for PTC.