Tracheal necrosis following thyroid radiofrequency ablation

Delayed Tracheal Perforation After Microwave Ablation of Papillary Thyroid Microcarcinoma: A Case Report and Literature Review

Microwave ablation (MWA) is a relatively new, well-tolerated, minimally invasive approach, developed in recent years as an alternative to surgery for low-risk papillary thyroid microcarcinoma (PTMC). We describe an 81-year-old patient with unifocal PTMC who refused active surveillance and underwent percutaneous MWA. Two weeks after the procedure, the patient presented dyspnea and cough, and delayed tracheal perforation was confirmed by computed tomography. Conservative therapy was chosen as the initial treatment, and the tracheal defect was confirmed healing successfully 1 month later. Radiologists should be aware of the possibility of delayed tracheal perforation following MWA even in the absence of unusual intraoperative events.

Thermal Ablation of Thyroid Nodules, From the AJR "How We Do It" Special Series

Ablation has been shown to be an effective option for treatment of well-selected patients with thyroid nodules, particularly benign nodules, and thermal ablation is being increasingly used for this purpose. The general approach to thermal ablation of the thyroid will be familiar to interventional radiologists who perform ablation in other tissues; however, thermal ablation of the thyroid has additional unique considerations. In this review, we provide evidence-based and real-world guidance on the performance of thermal ablation for the treatment of patients with thyroid nodules, drawing on our collective experience and clinical practice. We describe patient selection, ablation modalities, equipment, general procedural approach, additional technical considerations, and postprocedural follow-up. We discuss various clinical scenarios; give tips on performing specific portions of the procedure; and highlight a range of relevant anatomic, biochemical, and clinical factors as a guide for interventional radiologists in establishing a successful thyroid ablation practice.

The Role of Radiofrequency Ablation in Benign and Malignant Thyroid Nodules

Radiofrequency ablation (RFA) offers a minimally invasive solution for benign, autonomously functioning (AFTN), and malignant thyroid nodules. The technique utilizes high-frequency alternating current to induce coagulative necrosis, effectively destroying target tissue. RFA is performed in the outpatient setting with local anesthesia and sonographic guidance. RFA is effective in producing substantial volume reduction rates in benign nodules and is emerging as a favorable option in AFTN and papillary thyroid microcarcinoma. RFA's advantages include lower complication rates, minimal scarring, and improved quality-of-life outcomes compared to surgery. However, its efficacy in larger and recurrent malignancies requires further investigation.

Radiofrequency ablation for papillary thyroid microcarcinoma with a trachea-adjacent versus trachea-distant location

OBJECTIVE

To evaluate the outcomes of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) adjacent to the trachea and compare them with those of PTMC distant from the trachea.

METHODS

Patients who received RFA for solitary low-risk PTMC between June 2014 and July 2020 were reviewed and classified into adjacent and distant groups. To balance between-group confounders, the propensity score matching approach was employed. Volume, volume reduction ratio (VRR), tumor disappearance, complications, and disease progression were assessed and compared between the groups. Furthermore, factors affecting disease progression were evaluated.

RESULTS

A total of 122 and 470 patients were included in the adjacent and distant groups, respectively. Overall VRR was 99.5% ± 3.1 and cumulative tumor disappearance rate was 99.4% after a mean follow-up time of 40.1 months ± 16.2. Overall disease progression and complications incidence were 3.7% and 1.0%, respectively. No substantial differences were observed between the two groups in the latest volume (0.8 mm3 ± 4.1 vs. 0.9 mm3 ± 4.2, p = .77), VRR (99.7% ± 1.6 vs. 99.5% ± 2.7, p = .75), cumulative tumor disappearance rate (92.6% vs. 94.2%, p = .58), and incidence of disease progression (4.1% vs. 4.5%, p = .70) and complication (1.7% vs. 0.8%, p = .86) after 1:2 matching. Additionally, tracheal adjacency exhibited no association with disease progression in multivariate Cox regression analysis (p = .73).

CONCLUSION

For eligible patients with PTMC located adjacent to or distant from the trachea, RFA may offer a safe and effective alternative treatment method.

Transitioning from Traditional Academic Decision Making to Patient-Centric Healthcare Choices: The Example of Thyroid Thermal Ablation Techniques for Papillary Thyroid Microcarcinomas

Percutaneous thermal ablation techniques (TATs) have contributed to improving thyroid tumor management for almost twenty years [...].

Percutaneous Radiofrequency Ablation of Thyroid Carcinomas Ineligible for Surgery, in the Elderly

Thirty to 50% of differentiated thyroid carcinomas include papillary thyroid microcarcinomas (mPTC). Most of these tumors remain clinically silent, have a bright prognosis and a disease-specific mortality <1%. Surgery has been recommended as first line-treatment by current guidelines, the standard treatment being lobectomy. However, surgery has some drawbacks, including potential recurrent laryngeal nerve paralysis, hypothyroidism, hypoparathyroidism, in -patient basis hospital stay, lifelong medication, scarring of the neck, and general anesthesia related risks. Moreover, elderly patients who present severe comorbidities, could be ineligible for surgery, and others may refuse invasive surgery. Another option supported by the American Thyroid Association is active surveillance. This option can be considered as unattractive and difficult to accept by European patients, as there is a 2-6% risk of disease progression. Percutaneous image-guided thermal ablation has been successfully applied in the treatment of liver and lung tumors in the 1990s and 2000s; and has recently been proposed as an alternative to surgery in patients presenting with thyroid diseases. This minimally invasive treatment has similar efficacy, fewer complications, better quality of life and cosmetic outcomes than surgery. We report herein two cases of radiofrequency ablation of mPTC and T2 PTC in elderly patients who were ineligible for surgery.

[Does preoperative risk grading have clinical value for benign thyroid nodular ablation?]

OBJECTIVE

To explore the risk grading method for benign thyroid nodules before microwave ablation and the clinical significance of risk grading.

METHODS

This study was conducted among 527 patients undergoing ultrasound-guided microwave ablation of benign thyroid nodules between July, 2017 and December, 2020.Based on anatomic relationship of the thyroid nodules with the adjacent tissues, the ablation risk was classified into 4 levels: low, medium, high and extremely high risks.The incidence of severe complications and the rate of residual nodules following the ablation were recorded.

RESULTS

In the patients graded to have low, medium, high and extremely high preoperative risks, the incidences of severe complications following the ablation were 0%, 0.88%, 2.41% and 6.78%, respectively, showing no significant differences among the different risk groups (P > 0.05).The rates of postoperative residual nodules in the 4 risk groups were 1.59%, 6.14%, 14.43% and 71.19%, respectively, showing a significant difference between the low and medium risk groups and the high and extremely high risk groups (P < 0.001).

CONCLUSION

Preoperative risk grading for thyroid nodular ablation can be helpful for prevention of severe complications during ablation and prediction of residual nodules after ablation.