General Principles for the Safe Performance, Training, and Adoption of Ablation Techniques for Benign Thyroid Nodules: An American Thyroid Association Statement

Abstract

Background: The primary goal of this interdisciplinary consensus statement is to provide a framework for the safe adoption and implementation of ablation technologies for benign thyroid nodules. Summary: This consensus statement is organized around three key themes: (1) safety of ablation techniques and their implementation, (2) optimal skillset criteria for proceduralists performing ablative procedures, and (3) defining expectations of success for this treatment option given its unique risks and benefits. Ablation safety considerations in pre-procedural, peri-procedural, and post-procedural settings are discussed, including clinical factors related to patient selection and counseling, anesthetic and technical considerations to optimize patient safety, peri-procedural risk mitigation strategies, post-procedural complication management, and safe follow-up practices. Prior training, knowledge, and steps that should be considered by any physician who desires to incorporate thyroid nodule ablation into their practice are defined and discussed. Examples of successful clinical practice implementation models of this emerging technology are provided. Conclusions: Thyroid ablative procedures provide valid alternative treatment strategies to conventional surgical management for a subset of patients with symptomatic benign thyroid nodules. Careful patient and nodule selection are critical to the success of these procedures as is extensive pre-procedural patient counseling. Although these emerging technologies hold great promise, they are not without risk and require the development of a unique skillset and environment for optimal, safe performance and consistent outcomes.

Radiofrequency ablation as a novel modality in Ecuador for treating toxic thyroid nodules: a case series

“…We followed Korean guidelines to include the patient for RFA. The inclusion criteria of our patients agree with a recent statement of the ATA, citing that a unique skill set, and environment are needed for optimal, safe performance and consistent outcomes ( 8 ).…”

Novel and Advanced Ultrasound Techniques for Thyroid Thermal Ablation

“…6 ) [ 15 ]. The posterior approach is strongly recommended for ablating deep nodules in the right lobe, considering the slightly lateral path of the RLN compared to the left side [ 10 ]. Using a large volume of HD fluid, typically greater than 40 mL, has yielded satisfactory outcomes [ 20 ].…”

“…Moreover, advanced US techniques, such as hydrodissection (HD) and vascular ablation, have been introduced to improve safety and efficacy, thereby minimizing complications [ 7 ]. It is important to recognize that there is a learning curve associated with US-guided therapeutic procedures [ 8 - 10 ], and operators undertaking thyroid ablation require appropriate training and experience. While a successful training model [ 11 ] has been introduced to expedite the learning curve, limited attention has been given to training on US maneuvers in manipulating the ablation needle.…”

Proficiency in performing radiofrequency ablation procedure for non-functioning benign thyroid nodules: a qualitative rather than quantitative matter

“…Radiofrequency ablation (RFA), is a procedure performed through a trans-isthmic approach and a moving-shot technique, reported to display a high efficacy together with a low complication rate ( 3 ). In this regard, a recent interdisciplinary consensus statement of the American Thyroid Association aimed to provide a framework for the safe adoption and implementation of non-surgical ablation technologies for BTN, including data on the learning curve (LC) and necessary prior skillset ( 4 ).…”