Physician Profile: Professor Brian Lang

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Key Points

  • Brian Hung-Hin Lang, MS, MBBS, FACS, is an endocrine surgeon and a Clinical Professor in the Department of Surgery at the University of Hong Kong.
  • He is also Chief of the Division of Endocrine Surgery at Queen Mary Hospital in Hong Kong.
  • Dr. Lang and his team have treated more than 600 patients using focused ultrasound, primarily for benign thyroid nodules.

Brian Hung-Hin Lang, MS, MBBS, FACS, is a Clinical Professor in the Department of Surgery at the University of Hong Kong and the Chief of the Division of Endocrine Surgery at Queen Mary Hospital in Hong Kong.

Over the past seven years, Prof. Lang and his team have treated more than 600 patients using focused ultrasound, primarily for benign thyroid nodules. Because of this vast experience and expertise, Queen Mary Hospital and its associated sites in Hong Kong have become one of the most active areas today using Theraclion’s EchoPulse® device.

FUSHK director Carolyn Yeh recently visited Prof. Lang and observed a focused ultrasound treatment.

“Attending a benign thyroid nodule treatment led by Prof. Lang was a fascinating experience,” Yeh said. “It was truly remarkable that under Prof. Lang’s expert handling of the device, intersecting beams of ultrasound energy focused precisely on the target achieved what was possible only with surgery traditionally. Prof. Lang and his team are providing qualified patients in Hong Kong with a tremendous opportunity to address their nodules noninvasively and with lower risk of complications compared with the standard of care.”

We recently spoke with Prof. Lang to learn about his practice and why he believes focused ultrasound offers so much to these patients.

Focused Ultrasound Work

When and how did you get interested in focused ultrasound?
In 2014, I was approached by one of the founders of Theraclion in Hong Kong. Theraclion had established an echotherapy division to promote its EchoPulse device, which is an ultrasound-guided high-intensity focused ultrasound (HIFU) system designed specifically for the treatment of thyroid nodules and breast fibroadenomas.

That December, I visited a hospital in Frankfurt, Germany, and observed HIFU treatments using the EchoPulse device. I learned from that team’s experience; so, after coming back from the trip, I decided to start our own HIFU program in Hong Kong. We performed our first treatment at the end of 2015, and we were the first center to do this treatment in Asia. I believe that our group is among the largest treatment sites in terms of patient volume using the Theraclion system.

What are your areas of interest in focused ultrasound?
I use focused ultrasound for the thermal ablation of benign thyroid nodules and nontoxic multinodular goiter.

How many patients have you treated?
We have treated more than 600 patients since the end of 2015 (just over six years).

What is the goal of your work?
Our main goal is to provide the least invasive and safest treatment for our patients who need surgery but do not necessarily want or are not fit to undergo surgery. HIFU ablation is a good alternative to surgery. To that end, our site mainly focuses on the clinical outcomes of our treatment. Our treatments are performed at three different hospitals or sites in Hong Kong. We are interested in looking at outcomes such as the extent of swelling or shrinkage over time after single-session HIFU ablation, safety and complications, patient satisfaction, quality of life, and medical cost.

What are your funding sources?
Our funding comes mainly from the hospital, our department, and some from research grants.

Who are your team members?
I work with Dr. Matrix Fung, who is also an endocrine surgeon, and three surgical residents.

Who are your internal and external collaborators?
We have a multidisciplinary team comprised of three endocrinologists, two clinical oncologists, a community health researcher, and two pathologists. I also work closely with a PhD student from China.

What are your greatest achievements?
I was awarded two competitive research grants recognizing our work in HIFU:

“A randomized, open-label, parallel-group study to explore the efficacy of high-intensity focused ultrasound (HIFU) versus fixed-dose radioiodine-131 in the treatment of relapsed Graves’ disease.”
Sponsor: Health and Medical Research Fund (HMRF) (#04150716)

“A randomized, open-label, parallel-group study to determine the efficacy of sequential high-intensity focused ultrasound (HIFU) ablation versus fixed-dose radioiodine-131 therapy in moderate-sized non-toxic multinodular goiter.”
Sponsor: Health and Medical Research Fund (HMRF) (#06171646)

Looking Ahead

What do you see as impediments to your success?
Because it is a good treatment, I would like to continue to make progress toward improving the treatment efficiency (i.e., shortening treatment time) of the EchoPulse treatments.

What comes next?
It would be nice to compare different ablation techniques. The most common technique globally is still radiofrequency ablation, not HIFU. I am also interested in finding new ways to ablate thyroid nodules more efficiently with HIFU.

Recent Key Publications

  1. Lang BH, Woo YC, Chiu KW. Single-Session High-Intensity Focused Ultrasound Treatment in Large-Sized Benign Thyroid Nodules. Thyroid. 2017 May;27(5):714-721. doi: 10.1089/thy.2016.0664. Epub 2017 Mar 22. PMID: 28326895.
  2. Lang BH, Woo YC, Wong CKH. High-Intensity Focused Ultrasound for Treatment of Symptomatic Benign Thyroid Nodules: A Prospective Study. Radiology. 2017 Sep;284(3):897-906. doi: 10.1148/radiol.2017161640. Epub 2017 Apr 18. PMID:
    28419814.
  3. Lang BH, Wu ALH. High intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a systematic review. J Ther Ultrasound. 2017 May 17;5:11. doi: 10.1186/s40349-017-0091-1. PMID: 28523127; PMCID: PMC5434558.
  4. Lang BHH, Wong CKH, Ma EPM. Single-session high intensity focussed ablation (HIFU) versus open cervical hemithyroidectomy for benign thyroid nodule: analysis on early efficacy, safety and voice quality. Int J Hyperthermia. 2017 Dec;33(8):868-874. doi: 10.1080/02656736.2017.1305127. Epub 2017 Mar 24. PMID: 28540785.
  5. Lang BHH, Woo YC, Chiu KW. High-intensity focused ablation (HIFU) of single benign thyroid nodule rarely alters underlying thyroid function. Int J Hyperthermia. 2017 Dec;33(8):875-881. doi: 10.1080/02656736.2017.1318456. Epub 2017 Apr 24. PMID: 28540804.
  6. Lang BHH, Woo YC, Chiu KW. Vocal cord paresis following single-session high intensity focused ablation (HIFU) treatment of benign thyroid nodules: incidence and risk factors. Int J Hyperthermia. 2017 Dec;33(8):888-894. doi: 10.1080/02656736.2017.1328130. Epub 2017 Jun 6. PMID: 28540836.
  7. Lang BH, Woo YC, Wong IY, Chiu KW. Single-Session High-Intensity Focused Ultrasound Treatment for Persistent or Relapsed Graves Disease: Preliminary Experience in a Prospective Study. Radiology. 2017 Dec;285(3):1011-1022. doi: 10.1148/radiol.2017162776. Epub 2017 Jul 20. PMID: 28727542.
  8. Lang BHH, Woo YC, Chiu KWH. The percentage of serum thyroglobulin rise in the first-week did not predict the eventual success of high-intensity focused ablation (HIFU) for benign thyroid nodules. Int J Hyperthermia. 2017 Dec;33(8):882-887. doi: 10.1080/02656736.2017.1361047. Epub 2017 Aug 10. PMID: 28793806.
  9. Lang BH, Wu ALH. The efficacy and safety of high-intensity focused ultrasound ablation of benign thyroid nodules. Ultrasonography. 2018 Apr;37(2):89-97. doi: 10.14366/usg.17057. Epub 2017 Oct 10. PMID: 29207852; PMCID: PMC5885474.
  10. Lang BHH, Woo YC, Chiu KW. Significance of hyperechoic marks observed during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Eur Radiol. 2018 Jun;28(6):2675-2681. doi: 10.1007/s00330-017-5207-z. Epub 2018 Jan 8. PMID: 29313120.
  11. Lang BHH, Woo YC, Chiu KW. Evaluation of pain during high-intensity focused ultrasound ablation of benign thyroid nodules. Eur Radiol. 2018 Jun;28(6):2620-2627. doi: 10.1007/s00330-017-5200-6. Epub 2018 Jan 12. PMID: 29330630.
  12. Lang BHH, Woo YC, Chiu KW. Sequential high intensity focused ultrasound (HIFU) ablation in the treatment of benign multinodular goitre: an observational retrospective study. Eur Radiol. 2018 Aug;28(8):3237-3244. doi: 10.1007/s00330-018-5333-2. Epub 2018 Mar 19. PMID: 29556769.
  13. Lang BHH, Woo YC, Chiu KW. Two-year efficacy of single-session high- intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Eur Radiol. 2019 Jan;29(1):93-101. doi: 10.1007/s00330-018-5579-8. Epub 2018 Jun 19. PMID: 29922925.
  14. Lang BH, Woo YC, Chiu KW. Role of second high-intensity focused ultrasound (HIFU) treatment for unsatisfactory benign thyroid nodules after first treatment. Eur Radiol. 2019 Mar;29(3):1469-1478. doi: 10.1007/s00330-018-5671-0. Epub 2018 Aug 7. PMID: 30088067.
  15. Lang BHH, Woo YC, Chiu KW. Changes in serum thyroglobulin and antithyroglobulin shortly following high-intensity focused ablation of benign thyroid nodules in patients with positive antithyroglobulin status. Int J Hyperthermia. 2018;35(1):637-643. doi: 10.1080/02656736.2018.1516302. Epub 2018
    Oct 10. PMID: 30303432.
  16. Lang BHH, Wong CKH, Ma EPM, Woo YC, Chiu KW. A propensity-matched analysis of clinical outcomes between open thyroid lobectomy and high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Surgery. 2019 Jan;165(1):85-91. doi: 10.1016/j.surg.2018.05.080. Epub 2018 Nov 2. PMID:30392858.
  17. Lang BH, Woo YC, Chiu KW. High intensity focused ultrasound (HIFU) ablation of benign thyroid nodule is safe and efficacious in patients who continue taking an anti-coagulation or anti-platelet agent in the treatment period. Int J Hyperthermia. 2019;36(1):186-190. doi: 10.1080/02656736.2018.1548034. Epub 2018 Dec 16. PMID: 30556448.
  18. Kotewall N, Lang BHH. High-intensity focused ultrasound ablation as a treatment for benign thyroid diseases: the present and future. Ultrasonography. 2019 Apr;38(2):135-142. doi: 10.14366/usg.18040. Epub 2018 Nov 9. PMID: 30690961; PMCID: PMC6443589.
  1. Lang BHH, Woo YC, Chiu KW. Two sequential applications of high-intensity focused ultrasound (HIFU) ablation for large benign thyroid nodules. Eur Radiol. 2019 Jul;29(7):3626-3634. doi: 10.1007/s00330-019-06021-1. Epub 2019 Feb 18. PMID: 30778718.
  2. Lang BHH, Woo YC, Chiu KW. Effect of perithyroidal lignocaine infusion (PLI) to pain experienced during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Eur Radiol. 2019 Oct;29(10):5280-5287. doi: 10.1007/s00330-019-06160-5. Epub 2019 Mar 27. PMID: 30919068.
  3. Lang BH, Woo YC, Chiu KW. Two-year outcomes of single-session high-intensity focused ultrasound (HIFU) treatment in persistent or relapsed Graves’ disease. Eur Radiol. 2019 Dec;29(12):6690-6698. doi: 10.1007/s00330-019-06303-8. Epub 2019 Jun 17. PMID: 31209622.
  4. Lang BHH, Woo YC, Chiu KW. Identifying predictive factors for efficacy in high intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a retrospective analysis. Int J Hyperthermia. 2020;37(1):324-331. doi: 10.1080/02656736.2020.1747646. PMID: 32253953.
  5. Lang BHH, Woo YC, Chiu KW. Combining high-intensity focused ultrasound (HIFU) ablation with percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules. Eur Radiol. 2021 Apr;31(4):2384-2391. doi: 10.1007/s00330-020-07317-3. Epub 2020 Sep 24. PMID: 32974689.