Benign Predominantly Solid Thyroid Nodules: Prospective Study of Efficacy of Sonographically Guided Radiofrequency Ablation Versus Control Condition

Baek, Jung Hwan; Kim, Yoon Suk; Lee, Ducky; Huh, Jung Yin; Lee, Jeong Hyun

doi:10.2214/ajr.09.3372

Cited by 274 publications

(311 citation statements)

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“…The first RFA studies on thyroid nodules were performed with a 17-G straight internally cooled electrode needle with a 1-cm active tip [33][34][35][36][37] or with 14-gauge multi-tined expandable electrodes to obtain a more extended ablation area [38][39][40]. Thinner (18-G or 19-G) internally cooled multi-tined (0.5-1-1.5 cm) electrode needles were later developed specifically for thyroid lesions, to make control of the needle easier, minimizing normal tissue injury [41][42][43][44][45][46][47][48][49].…”

Section: Rfa Devices and Proceduresmentioning

confidence: 99%

“…Most procedures are performed with local anesthesia [33][34][35][36][37][38][40][41][42][43][44][45][46][47][48][49].…”

Section: Rfa Devices and Proceduresmentioning

confidence: 99%

“…Two techniques have been used to perform RF ablation: the ''moving shot technique,'' proposed by Baek et al [37] and actually more frequently used than the ''fixed electrode technique.'' In the ''moving shot technique,'' the thyroid nodule is divided into multiple small conceptual ablation units and the ablation procedure is performed unit by unit, moving the electrode continuously.…”

Section: Rfa Devices and Proceduresmentioning

confidence: 99%

“…Baek et al showed that the major complication rate was lower for patients treated by experienced operators than for those treated by less-experienced operators, indicating that RFA is a safe procedure when performed by well-trained operators [52]. Voice change may be caused by the involvement of the recurrent laryngeal or vagus nerve [34,37]. Voice changes are usually transient, with most patients recovering within 3 months [34,44,46,47,52].…”

Section: Complicationsmentioning

confidence: 99%

“…To prevent injury to the recurrent laryngeal nerve, RFA should be performed using the moving shot technique, and by undertreating the ideal ablation units adjacent to the nerve [34,36,37,41]. The vagus nerve is usually located between the common carotid artery and internal jugular vein, but may also be located adjacent to the thyroid gland [53,54].…”

Section: Complicationsmentioning

confidence: 99%

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Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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Benign thyroid nodules are a common disease in the general population. Most often, they are completely asymptomatic and discovered occasionally during routine ultrasound examinations, and do not require any treatment. When thyroid nodules become symptomatic, surgical excision is still considered standard treatment. In the last few years, several experiences in the treatment of benign thyroid nodules through image-guided percutaneous thermal ablation have been reported with encouraging results, so that currently, these treatments are often proposed as first-choice options for patients with symptomatic benign thyroid nodules. In this paper, we discuss the present literature on the topic, focusing on different techniques available for image-guided percutaneous ablation, particularly radiofrequency (RFA), laser (LA), microwave (MWA), and high-intensity-focus ultrasound (HIFU). Little evidence about the efficacy of MWA and HIFU is now available. According to the literature, good results have been obtained with RFA and LA. Regarding RFA, volume reduction after ablative treatment has been found to range from 47 to 84 % at 3-6 months, and from 62 to 93 % at 1 year; LA also seems to be effective in achieving shrinkage of thyroid nodules, with volume reduction from 37 to 81 % at 3-6 months, and from 13 to 82 % at 1-year follow-up. Moreover, applications of advanced image-guidance modality, such as contrast-enhanced ultrasound and virtual navigation with fusion imaging, are discussed.Keywords Laser Á Radiofrequency Á Microwave Á Highintensity focused ultrasound Á Thyroid nodule SOMMARIO I noduli benigni della tiroide sono una evenienza comune nella popolazione generale. Più spesso vengono scoperti occasionalmente durante un esame ecografico fatto per altri motivi, sono asintomatici e non richiedono alcun trattamento. Qualora i noduli diventino sintomatici, l'escissione chirurgica è ancora considerato il trattamento standard. Tuttavia, negli ultimi anni, è cresciuta l'esperienza circa il trattamento di tali noduli tramite ablazione percutanea sotto guida ecografica tanto che, attualmente, questo viene spesso proposto come trattamento di scelta. Lo scopo del nostro lavoro è fare una revisione della letteratura riguardante l'argomento, con un particolare focus sulle differenti tecniche attualmente a disposizione, in particolare radiofrequenza (RFA), laser (LA), microonde (MWA) e high-intensity-focus ultrasound (HIFU). Al momento ci sono ancora poche evidenze sull'efficacia di MWA e HIFU. Secondo quanto riportato in letteratura, buoni risultati sono stati ottenuti con RFA e LA. Riguardo la radiofrequenza, la riduzione volumetrica dopo la procedura ablativa va da 47 a 84 % a 3-6 mesi e da 62 a 93 % a 1 anno; anche il laser sembra essere efficace nel causare la riduzione del nodulo, con percentuali che vanno da 37 a 81 % a 3-6-mesi a da 13 a 82 % a 1 anno di follow-up Abbiamo poi discusso brevemente le

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Section: Rfa Devices and Proceduresmentioning

confidence: 99%

“…Most procedures are performed with local anesthesia [33][34][35][36][37][38][40][41][42][43][44][45][46][47][48][49].…”

Section: Rfa Devices and Proceduresmentioning

confidence: 99%

Section: Rfa Devices and Proceduresmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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Thyroid Nodule Rupture Following Radiofrequency Ablation for Benign Thyroid Nodules

Austerlitz,

Mann,

Noel

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceNodule rupture is a rare but serious complication of thyroid radiofrequency ablation (RFA). With growing adoption of thyroid RFA across the US, an understanding of thyroid nodule rupture (TNR) is crucial for recognition, management, and, ultimately, prevention.ObjectiveTo determine procedural and patient factors that may contribute to TNR and describe experiences in managing TNR while synthesizing existing literature.Design, Setting, and ParticipantsThis retrospective case series examined all RFA procedures for benign thyroid nodules performed by 2 attending physicians at a single academic referral center between December 2019 and January 2024. A total of 298 consecutive patients underwent RFA for benign thyroid nodules. Criteria for offering RFA included nodules with 2 benign fine-needle aspirations, no suspicious ultrasonography features, a greatest dimension of 2 cm or greater, compressive or cosmetic concerns, and accessibility to a straight needle.ExposuresAll RFAs were performed using ultrasonography guidance using the moving-shot technique and a 7-mm or 10-mm active tip.Main Outcomes and MeasuresThe primary outcome was TNR, and measures were procedure, nodule, and patient characteristics that may have contributed to its pathogenesis. Secondary outcomes were nodule volume reduction, thyroid function, and management and sequelae of TNR. The hypothesis on the pathogenesis of TNR was formed before data collection.ResultsSix of 298 patients (2%; 4 women [67%]) with a mean age of 48.5 years (range, 34-65 years) experienced TNR for a mean of 36 days postprocedure (range, 19-54 days). The mean (SD) initial nodule volume among patients with TNR was 31.45 (16.52) mL, and 3 of 6 patients (50%) underwent prior lobectomy. All ruptures were anterior. All patients were treated conservatively, and none required surgery. Five patients recovered completely; the sixth and most recent patient was healing as of last follow-up.Conclusions and RelevanceThere are limited data on the etiology and optimal management of TNR. These 6 cases of anterior rupture suggest that a potential contributor to TNR is thermal and mechanical trauma exerted at the fulcrum point during the moving-shot technique. The use of a smaller active tip (eg, 7 mm) and cessation of energy delivery before this point may help avoid TNR. More robust reporting of this complication may clarify risk factors for and enhance prevention of TNR.

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Levothyroxine or minimally invasive therapies for benign thyroid nodules

Bandeira‐Echtler

Bergerhoff

Richter

2014

Cochrane Database of Systematic Reviews

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No study evaluated all-cause mortality, health-related quality of life or provided systematic data on the development of thyroid cancer. Longest follow-up was five years and median follow-up was 12 months. Nodule volume reductions were achieved by PEI, LP and RF, and to a lesser extent, by LT4. However, the clinical relevance of this outcome measure is doubtful. PEI, LP and RF led to improvements in pressure symptoms and cosmetic complaints. Adverse events such as light-to-moderate periprocedural pain were seen after PEI, LP and RF. Future studies should focus on patient-important outcome measures, especially health-related quality of life, and compare minimally invasive procedures with surgery. RCTs with follow-up periods of several years and good-quality observational studies are needed to provide evidence on the development of thyroid cancer, all-cause mortality and long-term adverse events.

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Benign Predominantly Solid Thyroid Nodules: Prospective Study of Efficacy of Sonographically Guided Radiofrequency Ablation Versus Control Condition

Abstract: This study confirmed that radiofrequency ablation is effective for reducing nodule volume and relieving nodule-related clinical problems and that an effect due to spontaneous nodule reduction can be excluded owing to the results of the comparison with a similar control group.

Cited by 274 publications

References 38 publications

Image-guided thermal ablation of benign thyroid nodules

Image-guided thermal ablation of benign thyroid nodules

Thyroid Nodule Rupture Following Radiofrequency Ablation for Benign Thyroid Nodules

Levothyroxine or minimally invasive therapies for benign thyroid nodules

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