Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules

Abstract

Thyroid nodules are commonly encountered in health care practice. They are usually benign in nature, with few cases being malignant, and their detection has increased in the adult population with the help of ultrasonography. Thyroidectomy or surgery is the first-line treatment and traditional method for thyroid nodules; however, thyroidectomy leaves permanent scars and requires long-term use of levothyroxine after surgery, which makes patients more reticent to accept this treatment. Thermal ablation is a minimally-invasive technique that have been employed in the treatment of benign and malignant thyroid nodules nodules, and have been shown to be effective and safe. Several studies, including long-term, retrospective, and prospective studies, have investigated the use of ablation to treat benign thyroid nodules and malignant thyroid nodules, including papillary thyroid carcinoma. Here, we review the recent progress in thermal ablation techniques for treating benign and malignant nodules, including their technicalities, clinical applications, pitfalls and limitations, and factors that could affect treatment outcomes. Special in-depth elaboration on the recent progress of the application of thermal ablation therapy in malignant thyroid nodules.

Analysis of risk factors for intra-cystic hemorrhage in microwave ablation of partially cystic thyroid nodules

“…( 17 ) and Agyekum et al. ( 18 ) were found to report the intraoperative complications related to cystic nodule ablation. However, none of these articles discussed intra-ablation hemorrhage in the cystic nodules.…”

“…Common procedure-related complications of thyroid nodule ablation are hoarseness, nodule rupture, and hemorrhage ( 17 ). Among these, intraoperative hemorrhage can lead to eventual hematoma formation, thereby prolonging the operation time and delaying the postoperative recovery ( 18 ). Since only a handful reports are available on the methods regarding the management of cystic-solid thyroid nodules and prevention of intraoperative intra-capsular hemorrhage ( 13 , 19 ), this study aims to analyze the risk factors for intra-capsular hemorrhage during complicated cystic-solid nodule ablation, and to design a working prediction model to help better design targeted ablation plans for different types of cystic-solid nodules.…”

“…Common procedure-related complications of thyroid nodule ablation are hoarseness, nodule rupture, and hemorrhage (17).…”

Assessing the relative effectiveness of various ultrasound-guided ablation techniques for treating benign thyroid nodules: A systematic review and network meta-analysis

“…[ 3 ] While the majority of BTNs do not necessitate treatment, intervention becomes necessary when nodules cause symptoms, enlargement, or raise suspicion of malignancy. [ 4 , 5 ] The standard treatment methods for BTNs requiring intervention are surgical removal of the nodules or radioactive iodine therapy. However, thyroidectomy results in a permanent scar and requires long-term levothyroxine use postoperatively, making many patients reluctant to undergo this treatment.…”

Systematic review and meta-analysis: diagnostic value of different ultrasound for benign and malignant thyroid nodules

“…In adults, thyroid nodules occur about 45-56% of the time, of which 5.0-6.5% are thyroid cancers. Thyroid carcinoma can be classified into four types according to pathological features, namely, follicular carcinoma, papillary carcinoma, medullary carcinoma, and undifferentiated carcinoma (4)(5)(6)(7). Thyroid nodules are usually insidious, with no obvious clinical symptoms and can be easily missed.…”