Microwave ablation for thyroid nodules: a new string to the bow for percutaneous treatments?

Abstract

Background: Thyroid nodules are a fairly common finding in general population and, even if most of them are benign, a treatment can be however necessary. In the last years, non surgical minimally invasive techniques have been developed to treat this pathology, starting from percutaneous ethanol injection (PEI), to laser ablation (LA), radiofrequency ablation (RFA) and, most recently, microwave ablation (MWA). Methods:We reviewed all medical literature searching in pubmed.gov the terms "microwave" & "thyroid".We found three original studies concerning MWA treatment, for a total of 263 patients (mean age 51.0 years; range, 15-80 years; male to female ratio 2.55) and 522 nodules.Results: A total of 522 nodules (338 solid, 22 cystic, 162 mixed) in 263 patients were treated. Studies have shown a mean reduction in volume of thyroid nodules ranging from 45.9% to 65%. No study reported a significant and definitive change in laboratory parameters, except for one case (Heck et al.). No studies have reported major complications after procedure.Conclusions: MWA is a new, promising technique among the minimally invasive treatments of thyroid nodules. Actually, the larger diameter of MW antenna seems to be the major limiting factor in the use of this technique. More studies are necessary to evaluate feasibility, safety and efficacy of the procedure.

A comparative study of short-term efficacy and safety for thyroid micropapillary carcinoma patients after microwave ablation or surgery

“…Many patients experience postoperative hoarseness and hypoparathyroidism, thus requiring lifelong thyroid hormone replacement therapy. In contrast, MWA minimizes recurrent laryngeal nerve and parathyroid injury rates because of real-time US guidance and the use of the hydrodissection technique [19]. Our experience confirms the reported high rates (7%) of transient hypoparathyroidism after surgery (TL þ unilateral CND).…”

“…During the period 2008-2017, laser ablation [22][23][24], radiofrequency ablation [18], and MWA [13] were reported as treatments for low-risk PTMC. MWA is more effective than other ablation techniques because of its good therapeutic effect and rapid rate of temperature increase [11,19,25]. We reported a significant reduction in the mean lesion volume (from 81.60 ± 9.99 to 21.41 ± 4.02 mm 3 ) and complete disappearance of the ablation zones (22.7%, 34/150) during follow-up, indicating that MWA is an effective "local" treatment for PTMC.…”

“…Routine sterile skin preparation was performed with 1% lidocaine as topical anesthesia. A mixture of 1% lidocaine and physiological saline solution was carefully injected into the thyroid capsule as hydrodissection to protect major structures (carotid vessels, trachea, recurrent laryngeal nerve, esophagus) from thermal injury [19].…”

The prostate cancer focal therapy

“…FT is a well-established treatment of many other solidorgan malignancies, including those in the breast (22,23), kidney (24,25), thyroid (26), liver (27,28), pancreas (29) and brain (30). The fundamental aspect of FT is the targeted destruction of neoplastic tissue with the preservation of surrounding healthy parenchyma (31).…”

Cooled tip radiofrequency ablation of benign thyroid nodules: preliminary experience with two different devices

“…In recent years, nonsurgical minimally invasive techniques have been developed: percutaneous ethanol injection (PEI), laser ablation (LA), radiofrequency ablation (RFA), microwave ablation (MWA) and high-intensity focused ultrasound (HIFU) (4)(5)(6)(7)(8).…”