Radiofrequency Ablation for the Treatment of Autonomously Functioning Thyroid Nodules

Baek, Jung Hwan; Moon, Won-Jin; Kim, Yoon Suk; Lee, Jeong Hyun; Lee, Ducky

doi:10.1007/s00268-009-0130-3

Cited by 209 publications

(268 citation statements)

References 32 publications

(48 reference statements)

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“…In the case of 99 m Tc-pertechnetate, "indifferent" or "hot" thyroid nodules, comprising intact iodine storing cells, are destroyed and subsequently scintigraphic imaging shows reduced tracer uptake in ablated tissue. Comparable results have been described in a number of cases by a study by Baek et al [23] after radiofrequency ablation. Since "cold nodules" do not show any uptake of 99 m Tc-pertechnetate, 99 m Tc-MIBI has to be used as an alternative tracer to provide a comparison of uptake in "cold" nodules prior to and after microwave ablation.…”

supporting

confidence: 71%

Diagnostic Accuracy of Elastography and Scintigraphic Imaging After Thermal Microwave Ablation of Thyroid Nodules

Korkusuz

Happel

Klebe

et al. 2015

Fortschr Röntgenstr

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!Purpose: The aim of this study is to evaluate structural alterations of thyroid tissue after microwave ablation using elastography and scintigraphic imaging to investigate the applicability of these diagnostic methods for follow-up. Materials and Methods: 35 patients with 39 thyroid nodules were evaluated using elastography and scintigraphic imaging before and after ultrasound-guided microwave ablation. Elastography was analyzed according to color-coded output and results were classified using a fourfold elasticity score (ES). Nodules color-coded blue were classified ES1 for high elasticity through ES2 and ES3 for lower elasticity, and nodules with very low elasticity were color-coded red and classified as ES4. 99m Tc-pertechnetate served as a tracer for scintigraphic imaging of hot and indifferent nodules and 99m Tc-MIBI for cold nodules. Results: Before microwave ablation, elastography detected a median elasticity score of ES 2 ± 0.7, and after ablation the median score was ES 3 ± 0.6. Overall, the median score increased by 1ES ± 0.6 (p < 0.01). Scintigraphic imaging detected a median reduction of tracer uptake in ablated tissue of 38.7 %± 27.5(p < 0.01). 99m Tc-pertechnetate scans showed a median decrease of tracer uptake of 26.3 %± 16.3 and 99m Tc-MIBI scans detected uptake reduction of 54.7 %± 29.2. Conclusion: Scintigraphic imaging using 99m Tcpertechnetate and 99m Tc-MIBI provides quantifiable results and is promising as a diagnostic follow-up after microwave ablation. Strain elastography detects decreasing tissue elasticity, but accuracy is limited by the necessary reduction of color-coded output to elasticity scores.

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supporting

confidence: 71%

Diagnostic Accuracy of Elastography and Scintigraphic Imaging After Thermal Microwave Ablation of Thyroid Nodules

Korkusuz

Happel

Klebe

et al. 2015

Fortschr Röntgenstr

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“…There was only one case of thyrotoxicosis, which spontaneously resolved within 30 days [46]. Major complications were, in the order of frequency, permanent voice change [33,34,44,46,47,52], rupture of the nodule [44,52], permanent hypothyroidism [41,52], and brachial plexus injury [47,52]. None of the patients experienced any lifethreatening complications related to RFA.…”

Section: Complicationsmentioning

confidence: 97%

“…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%

“…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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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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Radiofrequency Ablation for the Treatment of Autonomously Functioning Thyroid Nodules

Abstract: RFA seems to be effective and safe for the treatment of AFTN.

Cited by 209 publications

References 32 publications

Diagnostic Accuracy of Elastography and Scintigraphic Imaging After Thermal Microwave Ablation of Thyroid Nodules

Diagnostic Accuracy of Elastography and Scintigraphic Imaging After Thermal Microwave Ablation of Thyroid Nodules

Image-guided thermal ablation of benign thyroid nodules

Thyroid Nodule Rupture Following Radiofrequency Ablation for Benign Thyroid Nodules

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