Laser and radiofrequency ablations for benign and malignant thyroid tumors

Abstract

A growing body of evidence is being published regarding the safety and efficacy of minimally invasive image-guided ablation techniques. While clinical applications of these techniques are increasing, international societies have started to publish treatment guidelines and to make efforts to standardize both terminology and reporting criteria for image-guided thyroid ablations. Laser ablation and radiofrequency ablation (RFA) are among the most common ablation techniques either for benign and malignant thyroid nodules. Unlike laser ablation and RFA in the treatment of benign thyroid nodules, where safety and efficacy have been widely demonstrated, evidence regarding local tumor control of thyroid malignancies is still limited. However, preliminary results are encouraging and image-guided thermal ablation techniques can be considered a valid alternative to surgery for the treatment of benign thyroid nodules and recurrent thyroid cancers. This review evaluates the basic concept of RFA and laser ablations, their techniques, clinical outcomes, and complications based on the suggestions of several society guidelines. Multidisciplinary collaboration remains critical to identify patients which may benefit from minimally invasive image-guided thermal ablations, especially if surgery or radioiodine therapy are not feasible options.

Residual vital ratio: predicting regrowth after radiofrequency ablation for benign thyroid nodules

“…All the enrolled patients fulfilled these inclusion criteria [1]: confirmation of benign nodule status on two separate fineneedle aspiration (FNA) or core-needle biopsy (CNB) [2]; no suspicious malignant features on US examination [3,28,3] solid ( 10% of fluid component) or predominantly solid nodules(11-50% of fluid component) [4]; report of cosmetic and/ or symptomatic problems or concern of nodules growing rapidly or malignant transformation [5]; serum thyroid hormone and thyrotropin levels within normal ranges [6]; refusal or ineligibility for surgery [7]; follow-up time !6 months [8]; underwent CEUS during the follow-up. Exclusion criteria were [1]: follicular neoplasm or malignancy findings on FNA or CNB [2]; nodules with benign result on FNA or CNB had suspicious of malignancy in US, including marked hypoechoic, ill-defined margins, taller-than-wide shape or microcalcifications [3]; patients with cystic or predominantly cystic nodules [4]; patients with contra-lateral vocal cord paralysis [5]; previous radiation to the head and neck [6]; followup time < 6 months [7]; refused CEUS during the follow-up.…”

“…Patients often need thyroid hormone supplementation, which is associated with adverse effects on bones and cardiovascular systems [1,3]. Thus, thermal ablation techniques, such as radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA) and high-intensity focused ultrasound(HIFU) have been introduced and have yielded good results [4][5][6][7][8][9][10].…”

European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules

“…Recently, TA of thyroid tissue, that is destruction by heating and subsequent coagulative necrosis and fibrosis, was proven effective for the local control of papillary thyroid microcarcinomas (PTMC) and metastatic lymph nodes in patients at surgical risk [8,9]. Furthermore, a few centres have used TA for palliative purposes in thyroid cancer, neither amenable to surgical resection nor radioiodine ablation (RAI), with promising results [10,11]. In addition to LA and RFA, other techniques, like high intensity focused US (HIFU) and microwave ablation (MWA), are being tested for ablation of benign and malignant thyroid nodules [12,13].…”

Efficacy and safety of single-session radiofrequency ablation for benign thyroid nodules of different sizes: a retrospective study

“…In recent years, a growing number of studies investigating the treatment of benign thyroid nodules through minimally invasive image-guided thermal ablation, including radiofrequency (RFA), laser ablation (LA), microwave ablation, and high-intensity-focus ultrasound (HIFU) have reported encouraging results. In particular, RFA is feasible, safe, and effective in the treatment of benign thyroid nodules (BTNs) when performed by highly experienced operators [1][2][3][4][5]. According to the guidelines of the Korean Society of Thyroid Radiology and the Italian minimally-invasive treatments of the thyroid (MITT) group, thyroid RFA was used as a first-line treatment or as an alternative to surgery for patients with nonfunctioning solid BTNs complaining of symptomatic or cosmetic issues [4][5][6].…”