Radiofrequency Thermal Ablation for a Small Papillary Thyroid Carcinoma in a Patient Unfit for Surgery: A Case Report

Abstract

Ultrasound-guided radiofrequency thermal ablation has been proposed as an effective and safe procedure for treating patients who have low-risk papillary thyroid microcarcinomas and/or are unfit for surgery. We present the case of a 72-year old male patient with a small thyroid nodule diagnosed as papillary carcinoma after fine needle aspiration. Since the patient had other serious comorbidities, priority was given to other therapies and the malignant thyroid nodule was submitted to active surveillance. After detecting at a follow-up examination a slight dimensional increase of the nodule, the possibility of a radiofrequency thermal ablation was proposed to our patient, who accepted. The procedure was safely and effectively carried out. Follow-up examinations with ultrasonography (or contrast enhanced ultrasound), conducted after 1, 3, 6, and 12 months, demonstrated a progressive reduction of size and loss of vascularization in the treated area. The fine needle aspiration was repeated after 6 months: the sample revealed a very poor cellularity composed of inflammatory cells and thick colloid; no residual neoplastic cells were observed. Our experience confirmed what already demonstrated by previous reports: radiofrequency ablation can effectively eliminate small papillary carcinomas, with a very low complication rate. It may be an alternative strategy for the treatment of low-risk, indolent papillary thyroid microcarcinomas, thus avoiding the potential side-effects of surgery in patients at risk for relevant comorbidities.

Important parameters should be paid attention in PTMC radiofrequency ablation

“…However, in cases of incomplete ablation or tumor recurrence, there may be areas of enhancement within the ablation zone. It is important to monitor these ultrasound features during follow-up to evaluate the effectiveness of the RFA treatment 26 . The ultrasonography results were collected by patients’ ID.…”

A systematic review and meta-analysis comparing tumor progression and complications between radiofrequency ablation and thyroidectomy for papillary thyroid carcinoma

“…Although some studies support the efficacy of RFA on PTC or PTMC, contrasting results were described in different clinical settings ( 32 , 33 ). Although those evidence appears compelling, many questions remain.…”

Effects of Different Levels of Surgical Separation on Neck Bulge and Swallowing Disorders during Endoscopic Thyroidectomy

“…Papillary thyroid carcinoma has become the most prevalent thyroid malignant tumor type in recent years 1–3 . Surgical treatment is still the main option for thyroid cancer 4,5 . Currently, Endoscopic thyroidectomy（ETcan reach almost the same resection range as open surgery, plus the non-scarring nature, significantly improving the patient’s quality of life after surgery 6,7 …”

“…[1][2][3] Surgical treatment is still the main option for thyroid cancer. 4,5 Currently, Endoscopic thyroidectomy(ETcan reach almost the same resection range as open surgery, plus the non-scarring nature, significantly improving the patient's quality of life after surgery. 6,7 Protection of the recurrent laryngeal nerves and parathyroid glands during thyroidectomy is a critical surgical consideration for every thyroid surgeon.…”