Thermal Ablation for Benign Thyroid Nodules: Radiofrequency and Laser

Baek, Jung Hwan; Lee, Jeong Hyun; Valcavi, Roberto; Pacella, Claudio M.; Rhim, Hyunchul; Na, Dong Gyu

doi:10.3348/kjr.2011.12.5.525

Cited by 198 publications

(220 citation statements)

References 57 publications

(192 reference statements)

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“…Application of energy causes the agitation of tissue ions, generating an increase of local temperature with subsequent controlled tissue necrosis. Tumor tissue farther from the electrode is heated slowly by the thermal current conducted from the hot region around the electrode [32].…”

Section: Rfa Devices and Proceduresmentioning

confidence: 99%

“…Second, the ''danger triangle'', which includes the laryngeal recurrent nerve and the esophagus, is less exposed with this approach. Finally, the electrode passes through an adequate volume of thyroid parenchyma to prevent electrode movement [32].…”

Section: Rfa Devices and Proceduresmentioning

confidence: 99%

“…The duration of laser illumination ranges from 6 to 30 min, depending on nodule size. Light irradiation is continuous, being suspended only in the case of severe pain, cough, or appearance of other side effects [32]. During LA, the necrosis of the tissue is visible as an irregular echogenic area, enlarging during the procedure.…”

Section: La Devices and Proceduresmentioning

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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Section: Rfa Devices and Proceduresmentioning

confidence: 99%

Section: Rfa Devices and Proceduresmentioning

confidence: 99%

Section: La Devices and Proceduresmentioning

confidence: 99%

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Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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“…On the basis of previous experience, the RF ablation was performed by using a transisthmic approach and the moving-shot technique. [6][7][8]10,15,17,[25][26][27] For this, an 18-ga 7-cm-long monopolar modified internally cooled electrode (Well-Point RF electrode; Taewoong Medical, Kimpo, Korea or VIVA; STARmed, Gyeonggi, Korea) with a 1-or 1.5-cm active tip and a 200-W RF generator (VIVA RF Generator; STARmed) was used. When RF ablation was started with the 11 patients, echogenic bubbles developed much faster than would normally occur.…”

Section: Methodsmentioning

confidence: 99%

Combination Therapy Consisting of Ethanol and Radiofrequency Ablation for Predominantly Cystic Thyroid Nodules

Yoon

Baek

Lee

et al. 2013

AJNR Am J Neuroradiol

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SUMMARY:Predominantly cystic thyroid nodules are often aspirated before radiofrequency ablation to enhance its efficacy; however internal bleeding during the aspiration is a problem. We evaluated the feasibility and safety of ethanol ablation to control internal bleeding that occurred during preparatory aspiration. Between September 2010 and August 2011, 11 of 40 predominantly cystic nodules bled internally during fluid aspiration before radiofrequency ablation. To control the bleeding, 99% ethanol was injected. The efficacy of ethanol in controlling bleeding, final nodule volume and complications were assessed. Control of the bleeding by ethanol ablation and subsequent radiofrequency ablation was feasible in all patients. Ninety-one percent (10/11) could be treated in 1 session. The mean nodule volume dropped from 17.1 to 4.3 mL (P Ͻ .018). There were no major complications. Ethanol ablation and radiofrequency ablation combination therapy is a feasible and safe technique for treating predominantly cystic thyroid nodules that exhibit internal bleeding during preparatory aspiration. ABBREVIATIONS:EA ϭ ethanol ablation; RF ϭ radio-frequency; US ϭ ultrasound

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“…Its energy output is relatively high in the confined space of the thyroid, which results in less controllability and predictability [16,17]. Since an effect on surrounding nerves and vessels can't be excluded, the procedure has to be guided carefully [18]. Currently, guidance is primarily performed using conventional B-mode sonography with high-resolution transducers, which especially improves guidance with respect to superficial structures and facilitates the maintenance of a safety distance.…”

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confidence: 99%

Microwave Ablation of Symptomatic Benign Thyroid Nodules: Energy Requirement per ml Volume Reduction

Korkusuz

Kohlhase

Gröner

et al. 2016

Fortschr Röntgenstr

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Zusammenfassung ▼Hintergrund: Mikrowellenablationen (MWA) stellen eine neuartige thermoablative Behandlung für benigne Schilddrüsenknoten dar. Ziel war es, die benötigte Energie pro ml Volumenreduktion zu benutzen, um die benötigte Energie für ein volume-of-interest (VOI) abschätzen zu können. Methode: 25 Patienten mit 25 Knoten (6 solide, 13 komplex und 6 zystisch) wurden durch MWA behandelt. Die übertragene Energie (E) wurde mit der Volumenveränderung (Δ V) nach 3 Monaten korreliert. Der Energiebedarf pro ml Volumenreduktion wurde durch E/Δ V bestimmt. Ergebnisse: MWA zeigte eine signifikante (p < 0,0001) Volumenreduktion (Δ V) im Mittel von 12,4 ± 13,0 ml (range: 1,5 -63,2 ml) und eine relative Reduktion von 52 ± 16 % (range: 22 -77 %). Es zeigte sich eine positive Korrelation zwischen E und Δ V (r = 0,82; p < 0,05). Die mittlere E/Δ V war 1,52 ± 1,08 (range: 0,4 -4,6) kJ/ml für alle Knoten und 2,30 ± 1,5 (0,9 -4,6); 1,5 ± 0,9 (0,4 -3,6); 0,75 ± 0,25 (0,4 -1,2) kJ/ml für solide, komplexe und zystische Knoten mit einer signifikanten Differenz der in E/Δ V zwischen soliden und zystischen Knoten (p < 0,03 Abstract ▼Purpose: Microwave ablation (MWA) represents a novel thermal ablative treatment of benign thyroid nodules. The aim was to determine the energy required per ml volume reduction in order to match the required energy to the volume-of-interest (VOI). Materials and Methods: 25 patients with 25 nodules (6 solid, 13 complex and 6 cystic) were treated by microwave ablation (MWA). The transmitted energy (E) was correlated with the volume change (Δ V) after 3 months. The energy required per ml volume reduction after 3 months was calculated by E/Δ V. Results: MWA resulted in a significant (p < 0.0001) volume reduction (Δ V) with a mean of 12.4 ± 13.0 ml (range: 1.5 -63.2 ml) and relative reduction of 52 ± 16 % (range: 22 -77 %). There was a positive correlation between E and Δ V (r = 0.82; p < 0.05). The mean E/Δ V was 1.52 ± 1.08 (range: 0.4 -4.6) kJ/ml for all nodules and 2.30 ± 1.5 (0.9 -4.6), 1.5 ± 0.9 (0.4 -3.6), 0.75 ± 0.25 (0.4 -1.2) kJ/ ml, respectively, for solid, complex and cystic nodules with a significant difference in E/Δ V for solid and cystic (p < 0.03). Conclusion: The energy required per volume depends on the nodule consistency. Solid nodules require more energy than cystic ones. The estimation of the energy needed per volume-of-interest as an additional parameter should help to avoid under-or overtreatment. Key Points:▶ The estimated required energy for a volumeof-interest depends on the nodule consistency ▶ In solid nodules a higher energy transmission than in cystic nodules is recommended ▶ The energy transmission as an additional marker to ultrasound is helpful for improving periprocedural monitoring This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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Thermal Ablation for Benign Thyroid Nodules: Radiofrequency and Laser

Cited by 198 publications

References 57 publications

Image-guided thermal ablation of benign thyroid nodules

Image-guided thermal ablation of benign thyroid nodules

Combination Therapy Consisting of Ethanol and Radiofrequency Ablation for Predominantly Cystic Thyroid Nodules

Microwave Ablation of Symptomatic Benign Thyroid Nodules: Energy Requirement per ml Volume Reduction

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