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Richter JP, Richter CP, Gröner D. [Ultrasound-guided ablation techniques for thyroid lesions]. Laryngorhinootologie 2023; 102:916-927. [PMID: 37734389 DOI: 10.1055/a-2144-4132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Ultrasound-guided ablation techniques have been increasingly introduced into routine treatment of thyroid lesions as a complement to existing surgical therapies and radioiodine treatment. In cystic or predominantly cystic lesions instillation therapy (ethanol/polidocanol ablation) has yielded good results. Novel thermal ablation techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA) and high intensity focused ultrasound (HIFU), induce irreversible cellular effects by locally applying temperatures ≥ 60 °C to the targeted thyroid region. Lesions causing local symptoms or focal hyperfunctionality can thus be selectively treated under continuous sonographic monitoring. While a considerable body of evidence supports the efficacy and safety of various local ablative techniques, future challenges lie in initiating comparative prospective trials and in standardizing clinical practice, training and continuous quality assessment on a regional and superregional level. In the future, it shall be indicated to include local ablative techniques - so far not known to all patients in Germany - into the informed decision-making process as a suitable alternative or supplement to existing therapies.
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Affiliation(s)
- Johannes-Paul Richter
- Klinik für Nuklearmedizin, Universitätsklinikum Magdeburg, Otto-von-Guericke-Universität, Magdeburg
| | - Carl-Philip Richter
- Chirurgische Klinik am Rathenauplatz, Schilddrüsenzentrum Baden-Württemberg, Heilbronn
| | - Daniel Gröner
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt am Main, Frankfurt am Main
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Klimek K, Mader N, Happel C, Sabet A, Grünwald F, Groener D. Heat sink effects in thyroid bipolar radiofrequency ablation: an ex vivo study. Sci Rep 2023; 13:19288. [PMID: 37935715 PMCID: PMC10630443 DOI: 10.1038/s41598-023-45926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
The study aimed to investigate heat sink effects in radiofrequency ablation (RFA) under thyroid-specific conditions. In an ex vivo model, bovine thyroid lobes were ablated using bipolar RFA with 2.0 kJ energy input at a power level set to 10 W (n = 35) and 25 W (n = 35). Glass vessels (3.0 mm outer diameter) placed within the ablation zone were used to deliver tissue perfusion at various flow rates (0, 0.25, 0.5, 1, 5, 10, 20 ml/min). Temperature was measured in the proximity of the vessel (Tv) and in the non-perfused contralateral region of the ablation zone (Tc), at equal distances to the ablation electrode (d = 8 mm). Maximum temperature within the perfused zone was significantly lowered with Tv ranging from 54.1 ± 1.5 °C (20 ml/min) to 56.9 ± 1.5 °C (0.25 ml/min), compared to Tc from 63.2 ± 3.5 °C (20 ml/min) to 63.2 ± 2.6 °C (0.25 ml/min) (10 W group). The cross-sectional ablation zone area decreased with increasing flow rates from 184 ± 12 mm2 (0 ml/min) to 141 ± 20 mm2 (20 ml/min) at 10 W, and from 207 ± 22 mm2 (0 ml/min) to 158 ± 31 mm2 (20 ml/min) in the 25 W group. Significant heat sink effects were observed under thyroid-specific conditions even at flow rates ≤ 1 ml/min. In thyroid nodules with prominent vasculature, heat dissipation through perfusion may therefore result in clinically relevant limitations to ablation efficacy.
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Affiliation(s)
- Konrad Klimek
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Nicolai Mader
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
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Grünwald F, Baumgarten J, Happel C, Sabet A, Gröner D. [Radiofrequency ablation of benign thyroid nodules]. Laryngorhinootologie 2022; 101:569-573. [PMID: 35738271 DOI: 10.1055/a-1057-3222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Radiofrequency ablation is an effective tool to treat benign thyroid nodules up to about 100 ml. It is well tolerated and is - together with echopulse therapy - currently the most frequently used technique in Germany for the local therapy of benign thyroid nodules. Overall, a volume reduction of about 50 % to 70 % can be expected. Cystic nodules and mixed-pattern lesions respond slightly better than solid nodules. Initial volume, structure and echogenicity are important parameters influencing the therapeutic efficacy. Bipolar as well as monopolar methods are used - the choice of the method depends mainly on the personal experience. For bigger nodules, the bipolar technique is preferred. Cooled systems should be favored, especially when using larger probes. Serious side effects are rare (< 1 %) and transient in most cases.
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Affiliation(s)
- Frank Grünwald
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Justus Baumgarten
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Christian Happel
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Amir Sabet
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Daniel Gröner
- Klinik für Nuklearmedizin, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Frankfurt am Main
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Jasim S, Patel KN, Randolph G, Adams S, Cesareo R, Condon E, Henrichsen T, Itani M, Papaleontiou M, Rangel L, Schmitz J, Stan MN. American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions. Endocr Pract 2022; 28:433-448. [PMID: 35396078 DOI: 10.1016/j.eprac.2022.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE The objective of this disease state clinical review is to provide clinicians with a summary of the nonsurgical, minimally invasive approaches to managing thyroid nodules/malignancy, including their indications, efficacy, side effects, and outcomes. METHODS A literature search was conducted using PubMed and appropriate key words. Relevant publications on minimally invasive thyroid techniques were used to create this clinical review. RESULTS Minimally invasive thyroid techniques are effective and safe when performed by experienced centers. To date, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Both ultrasound-guided laser and radiofrequency ablation can be safely used for symptomatic solid nodules, both toxic and nontoxic. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. Despite limited data, encouraging results suggest that minimally invasive techniques can also be used in small-size primary and locally recurrent thyroid cancer. CONCLUSION Surgery and radioiodine treatment remain the conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective alternatives when used appropriately and by trained professionals to treat symptomatic or enlarging thyroid masses.
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Affiliation(s)
- Sina Jasim
- Division of Endocrinology, Metabolism and Lipid Research, School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
| | | | - Gregory Randolph
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Adams
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, Florida
| | - Roberto Cesareo
- Unit of Metabolic Diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leonardo Rangel
- Head and Neck Surgery Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - John Schmitz
- Mayo Clinic Department of Radiology, Rochester, Minnesota
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
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Wu T, Zheng B, Tan L, Yin T, Lian Y, Xu S, Ye J, Ren J. A novel parallel overlapping mode for complete ablation of large benign thyroid nodules in a single-session radiofrequency ablation. Front Endocrinol (Lausanne) 2022; 13:915303. [PMID: 35992133 PMCID: PMC9390060 DOI: 10.3389/fendo.2022.915303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/04/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) has been widely applied in patients with benign thyroid nodules (BTNs), and complete ablation in a single-session treatment brings great benefits to patients. While how the ablation should be planned and performed to achieve complete ablation in a single-session treatment in large BTNs remains unknown. PURPOSE To determine a more suitable ablation strategy for sufficient treatment in a single-session treatment. MATERIALS AND METHODS This retrospective study included 108 BTNs receiving RFA treatment. These patients were divided into two groups: group A using one insertion point with a fan-shaped overlapping mode and group B using multiple insertion points with a novel parallel overlapping mode. All the treatments used a hydrodissection approach and moving-shot technique. Contrast-enhanced ultrasonography (CEUS) was used to guide the supplementary ablation. Follow-ups were performed at 1, 3, 6 and 12 months. The rates of supplementary ablation, initial ablation ratio (IAR), the rates of complete ablation (CAR), treatment effects and complications between the two groups were compared. RESULTS The group B had larger treated nodules (10.2ml vs 6.4ml, P<0.001) than group A, while group B had a lower rate of supplementary ablation (21.6% vs 75.4%, P<0.001), especially in the BTNs with craniocaudal diameters ≥30mm (22.0% vs 100%, P<0.001). With the assistance of supplementary ablation, both groups achieved similar IAR (100% vs 100%, P=0.372) and CAR (94.7% vs 94.1%, P=1.000). Two groups showed similar VRRs at 12-month follow-up (77.9% vs 77.5%, P=0.894) and similar rates of complications (3.5% vs 2.0%, P=1.000). CONCLUSIONS Needle placement using the multiple insertion points with a novel parallel overlapping mode would be easier to achieve complete ablation with less supplementary ablation, especially in large nodules.
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Affiliation(s)
- Tao Wu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bowen Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lei Tan
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Tinghui Yin
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yufan Lian
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shicheng Xu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin Ye
- Department of Otolaryngology-Head and Neck Surgery, Third Affiliated Hospital of Sun Yat−Sen University, Guangzhou, China
- *Correspondence: Jin Ye, ; Jie Ren,
| | - Jie Ren
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Jin Ye, ; Jie Ren,
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Muhammad H, Santhanam P, Russell JO. Radiofrequency ablation and thyroid nodules: updated systematic review. Endocrine 2021; 72:619-632. [PMID: 33449296 DOI: 10.1007/s12020-020-02598-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE In the thyroid gland, radiofrequency ablation (RFA) is being applied to both benign nodules and cancers internationally, while interest is also growing in the West. Benign thyroid nodules (BTNs) may be candidates for intervention when symptoms develop. For differentiated thyroid cancers (DTC), surgery is currently the first-line treatment. However, for candidates with high surgical risk or those who refuse to undergo repeated surgery, newer techniques such as RFA are an option. Surgery is associated with complications including hypothyroidism, voice change, hypocalcemia, and a scar. RFA has been used in Asian and European institutions as an alternative to surgery, but is relatively new in North America. Although RFA is not associated with significant complications, few randomized control trials have assessed its efficacy. The studies to date suggest a low rate of severe complications and a small need for thyroid hormone replacement following RFA. Further large-scale studies focusing on a Western population are needed. The aim of this review is to evaluate the evidence with respect to the current studies and data about the safety and efficacy of radiofrequency ablation for the management of BTNs and DTC. METHODS We systematically searched the PubMed/MEDLINE, EMBASE, Clinical Queries, and Web of Science databases, for articles published up to April 30th, 2020. RESULTS Total of 75 studies that met the inclusion criteria were included in the review. Thirty-five studies focused on RFA use for solid nodules, 12 studies on predominantly cystic nodules, 10 for autonomously functioning thyroid nodules, and 18 studied were published on differentiated thyroid cancer. CONCLUSIONS RFA seems to be an effective and safe alternative to surgery in high-risk surgical patients with thyroid cancers and for selected BTNs. Additional trials with longer follow-up in North American patients are needed to validate its full role in the armamentarium of thyroid ologists.
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Affiliation(s)
- Haris Muhammad
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, 21204, USA
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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Sharma RK, Kuo JH. Complications of RFA for Thyroid Nodules: Prevention and Management. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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8
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Muhammad H, Santhanam P, Russell JO, Kuo JH. RFA and benign thyroid nodules: Review of the current literature. Laryngoscope Investig Otolaryngol 2021; 6:155-165. [PMID: 33614945 PMCID: PMC7883624 DOI: 10.1002/lio2.517] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022] Open
Abstract
Benign thyroid nodules (BTNs) are commonly found in the general population. They are usually asymptomatic and their incidence has increased as a result of wide-spread use of ultrasound. Benign nodules are typically monitored clinically until they increase in size, resulting in compressive symptoms warranting surgery. However, although surgery is generally well-tolerated and of low-risk, it is associated with a small risk for several complications including hypothyroidism, nerve injury, hematoma, injury to other structures and wound infection. Recently, newer image-guided ablation techniques including radiofrequency ablation (RFA) have been introduced. RFA has a similar safety profile when compared to surgery and has shown promising results in challenging surgical candidates. Though several studies have been published in Asian and European countries on the efficacy of RFA, limited data is available on the North American population. The aim of the study is to review the current literature establishing the clinical outcomes and safety of RFA for benign nodules. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Haris Muhammad
- Department of Internal MedicineGreater Baltimore Medical CenterTowsonMarylandUSA
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes, & Metabolism, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jonathon O. Russell
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jennifer H. Kuo
- Department of Surgery, Section of Endocrine SurgeryColumbia University Medical CenterNew YorkNew YorkUSA
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Nguyen VB, Nguyen TX, Nguyen VVH, Nguyen HT, Nguyen DT, Le CV. Efficacy and Safety of Single-Session Radiofrequency Ablation in Treating Benign Thyroid Nodules: A Short-Term Prospective Cohort Study. Int J Endocrinol 2021; 2021:7556393. [PMID: 34552630 PMCID: PMC8452432 DOI: 10.1155/2021/7556393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/15/2021] [Accepted: 09/02/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The aims of this study are to evaluate the safety and efficacy of RFA in the treatment of benign thyroid nodule(s) and to find independent factors related to the volume reduction rate of the nodule(s). MATERIALS AND METHODS This short-term prospective study from a single medical center was conducted on 93 benign thyroid nodules in 93 patients treated with RFA. Two basic techniques were used: the trans-isthmic approach and moving-shot technique. Clinical and ultrasonography examinations were performed at 1- and 3-month follow-up after the treatment session. Primary outcomes included volume reduction ratio (VRR) at 1-month and 3-month follow-ups; secondary outcomes were therapeutic success rate and complications. Multiple linear regression analysis was used to determine independent factors associated with VRR. RESULTS A final sample of 78 patients with 78 nodules, given participant rate 83.8% (including 60 solid nodules, 16 predominantly cystic nodules, and 2 thyroid cysts), was followed up for 3 months. The mean volume reduction ratio was 41.47% and 64.72% after 1-month and 3-month follow-ups, respectively. The therapeutic success rate was 30.8% at 1-month and 84.6% at 3-month follow-ups. Symptom score and cosmetic score improved significantly. There was no change in thyroid function tests. Two minor complications (transient voice change) were found. The multiple linear regression analysis showed that the internal component of the nodules significantly related to the VRR during the 3-month follow-up (β = 23.00; 95%CI (7.59-38.45)). CONCLUSION RFA was demonstrated as a safe and effective option for benign thyroid nodules treatment. It can be used as an alternative treatment with encouraging results.
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Affiliation(s)
- Van Bang Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Thi Xuan Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Van Vy Hau Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Hai Thuy Nguyen
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Dinh Toan Nguyen
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Chi Van Le
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
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Sim JS, Baek JH. Long-Term Outcomes of Thermal Ablation for Benign Thyroid Nodules: The Issue of Regrowth. Int J Endocrinol 2021; 2021:9922509. [PMID: 34335748 PMCID: PMC8321738 DOI: 10.1155/2021/9922509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/20/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Thermal ablation (TA) for benign thyroid nodules (BTNs) is widely accepted as an effective and safe alternative to surgery. However, studies on the long-term outcomes of TA have reported problems with nodule regrowth and symptom recurrence, which have raised the need for adequate control of regrowth. Therefore, a more complete TA with a longer-lasting treatment effect may be required. In this study, we review and discuss long-term outcomes and regrowth of BTNs following TA and evaluate factors affecting the long-term outcomes. We also discuss the management of regrowth based on long-term outcomes.
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Affiliation(s)
- Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam 13590, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
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Papini E, Monpeyssen H, Frasoldati A, Hegedüs L. 2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules. Eur Thyroid J 2020; 9:172-185. [PMID: 32903999 PMCID: PMC7445670 DOI: 10.1159/000508484] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | | | - Andrea Frasoldati
- Department of Endocrinology and Metabolism, Arcispedale Santa Maria Nuova IRCCS-ASL, Reggio Emilia, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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Lee M, Baek JH, Suh CH, Chung SR, Choi YJ, Lee JH, Ha EJ, Na DG. Clinical practice guidelines for radiofrequency ablation of benign thyroid nodules: a systematic review. Ultrasonography 2020; 40:256-264. [PMID: 32660208 PMCID: PMC7994735 DOI: 10.14366/usg.20015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose Thermal ablation is a novel treatment alternative for benign thyroid nodules, and one of the most promising thermal ablation techniques is radiofrequency ablation (RFA). Considering the increasing use of thyroid RFA, some scientific societies have proposed clinical practice guidelines. We systemically reviewed and compared these guidelines for thyroid RFA to identify a standard treatment strategy that represents the positions of most societies. Methods We searched the MEDLINE and EMBASE databases for studies with human participants that were published in English between January 1, 2000 and August 2, 2019. Studies containing clinical practice guidelines for the RFA of benign thyroid nodules were included. We extracted data regarding indications, pre- and post-procedural evaluations, treatment techniques, and the need to obtain informed consent. Results Of the 83 studies found, four studies were included, and one study was added after searching the bibliographies of those articles. The five included studies were guidelines developed by the Korean Society of Thyroid Radiology, a group of experts from Italian scientific societies, the Italian Working Group on Minimally Invasive Treatments of the Thyroid, the United Kingdom’s National Institute for Health and Clinical Excellence, and a group of four professional Austrian thyroid associations. Indications, pre- and post-procedural evaluations, and techniques were similar across studies; however, differences in each of these categories were found. Conclusion While the reviewed guidelines are similar with regard to major categories, international guidelines for the RFA of benign thyroid nodules should be established in the future.
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Affiliation(s)
- Minkyoung Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea.,Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea
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Yang H, Wu Y, Luo J, Yang X, Yan J. Lever-elevating vs. liquid-isolating maneuvers during microwave ablation of high-risk benign thyroid nodules: a prospective single-center study. Int J Hyperthermia 2020; 36:1239-1245. [PMID: 31818160 DOI: 10.1080/02656736.2019.1690711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim: To compare the effects of the liquid-isolating maneuver and the lever-elevating maneuver in protecting cervical structures during microwave ablation for treating high-risk benign thyroid nodules.Methods: This prospectively study was approved by the Medical Ethics Committee of Panzhihua Central Hospital. A total of 174 patients were enrolled and randomly assigned to a liquid-isolating maneuver group (LIM, n = 87) or a lever-elevating maneuver group (LEM, n = 87). Operation time, postoperative voice change, time to recovery of baseline voice, peri-thyroid hematoma, neck tension, and intraoperative vasovagal reaction were assessed.Results: Operation time was greater in the LIM group than in the LEM group (44.75 ± 13.14 vs. 32.87 ± 10.84 min; p = .017).Voice changes were observed in 6 patients in the LIM group and 2 in the LEM group (6.9% vs. 2.3%, p = .278). The time to recovery of baseline voice was significantly greater in the LIM group compared with the LEM group (36.15 ± 10.24 vs. 24.48 ± 11.53 days, p = .014). The incidences of peri-thyroid hematoma and neck tension were higher in the LIM than in the LEM group (11.5% vs. 3.4%, 10.3% vs. 2.3%, p = .044 and p = .029). One patient (1.1%) in the LEM group and none of the patients in the LIM group experienced a vasovagal response (p = 1.000).Conclusion: The lever-elevating method is feasible and effective for the microwave ablation of benign thyroid nodules, with better protection of neck structures than observed with the liquid-isolating method.
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Affiliation(s)
- Huaxiang Yang
- Department of General Surgery, General Hospital of Tianjin Medical University, Tianjin, China
| | - Yanjun Wu
- Department of General Surgery, Central Hospital of Panzhihua City, Panzhihua, China
| | - Jie Luo
- Department of General Surgery, Central Hospital of Panzhihua City, Panzhihua, China
| | - Xiaoliang Yang
- Department of General Surgery, Central Hospital of Panzhihua City, Panzhihua, China
| | - Jing Yan
- Department of General Surgery, Central Hospital of Panzhihua City, Panzhihua, China
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Cui R, Yu J, Han ZY, Liu FY, Yu XL, Liang P. Ultrasound-Guided Percutaneous Microwave Ablation for Substernal Goiter: Initial Experience. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2883-2891. [PMID: 30900322 DOI: 10.1002/jum.14992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To preliminarily evaluate the safety, effectiveness, and feasibility of microwave ablation (MWA) for substernal goiter (SSG) in select patients and to provide a relevant treatment reference for further studies. METHODS From April 2017 to December 2017, 10 patients with SSG were treated by MWA. All patients were followed for at least 3 months to observe the therapeutic effects and complications. Therapeutic effects were assessed at follow-up for the relief of patients' symptoms, resolution of the cosmetic grade, and volume reduction rate (VRR) of SSG. Possibly related factors for the 3-month VRR of the nodules were analyzed. RESULTS The study included 9 female patients and 1 male patient with a mean age ± SD of 56.8 ± 10.1 years (range, 34-70 years). The mean volume of the nodules was 52.9 ± 27.9 mL (range, 23.7-122.6 mL). The nodule volume was significantly reduced at the 3-month follow-up (17.5 ± 9.5 mL; P < .05). The mean 3-month VRR of the index nodule was 66.7% ± 7.1%. A higher ablated portion-to-nodule ratio 1 day after MWA predicted a higher 3-month VRR (Spearman r = 0.646; P = .044). The mean symptom score (from 4.5 ± 1.7 to 1.5 ± 1.0; P = .005) and cosmetic grade (from 3.3 ± 0.5 to 2.2 ± 0.4; P = .004) declined significantly 3 months after the procedure. No complications or unexpected side effects were observed. CONCLUSIONS Our preliminary results support the effectiveness and safety of MWA for local control of SSG. This technology can be applied in select patients with SSG who are ineligible for surgery.
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Affiliation(s)
- Rui Cui
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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15
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Vuong NL, Dinh LQ, Bang HT, Thuy TTM, Bac NH, Vy TT. Radiofrequency Ablation for Benign Thyroid Nodules: 1-Year Follow-Up in 184 Patients. World J Surg 2019; 43:2447-2453. [PMID: 31165252 DOI: 10.1007/s00268-019-05044-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benign thyroid nodules are common, and must be treated when symptomatic. Non-surgical minimally invasive modalities, including radiofrequency ablation (RFA), have been widely used with good results. The factors related to the efficacy of RFA are still debated. This study was to evaluate the safety, efficacy and related factors of RFA in the treatment of benign thyroid nodules. METHODS A retrospective single-center study was conducted on 251 benign thyroid nodules in 184 patients treated with RFA. The procedure was performed under ultrasound (US) guidance using the trans-isthmic approach and the moving-shot technique. Clinical and US examinations were performed at 1, 3, 6, 12 months, and then at 6 month intervals. Study outcomes were volume reduction ratio (VRR) and complications. RESULTS There were 153 women and 31 men included in the study. The mean age was 43.9 years. The median initial largest diameter and volume of nodules were 30 mm and 6.18 ml. The median length of follow-up was 12 months. Two minor complications were found. The mean VRR was 66.8; 74.3; and 81% after 3, 6, and 12 months, respectively. Initial solidity was a factor related to the efficacy: cystic nodules had higher VRR compared to solid ones. CONCLUSIONS RFA is safe, effective and can be used as a routine treatment for benign thyroid nodules. More prospective multicenter studies with long-term follow-up are required to improve the safety and efficacy of RFA.
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Affiliation(s)
- Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Quang Dinh
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ho Tat Bang
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Thi Mai Thuy
- Department of Medical Imaging, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Bac
- University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Thanh Vy
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
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16
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Dobnig H, Amrein K. Value of monopolar and bipolar radiofrequency ablation for the treatment of benign thyroid nodules. Best Pract Res Clin Endocrinol Metab 2019; 33:101283. [PMID: 31278063 DOI: 10.1016/j.beem.2019.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Only a few thyroid nodules are perceived as functional or optically disturbing. If there is a need for action, surgical intervention is the long-term standard by which thermoablative procedures (radiofrequency-, laser-, microwave ablation, high intensity focused ultrasound) must be measured against in terms of safety, effectiveness and patient satisfaction. Prior to intervention assessment of the dignity of the nodule by ultrasound-guided fine needle aspiration is essential for cold and warm nodules, as is the confirmation of an inconspicuous cervical lymph node status. The short-term treatment results of these newer interventions in terms of nodule volume reduction and symptomatic improvement are promising and the general complication rate of the procedures is low. Since functional thyroid parenchyma is preserved, maintaining normal thyroid status is the rule. The procedure is usually performed on an outpatient basis, under local anesthesia and monitoring. The subsequent convalescence is usually very short. Most studies are available on monopolar radiofrequency ablation. Several professional societies have defined indications for radiofrequency ablation (RFA), but these need to be further refined based on practical experience and literature. An acceptable long-term recurrence rate still has to be proven for practically all thermoablative methods, for monopolar RFA limited long-term data are encouraging so far. The recurrence rate as well as patient satisfaction will provide the basis for a meaningful overall cost-benefit analysis in the future.
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Affiliation(s)
- Harald Dobnig
- Thyroid Endocrinology Osteoporosis Institute Dobnig, Graz, Austria; Thyroid Practice for Radiofrequency Ablation, Vienna, Austria.
| | - Karin Amrein
- Thyroid Endocrinology Osteoporosis Institute Dobnig, Graz, Austria; Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Austria
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17
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Radiofrequency ablation of thyroid nodules: “Good Clinical Practice Recommendations” for Austria. Wien Med Wochenschr 2019; 170:6-14. [DOI: 10.1007/s10354-019-0682-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/06/2019] [Indexed: 12/15/2022]
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18
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Shengnan HMD, Lin Y, Lili PMD, Zhao WMD, Ming-an YMD. Microwave Ablation of An Autonomous Functioning Thyroid Nodule in A Pregnant Patient: A Case Report. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2019. [DOI: 10.37015/audt.2019.190824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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19
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Vorländer C, David Kohlhase K, Korkusuz Y, Erbelding C, Luboldt W, Baser I, Korkusuz H. Comparison between microwave ablation and bipolar radiofrequency ablation in benign thyroid nodules: differences in energy transmission, duration of application and applied shots. Int J Hyperthermia 2018; 35:216-225. [DOI: 10.1080/02656736.2018.1489984] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Christian Vorländer
- Department of Endocrine Surgery, Burgerhospital Frankfurt, Frankfurt, Germany
| | | | - Yücel Korkusuz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Erbelding
- Department of Nuclear Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Ilknur Baser
- German Center of Thermoablation, Frankfurt, Germany
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20
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Radiofrequenzablation von Schilddrüsenknoten: Good Clinical Practice Empfehlungen. AUSTRIAN JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM 2018. [DOI: 10.1007/s41969-018-0043-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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21
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Korkusuz H, Wolf T, Grünwald F. Feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma: a first evaluation. Int J Hyperthermia 2018; 34:639-643. [DOI: 10.1080/02656736.2018.1453552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- H. Korkusuz
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - T. Wolf
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - F. Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
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22
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Kim JH, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, Choi YJ, Chung SR, Ha EJ, Hahn SY, Jung SL, Kim DS, Kim SJ, Kim YK, Lee CY, Lee JH, Lee KH, Lee YH, Park JS, Park H, Shin JH, Suh CH, Sung JY, Sim JS, Youn I, Choi M, Na DG. 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology. Korean J Radiol 2018; 19:632-655. [PMID: 29962870 PMCID: PMC6005940 DOI: 10.3348/kjr.2018.19.4.632] [Citation(s) in RCA: 340] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023] Open
Abstract
Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology (KSThR) developed recommendations for the optimal use of radiofrequency ablation for thyroid tumors in 2012. As new meaningful evidences have accumulated, KSThR decided to revise the guidelines. The revised guideline is based on a comprehensive analysis of the current literature and expert consensus.
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Affiliation(s)
- Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea
| | - Hye Shin Ahn
- Department of Radiology and Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea
| | - Seon Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan 48101, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul 03181, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul 06351, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Dae Sik Kim
- Department of Radiolgy, Incheon Medical Center, Incheon 22532, Korea.,Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea
| | - Soo Jin Kim
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea.,Department of Radiology, New Korea Hospital, Kimpo 10086, Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kwang Hwi Lee
- Department of Radiology, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, UAE
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul 04763, Korea
| | - Hyesun Park
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul 06351, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jin Yong Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam 13590, Korea
| | - Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul 03181, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul 04554, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea.,Department of Radiology, GangNeung Asan Hospital, Gangneung 25440, Korea
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23
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Korkusuz Y, Mader A, Gröner D, Ahmad S, Mader OM, Grünwald F, Happel C. Comparison of Mono- and Bipolar Radiofrequency Ablation in Benign Thyroid Disease. World J Surg 2018; 41:2530-2537. [PMID: 28474275 DOI: 10.1007/s00268-017-4039-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Radiofrequency ablation (RFA) is an approved minimal invasive method for the treatment of benign thyroid nodules. Several experimental, mainly ex vivo animal studies have compared the effectiveness of different RFA procedures in liver tissue. The aim of this retrospective clinical study was to evaluate the difference between monopolar and bipolar RFA in thyroid tissue considering thyroid volume reduction, patient discomfort and ultrasound evaluation. METHODS Eighteen patients with symptomatic complex benign thyroid nodules were treated in a single RFA session. Nine patients were treated with monopolar RFA, and nine other patients were treated with bipolar RFA. All patients underwent assessments before therapy and at 3-month follow-up (3MFU) including a complete hormone status (T3, T4, TSH, TG, TPOAb, TgAb, TRAb) and several ultrasound (US) evaluations using B-mode and color-coded Doppler imaging. The US evaluations contained measurement of volume, US Doppler, US echogenicity and US elastography. Additionally, applied energy (kJ), power output (W), number of shots (N) and total treatment time (s) were recorded in every case. RESULTS Monopolar RFA resulted in a significant (p < 0.05) average thyroid volume reduction of Ø 18 ± 77 ml (25.1 ± 103%) and a nodule volume reduction of Ø 10.6 ± 22 ml (60.3 ± 62%). Bipolar RFA resulted in a significant (p < 0.05) average thyroid volume reduction of Ø 21.2 ± 54 ml (43.2 ± 84%) and a nodule volume reduction of Ø 13.8 ± 33 ml (70.8 ± 46%). Both groups showed equal results concerning volume reduction (p > 0.05). Monopolar RFA did not lead to any significant changes concerning the US scores, whereas bipolar RFA led to a significant (p < 0.05) reduction in US Doppler and nodular blood flow. No significant difference between both groups could be found concerning applied energy, treatment time, power output and number of shots (p > 0.05). CONCLUSION Bipolar RFA did not show any disadvantages in comparison with monopolar RFA in the treatment of benign thyroid nodules. It shows better performance in terms of volume reduction and is superior when it comes to feasibility and patient discomfort. The recent study confirms the good ex vivo results for bipolar RFA.
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Affiliation(s)
- Yücel Korkusuz
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Alexander Mader
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany. .,Department of Nuclear Medicine, German Center for Thermoablation of Thyroid Nodules, University Medical Center Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Daniel Gröner
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Shadi Ahmad
- Department of General and Visceral Surgery, Agaplesion Elisabethenstift, Darmstadt, Germany
| | - Oscar Maximilian Mader
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
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24
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Wang JF, Wu T, Hu KP, Xu W, Zheng BW, Tong G, Yao ZC, Liu B, Ren J. Complications Following Radiofrequency Ablation of Benign Thyroid Nodules: A Systematic Review. Chin Med J (Engl) 2018; 130:1361-1370. [PMID: 28524837 PMCID: PMC5455047 DOI: 10.4103/0366-6999.206347] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: This systematic review examined whether radiofrequency ablation (RFA) is a safe treatment modality for benign thyroid nodules (BTNs). Data Sources: PubMed, Embase, and the Cochrane Library database were searched for articles that (a) targeted human beings and (b) had a study population with BTNs that were confirmed by fine-needle aspiration cytology and/or core needle biopsy. Study Selection: Thirty-two studies relating to 3409 patients were included in this systematic review. Results: Based on literatures, no deaths were associated with the procedure, serious complications were rare, and RFA appears to be a safe and well-tolerated treatment modality. However, a broad spectrum of complications offers insights into some undesirable complications, such as track needle seeding and Horner syndrome. Conclusions: RFA appears to be a safe and well-tolerated treatment modality for BTNs. More research is needed to characterize the complications of RFA for thyroid nodules.
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Affiliation(s)
- Jin-Fen Wang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Tao Wu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Kun-Peng Hu
- Department of General Surgery, Linnan Hospital, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510530, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, Endocrinology Unit, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Bo-Wen Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Ge Tong
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Zhi-Cheng Yao
- Department of General Surgery, Linnan Hospital, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510530, China
| | - Bo Liu
- Department of General Surgery, Linnan Hospital, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510530, China
| | - Jie Ren
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
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25
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Yoon RG, Baek JH, Chung SR, Choi YJ, Lee JH. Ex vivo comparison between thyroid-dedicated bipolar and monopolar radiofrequency electrodes. Int J Hyperthermia 2018; 34:624-630. [DOI: 10.1080/02656736.2018.1437283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Ra Gyoung Yoon
- Department of Radiology, University of Eulji College of Medicine, Eulji Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sae Rom Chung
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Radzina M, Cantisani V, Rauda M, Nielsen MB, Ewertsen C, D'Ambrosio F, Prieditis P, Sorrenti S. Update on the role of ultrasound guided radiofrequency ablation for thyroid nodule treatment. Int J Surg 2018; 41 Suppl 1:S82-S93. [PMID: 28506420 DOI: 10.1016/j.ijsu.2017.02.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 12/19/2022]
Abstract
Thyroid nodules can be frequently detected in general population, most of them are benign, however malignant cases are rising in the past decades. Ultrasound (US) is the most common imaging modality to assess thyroid nodular lesions, plan patient work-up and guide minimally invasive treatment. The present review paper has been researched to evaluate the current status of radiofrequency ablation (RFA) treatment in order to evaluate indications, techniques, complications, limitations and outcome assessment in benign solid, partially cystic nodules and recurrent malignant nodules. RFA comparison with other ablation techniques has been provided as well. US guided Radiofrequency ablation has been proved to be effective and safe in cases of benign thyroid nodules and a promising treatment method alternative to surgery for patients with recurrent papillary thyroid cancer. It's major role lies in significant reduction of thyroid nodule mean volume and improvement of the patient symptoms. However, future multicenter studies are warranted to better clarify the multi-parametric patient selection criteria and evaluate RFA technique efficacy, advantages and limitations in the variety of thyroid nodular disease.
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Affiliation(s)
- Maija Radzina
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Pilsonu Street 13, LV - 1002, Riga, Latvia.
| | - Vito Cantisani
- Department of Radiological Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185, Viale Regina Elena 324, Italy.
| | - Madara Rauda
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Pilsonu Street 13, LV - 1002, Riga, Latvia.
| | | | - Caroline Ewertsen
- Department of Radiology, University of Copenhagen, Copenhagen, Denmark.
| | - Ferdinando D'Ambrosio
- Department of Radiological Sciences, Policlinico Umberto I, Univ. Sapienza, Roma, 00185, Viale Regina Elena 324, Italy.
| | - Peteris Prieditis
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Pilsonu Street 13, LV - 1002, Riga, Latvia.
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Policlinico Umberto I, University Sapienza, Roma, 00185, Viale Regina Elena 324, Italy.
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Dietrich CF, Müller T, Bojunga J, Dong Y, Mauri G, Radzina M, Dighe M, Cui XW, Grünwald F, Schuler A, Ignee A, Korkusuz H. Statement and Recommendations on Interventional Ultrasound as a Thyroid Diagnostic and Treatment Procedure. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:14-36. [PMID: 29126752 DOI: 10.1016/j.ultrasmedbio.2017.08.1889] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
The recently published guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on interventional ultrasound (INVUS)-guided procedures summarize the intended interdisciplinary and multiprofessional approach. Herewith, we report on recommendations for interventional procedures for diagnosis and treatment of the thyroid gland.
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Affiliation(s)
- Christoph F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany; Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Thomas Müller
- Medizinische Klinik I, Klinikum am Steinenberg, Reutlingen, Germany
| | - Jörg Bojunga
- 1st Medical Department, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Maija Radzina
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Riga, Latvia
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Frank Grünwald
- Department of Nuclear Medicine, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany; German Center for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas Schuler
- Zentrum für Innere Medizin, Alb Fils Kliniken, Helfenstein Klinik, Germany
| | - Andre Ignee
- Medizinische Klinik 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Huedayi Korkusuz
- Department of Nuclear Medicine, Johann Wolfgang Goethe Universitätsklinikum, Frankfurt, Germany; German Center for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
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Korkusuz Y, Gröner D, Raczynski N, Relin O, Kingeter Y, Grünwald F, Happel C. Thermal ablation of thyroid nodules: are radiofrequency ablation, microwave ablation and high intensity focused ultrasound equally safe and effective methods? Eur Radiol 2017; 28:929-935. [PMID: 28894936 DOI: 10.1007/s00330-017-5039-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 06/06/2017] [Accepted: 08/16/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study compares volume reduction of benign thyroid nodules three months after Radiofrequency Ablation (RFA), Microwave Ablation (MWA) or High Intensity Focused Ultrasound (HIFU) to evaluate which of these methods is the most effective and safe alternative to thyroidectomy or radioiodine therapy. MATERIAL AND METHODS Ninety-four patients (39 male, 55 female) with a total of 118 benign, symptomatic thyroid nodules were divided into three subgroups. HIFU was applied to 14 patients with small nodules. The other 80 patients were divided up into two groups of 40 patients each for RFA and MWA in the assumption that both methods are comparable effective. The pre-ablative and post-ablative volume was measured by ultrasound. RESULTS RFA showed a significant volume reduction of nodules of 50 % (p<0.05), MWA of 44 % (p<0.05) and HIFU of 48 % (p<0.05) three months after ablation. None of the examined ablation techniques caused serious or permanent complications. CONCLUSION RFA, MWA and HIFU showed comparable results considering volume reduction. All methods are safe and effective treatments of benign thyroid nodules. KEY POINTS • Thermal Ablation can be used to treat benign thyroid nodules • Thermal Ablation can be an alternative to thyroidectomy or radioiodine therapy • Radiofrequency Ablation, Microwave Ablation, High Intensity Focused Ultrasound are safe and effective.
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Affiliation(s)
- Yücel Korkusuz
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Daniel Gröner
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Natascha Raczynski
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.
| | - Oleg Relin
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany
| | - Yasmina Kingeter
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
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29
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Jeong SY, Baek JH, Choi YJ, Lee JH. Ethanol and thermal ablation for malignant thyroid tumours. Int J Hyperthermia 2017; 33:938-945. [PMID: 28797186 DOI: 10.1080/02656736.2017.1361048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid malignancy and has a good prognosis and low mortality rate. Surgery is the standard treatment for patients with primary and recurrent thyroid cancer. Although patients with PTC usually exhibit excellent treatment outcome, the incidence of recurrence in the neck ranges from 20% to 59%. When a patient with thyroid cancer is contraindicated for surgery, ultrasound (US)-guided ablation techniques, including ethanol ablation (EA) and thermal ablations, are suggested alternatives. In this review, we evaluated the indications, devices, techniques, clinical outcomes, and complications associated with US-guided EA and thermal ablations based on available scientific evidence and expert opinions regarding the use of ablation for primary and recurrent thyroid cancers.
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Affiliation(s)
- So Yeong Jeong
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
| | - Jung Hwan Baek
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
| | - Young Jun Choi
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
| | - Jeong Hyun Lee
- a Department of Radiology and Research Institute of Radiology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea
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Park HS, Baek JH, Park AW, Chung SR, Choi YJ, Lee JH. Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques. Korean J Radiol 2017; 18:615-623. [PMID: 28670156 PMCID: PMC5447637 DOI: 10.3348/kjr.2017.18.4.615] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/09/2017] [Indexed: 12/21/2022] Open
Abstract
Radiofrequency ablation (RFA) is a well-known, effective, and safe method for treating benign thyroid nodules and recurrent thyroid cancers. Thyroid-dedicated devices and basic techniques for thyroid RFA were introduced by the Korean Society of Thyroid Radiology (KSThR) in 2012. Thyroid RFA has now been adopted worldwide, with subsequent advances in devices and techniques. To optimize the treatment efficacy and patient safety, understanding the basic and advanced RFA techniques and selecting the optimal treatment strategy are critical. The goal of this review is to therefore provide updates and analysis of current devices and advanced techniques for RFA treatment of benign thyroid nodules and recurrent thyroid cancers.
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Affiliation(s)
- Hye Sun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Auh Whan Park
- Department of Radiology, Vascular & Interventional Radiology Section, University of Virginia Health System, Charlottesville, VA 22908-0170, USA
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Mader A, Mader OM, Gröner D, Korkusuz Y, Ahmad S, Grünwald F, Kranert WT, Happel C. Minimally invasive local ablative therapies in combination with radioiodine therapy in benign thyroid disease: preparation, feasibility and efficiency - preliminary results. Int J Hyperthermia 2017; 33:895-904. [PMID: 28540810 DOI: 10.1080/02656736.2017.1320813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Initial studies of combinations of radioiodine therapy (RIT) and local ablative procedures for the treatment of thyroid nodules have shown promising results. The goal of this study was to evaluate the effectiveness of RIT combined with radiofrequency ablation (RFA) in patients with goitres and to determine which ablative procedure is the most suitable for a combined therapy. METHODS Thirty patients with goitres were divided into two subgroups. A test group of 15 patients received combined therapy (RIT + RFA) and a control group of 15 patients received RIT mono therapy. All patients underwent assessments including ultrasound, laboratory evaluation (T3, T4, TSH, TG, TPOAb, TgAbTRAb) and scintigraphic imaging with Tc-99m-Pertechnetate. The 3-month volume reduction was used to evaluate therapy effectiveness. RESULTS Combined therapy (subgroup 1) resulted in a significant (p < 0.05) thyroid volume reduction (22.3 ± 54 ml/32.2 ± 58.2%) with better performance (p > 0.05) than the control group (20.2 ± 32.2 ml/29.6 ± 42.1%). All patients became euthyroid after treatment. No major discomfort or complications occurred. A review of the literature investigating combinations of other local ablative procedures with RIT was performed to determine the most promising combination. CONCLUSIONS The present study confirms the positive experiences with the combined therapy of RIT and local ablative procedures shown in the current literature and approves this approach for the treatment of goitres with RFA + RIT. These findings, when confirmed by further studies, should expand the indication of combined therapy as a minimally invasive alternative to surgery.
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Affiliation(s)
- Alexander Mader
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Oscar Maximilian Mader
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Daniel Gröner
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Yücel Korkusuz
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Shadi Ahmad
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Frank Grünwald
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - W Tilman Kranert
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Christian Happel
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
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32
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Trujillo M, Bon J, Berjano E. Computational modelling of internally cooled wet (ICW) electrodes for radiofrequency ablation: impact of rehydration, thermal convection and electrical conductivity. Int J Hyperthermia 2017; 33:624-634. [DOI: 10.1080/02656736.2017.1303751] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Macarena Trujillo
- Biomedical Synergy, Department of Applied Mathematics, Universitat Politècnica de València, Valencia, Spain
| | - Jose Bon
- Food Technology Department, Universitat Politècnica de València, Valencia, Spain
| | - Enrique Berjano
- Biomedical Synergy, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
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Yue WW, Wang SR, Lu F, Sun LP, Guo LH, Zhang YL, Li XL, Xu HX. Radiofrequency ablation vs. microwave ablation for patients with benign thyroid nodules: a propensity score matching study. Endocrine 2017; 55:485-495. [PMID: 27905049 DOI: 10.1007/s12020-016-1173-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/05/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare the efficacy and the safety of radiofrequency ablation and microwave ablation for treatment of benign thyroid nodules using a propensity score matching study design. METHODS Two hundred and sixty patients with benign thyroid nodules were studied retrospectively, including 102 patients treated with radiofrequency ablation and 158 treated with microwave ablation. To reduce confounding bias due to retrospective assignment, propensity score matching was performed to balance the preablation data of the two groups. After matching, a total of 102 patient pairs (1:1) were created. The volume reduction ratio, therapeutic success rate, symptom and cosmetic score, and major complication were compared between the two groups at 1, 3, 6, and 12 months after treatment. RESULTS Between the well-matched groups, no significant differences were found in all nodule volume-related end points at 6 months (volume reduction ratio: 79.4 vs. 77.2 %, P = 0.108; symptom score: 2.1 vs. 1.9, P = 0.456; cosmetic score: 2.1 vs. 2.3, P = 0.119; therapeutic success rate: 99 vs. 97 %, P = 0.621) and 12 months (volume reduction ratio: 83.6 vs. 81.6 %, P = 0.144; symptom score: 1.5 vs. 1.5, P = 0.869; cosmetic score: 1.6 vs. 1.7, P = 0.409; therapeutic success rate: 100 vs. 100 %, P > 0.99) after treatment. No major complications occurred in either group (P > 0.99). CONCLUSIONS With well-matched groups and consistent procedure design, our results demonstrated that the volume reduction ratio, therapeutic success rate, symptom and cosmetic score, and complications related to treatment for the two techniques are equivalent. Radiofrequency ablation and microwave ablation are both effective and safe methods in treating benign thyroid nodules.
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Affiliation(s)
- Wen-Wen Yue
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Yantai, Shandong, 264100, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Yantai, Shandong, 264100, China.
| | - Feng Lu
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Yong-Lin Zhang
- Department of Medical Ultrasound, Yantai Affiliated Hospital, Binzhou Medical University, Yantai, Shandong, 264100, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China.
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Kim JH, Baek JH, Sung JY, Min HS, Kim KW, Hah JH, Park DJ, Kim KH, Cho BY, Na DG. Radiofrequency ablation of low-risk small papillary thyroidcarcinoma: preliminary results for patients ineligible for surgery. Int J Hyperthermia 2016; 33:212-219. [PMID: 27590679 DOI: 10.1080/02656736.2016.1230893] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The purpose of this study is to retrospectively evaluate the outcomes of radiofrequency ablation (RFA) of low-risk small papillary thyroid carcinomas (PTCs) in patients who were ineligible for surgery. MATERIALS AND METHODS Between 2005 and 2009, six PTCs (mean diameter, 0.92 cm; range, 0.6-1.3 cm) in six patients were treated with RFA by three radiologists in two hospitals. The inclusion criteria for this study were (1) pathologically confirmed PTC without cytological aggressiveness, (2) single PTC without extrathyroidal extension, (3) no metastatic tumours and (4) ineligibility for surgery. RFA was performed using a radiofrequency generator and an 18-gauge internally cooled electrode. The medical records were reviewed and analysed, focussing on the procedural profiles of RFA, symptoms and complications during and after RFA, and changes in tumours on follow-up ultrasonography. RESULTS Before and after RFA, the results of thyroid function tests were normal in all patients. During 48.5 ± 12.3 months (range, 36-65 months) of follow-up, along with a significant reduction in the mean volume (98.5 ± 3.3%), four ablation zones (4/6, 66.7%) completely disappeared. Two ablation zones exhibited only small calcified residues with nearly complete disappearance of the corresponding non-calcified solid portions, and in one of them, malignant cells were absent as assessed by fine-needle aspiration and core-needle biopsy. Transient hypertension with mild headache (n = 1) and mild neck pain (n = 1) developed during the procedure and subsided without any treatment. CONCLUSION Besides surgery and active surveillance, which are conflicting currently used management plans, RFA might represent an effective and a safe alternative for managing low-risk small PTCs, especially in patients ineligible for surgery.
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Affiliation(s)
- Ji-Hoon Kim
- a Department of Radiology, Seoul National University Hospital , Jongno-gu , The Republic of Korea
| | - Jung Hwan Baek
- b Department of Radiology, University of Ulsan College of Medicine, Asan Medical Centre , Seoul , The Republic of Korea
| | - Jin Yong Sung
- c Department of Radiology, Daerim St. Mary's Hospital , Seoul , The Republic of Korea
| | - Hye Sook Min
- d Department of Pathology, Seoul National University Hospital , Jongno-gu , The Republic of Korea ;,e Department of Preventive Medicine, Seoul National University , Gwanak-gu , The Republic of Korea
| | - Kyung Won Kim
- f Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Centre , Seoul , The Republic of Korea
| | - J Hun Hah
- g Department of Otolaryngology ? Head and Neck Surgery, Seoul National University Hospital , Jongno-gu , The Republic of Korea
| | - Do Joon Park
- h Departrment of Internal Medicine, Seoul National University Hospital , Jongno-gu , The Republic of Korea
| | - Kwang Hyun Kim
- i Department of Otolaryngology ? Head and Neck Surgery, SMG-SNU Boramae Medical Centre , Seoul , The Republic of Korea
| | - Bo Youn Cho
- j Department of Internal Medicine, Chung Ang University Hospital , Seoul , The Republic of Korea
| | - Dong Gyu Na
- k Department of Radiology, Human Medical Imaging and Intervention Centre , Seoul , The Republic of Korea
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