Statement and Recommendations on Interventional Ultrasound as a Thyroid Diagnostic and Treatment Procedure

Dietrich, Christoph F.; Müller, T.; Bojunga, Jörg; Ye, Dong; Mauri, Giovanni; Radziņa, Maija; Dighe, Manjiri; Cui, Xin‐Wu; Grünwald, Frank; Schüler, Andreas; Ignee, A.; Korkusuz, H.

doi:10.1016/j.ultrasmedbio.2017.08.1889

Cited by 80 publications

(71 citation statements)

References 235 publications

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“…During the TA procedure, frequent swallowing and head movements should be avoided. Hence, a mild conscious sedation (e.g., midazolam, 1-3 mg intravenously) may be helpful for keeping the patient relaxed throughout the procedure [9][10][11][12]. Local subcutaneous and pericapsular anesthesia is usually recommended when the TA technique requires large bore needles; in case of HIFU, although no invasive devices are required, local anesthesia may help diminish the pain caused by the mechanical injury to the skin and thyroid capsule by the US beam [9-11, 18, 19, 23, 24].…”

Section: Methodsmentioning

confidence: 99%

“…These non-surgical techniques are implemented over large parts of Europe and the Far East and are used in several thyroid centers. Despite this, there is little guidance, besides a few national consensus papers [9][10][11][12], on the appropriate use of TA in clinical practice. While US-guided diagnostic procedures are widely employed by European endocrinologists, routine use of US-guided therapeutic procedures is still limited to specialized thyroid centers [13].…”

Section: Scope Of the Documentmentioning

confidence: 99%

“…Clinical trials have reported varying schedules for clinical and US short-and long-term monitoring [9][10][11][12]. Clinical, biochemical (with at least TSH determination), and US examinations are recommended as follows: (a) early: at 3 months, for assessment of initial effects of TA and thyroid function analysis; (b) intermediate: at 6 and 12 months, as above, for the assessment of nodule volume reduction and presence of remaining viable areas, because the maximum nodule shrinkage is nearly always achieved by this time.…”

Section: Post-procedural Management and Follow-upmentioning

confidence: 99%

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2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

et al. 2020

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Standard therapeutic approaches for benign thyroid lesions that warrant intervention are surgery for cold and either surgery or radioiodine for autonomously functioning thyroid nodules (AFTN). Image-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for selected clinical conditions. Due to mounting scientific evidence and widening availability, ETA considered it appropriate to develop guidelines for the use of TA in adult patients. TA procedures are well tolerated, but a dedicated training of the operators is required and information on possible complications needs to be shared with the patients. The following factors should be considered when weighing between observation, surgery, and TA for benign thyroid nodules. In solid non-hyperfunctioning nodules, TA induces a decrease in thyroid nodule volume, paralleled by improvement in symptoms. Nodule re-growth is possible over time and may necessitate repeat treatment, or surgery, in a dialogue with the patient. In AFTN, radioactive iodine is the first-line treatment, but TA may be considered in young patients with small AFTN due to higher probability of restoring normal thyroid function and avoidance of irradiation. In cystic nodules, ethanol ablation (EA) is the most effective and least expensive treatment. TA may be considered for cystic lesions that relapse after EA or have a significant residual solid component following drainage and EA. TA should be restricted to benign lesions that cause symptoms or cosmetic concern. Presently, laser and radiofrequency ablation are the most thoroughly assessed techniques, with similar satisfactory clinical results. Microwaves and high-intensity focused ultrasound therapy options remain to be fully evaluated.© 2020 European Thyroid Association Published by S. Karger AG, Basel Recommendation 1. In adult patients with benign thyroid nodules that cause pressure symptoms and/or cosmetic concerns and decline surgery, image-guided TA should be considered as a costand risk-effective alternative option to surgical treatment or observation alone (1, ØØOO).Recommendation 2. We recommend against the use of TA for asymptomatic lesions (1, ØØØO).

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Section: Methodsmentioning

confidence: 99%

Section: Scope Of the Documentmentioning

confidence: 99%

Section: Post-procedural Management and Follow-upmentioning

confidence: 99%

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2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

et al. 2020

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“…Side effects, complications, tolerability and satisfaction were documented. The terminology and reporting criteria followed consensus guidelines [19,[21][22][23][24].…”

Section: Adverse Eventsmentioning

confidence: 99%

Laser Ablation of Benign Thyroid Nodules: A Prospective Pilot Study With a Preliminary Analysis of the Employed Energy

et al. 2019

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Background and Objectives To assess the effectiveness of ultrasound (US)‐guided laser ablation of benign thyroid nodules (TNs) under different amounts of applied energy. Study Design/Materials and Methods Thirty‐four euthyroid patients with 5–18 ml TNs were enrolled: 21 (laser ablation) and 13 (clinical follow up) patients with a mean age of 56.2 ± 12.0 and 54.7 ± 14.7 years, respectively. The laser ablation protocol used a 1.064 mm wavelength diode laser source; 3.5 W output power; 1,100–1,500 J and 5–8 min/illumination; and one or two fibers/session. Clinical, laboratory, and US data were obtained immediately before treatment and at 6 and 12 months follow‐up and were analyzed by Student's t test and Fisher's exact test. Low‐ and high‐energy subgroups were subsequently defined, and the receiver operating characteristic (ROC) curves were calculated. Results Laser ablation follow‐up showed an overall nodule volume reduction of more than 50%; improvement of symptoms and cosmetic complaints (P = 0.001); and stable laboratory data compared with the baseline and control groups. Minor complications were 9.5% ( n = 2). One or two fibers/session resulted in a similar nodule volume reduction among 10–18 ml nodules. Analysis of the applied energy suggested a 398.8 J/ml inferior cutoff (ROC curve: 0.889 sensitivity; 0.545 specificity) for the high‐energy subgroup ( n = 14, mean 599.9 ± 136.5 J/ml) to reduce the nodule volume over time (−55.1% vs. −58.4%, P = 0.55). The low‐energy subgroup ( n = 7, mean 240.2 ± 74.6 J/ml) did not show a persistent volume reduction ( P < 0.05) from the 6‐ to 12‐month follow‐ups (−56.6% vs. −53.7%). Conclusions Laser ablation of benign TNs achieved technique efficacy at 12 months posttreatment, with clinical improvement and few minor side effects. A single fiber in a single session with a high deployed energy (>398.8 J/ml) may be associated with improved results, a finding to be confirmed with a larger series. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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“…Practitioners need to be competent in the intravenous administration of contrast agents, be familiar with contraindications and be able to manage any possible adverse effects within the medical and legal framework of their country [4,38]. We refer to the educational activities of the collaborating societies of this paper, the World Federation of Ultrasound in Medicine and Biology (WFUMB) [9,23,[93][94][95][96][97][98][99][100][101][102], the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) [1,3,4,11,37,38,49,50,74,79,[103][104][105][106][107][108][109][110][111][112][113][114][115][116][117][118][119] and the CEUS LI-RADS Working Group for Liver Imaging Reporting and Data System (LI-RADS®) [34][35][36][120]…”

Section: Education Qualificationmentioning

confidence: 99%

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Statement and Recommendations on Interventional Ultrasound as a Thyroid Diagnostic and Treatment Procedure

Cited by 80 publications

References 235 publications

2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

Laser Ablation of Benign Thyroid Nodules: A Prospective Pilot Study With a Preliminary Analysis of the Employed Energy

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