Radiofrequency ablation for the management of thyroid nodules: A critical appraisal of the literature

Abstract

The majority of benign thyroid nodules are asymptomatic, remain stable in size and do not require treatment. However, a minority of patients with growing nodules may have local symptoms or cosmetic concerns, and thus demand surgical therapy. The timely use of ultrasound-guided, minimally invasive thermal therapies has changed the natural history of benign, enlarging thyroid nodules (TNs). These procedures produce persistent shrinkage of TNs and an improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first-line treatment for thyroid cysts, while in solid cold nodules, laser and radiofrequency ablation (RFA) have proven to be very effective and safe techniques in producing significant volume reduction that remains stable over several years. In particular, RFA seems to be suited for the management of small and medium nodules, while larger nodules may require repeated RFA treatments, and could be difficult to treat if they extend into the chest. RFA is performed in outpatient clinics and has a lower risk of complications compared to surgery. However, to date, there is still no unanimous consensus on the percutaneous treatment of benign nodules using such minimally invasive thermal techniques. In this review, we critically revise the literature to identify patients who are more likely to benefit from RFA treatment as an alternative to surgery.

Patient satisfaction after thyroid RFA versus surgery for benign thyroid nodules: a telephone survey

“…This is in line with our previous work, in which we analyzed the outcomes of patients treated by RFA to those who underwent hemithyroidectomy and found that both techniques were equally effective for treating nodule-related clinical problems, with the exception being patients with an initial nodular volume greater than 35 ml and AFTN [14], where surgery should be still preferred. This is also in line with the literature suggesting that the best results from RFA appear to be limited to small and, partially, medium nonfunctioning thyroid nodules [5,8].…”

“…It is still a matter of debate whether one is superior to the other [7]. Regarding their efficacy, LA can reduce nodule volume by 40%-80% [2], while RFA can reduce it by 50%-80% [2,8]. Although it may be perceived that RFA is somehow superior to LA in reducing thyroid nodule volume [9], Mauri et al have demonstrated that RFA and LA are similarly feasible, safe and effective in treating benign thyroid nodules when performed by the same team [10].…”

Nodular Thyroid Disease in the Era of Precision Medicine

“…Most benign thyroid nodules are asymptomatic, stable and do not require treatment, while large thyroid nodules may become responsible for pressure symptom, neck discomfort or cosmetic complaints thus resulting in decreased quality of life (99). Over the last two decades, non-surgical, minimally invasive USguided techniques have been proposed for the treatment of symptomatic nodules.…”

Which needle in the treatment of thyroid nodules?

“…Thus, the generator has to be set in relation to the presence of vulnerable structures near the target lesion, considering that the higher is the temperature reached by the tip, the larger will be the area of necrosis around the needle. Nevertheless, a minimum temperature of 50-80 ℃ for a number of minutes is generally needed to achieve a satisfactory result (18)(19)(20)(21)(22)(23).…”