Thermal ablation meta-analysis. The need of careful appraisal of meta-analysis methodology

Dear Editor, The authors of the meta-analysis entitled “Efficacy of thermal ablation in benign non-functioning solid thyroid nodule: a systematic review and meta-analysis” [1] would like to thank Pacella and Papini for their interest in our manuscript, and we are pleased to answer to the criticisms they raised [2]. Pacella and Papini criticized some metho dological aspects that, in their opinion, resulted in a biased contest in which RFA prevailed over laser. As reported in the text, this article “was conceived as an attempt to achieve robust evidence on the efficacy over time of thermal abla tion to reduce volume of benign non-functioning solid thyroid nodules (BNFSTN) and its correlated symptoms. Particularly, the present study focused on RFA and laser ablation, as the most worldwide used thyroid thermal ablation modalities, but it was not undertaken to compare the performance of these two options”. We carefully reviewed their notes and we felt that they deserved a point by-point reply to better understand our findings.