Primary papillary thyroid carcinoma previously treated incompletely with radiofrequency ablation

Sublethal thermal stress promotes migration and invasion of thyroid cancer cells

OBJECTIVE

Radiofrequency ablation is a viable option in the treatment of benign thyroid nodules. Some reports suggest that thermal ablation may also be safe for the management of low-risk thyroid cancer. In this study, we applied transient heat treatment to thyroid cancer cells to mimic clinical scenarios in which insufficient ablation leads to incomplete eradication of thyroid cancer.

METHODS

Differentiated thyroid cancer cell lines B-CPAP, TPC-1, and FTC-133 were subjected to heat treatment at different temperatures for 10 min. Effects on cell growth, clonogenicity, wound healing assay, and Transwell invasion were determined.

RESULTS

Heat treatment at 45°C or higher reduced cell growth, whereas viability of thyroid cancer cells was not changed after heat treatment at 37, 40, or 42°C. Heat treatment at 40°C increased the number of colony formations by 16% to 39%. Additionally, transient heat treatment at 40°C resulted in a 1.75-fold to 2.56-fold higher migratory activity than treatment at 37°C. Invasive capacity was increased after heat treatment, ranging from 115% to 126%. Expression of several epithelial-mesenchymal transition markers, including ZEB1, N-cadherin, and MMP2, was upregulated following heat treatment at 40°C.

CONCLUSION

We for the first time demonstrate that sublethal thermal stress may increase clonogenicity, migration, and invasion of thyroid cancer cells.

Safety and efficacy of microwave ablation for the treatment of low-risk papillary thyroid microcarcinoma: a prospective multicenter study

OBJECTIVES

To assess the safety and efficacy of ultrasound-guided thermal ablation for low-risk papillary thyroid microcarcinoma (PTMC) via a prospective multicenter study.

METHODS

From January 2017 through June 2021, low-risk PTMC patients were screened. The management details of active surveillance (AS), surgery, and thermal ablation were discussed. Among patients who accepted thermal ablation, microwave ablation (MWA) was performed. The main outcome was disease-free survival (DFS). The secondary outcomes were tumor size and volume changes, local tumor progression (LTP), lymph node metastasis (LNM), and complication rate.

RESULTS

A total of 1278 patients were included in the study. The operation time of ablation was 30.21 ± 5.14 min with local anesthesia. The mean follow-up time was 34.57 ± 28.98 months. Six patients exhibited LTP at 36 months, of whom 5 patients underwent a second ablation, and 1 patient received surgery. The central LNM rate was 0.39% at 6 months, 0.63% at 12 months, and 0.78% at 36 months. Of the 10 patients with central LNM at 36 months, 5 patients chose ablation, 3 patients chose surgery and the other 2 patients chose AS. The overall complication rate was 1.41%, and 1.10% of patients developed hoarseness of the voice. All of the patients recovered within 6 months.

CONCLUSIONS

Thermal ablation of low-risk PTMC was observed to be safe and efficacious with few minor complications. This technique may help to bridge the gap between surgery and AS as treatment options for patients wishing to have their PTMC managed in a minimally invasive manner.

CLINICAL RELEVANCE STATEMENT

This study proved that microwave ablation is a safe and effective treatment method for papillary thyroid microcarcinoma.

KEY POINTS

Percutaneous US-guided microwave ablation of papillary thyroid microcarcinoma is a very minimally invasive treatment under local anesthesia during a short time period. The local tumor progression and complication rate of microwave ablation in the treatment of papillary thyroid microcarcinoma are very low.

Rigorous radiofrequency ablation can completely treat low-risk small papillary thyroid carcinoma without affecting subsequent surgical management

OBJECTIVE

Minimally invasive therapies are gaining interest because of the indolence and excellent prognosis of low-risk papillary thyroid carcinoma (PTC). This study aimed to evaluate the outcomes of radiofrequency ablation (RFA) for low-risk PTC and to determine the effects of ablation on subsequent surgical management.

METHODS

A medical record review was conducted including patients with low-risk PTC who underwent surgery after RFA from July 2015 to July 2021. Demographic characteristics, tumor characteristics, ablation procedures, surgical findings, and pathological changes were reviewed for all patients. The primary outcomes were surgical and pathological changes in post-ablation patients.

RESULTS

Of the 10 patients with 11 PTCs, 9 (90%) were women; the median (SD) patient age was 41.5 (8.2) years. The maximum diameter range of PTCs was 3.0-12.0 mm. All 10 patients underwent rigorous RFA procedure involving a four-step approach, and had received surgical management. Intraoperatively, no patients had muscle and nerve injuries, and mild adhesion of the post-ablation lesions with the anterior cervical muscle was observed in two cases. Histopathologically, no residual PTCs were observed in the ablated areas in all patients. Central lymph node metastasis (LNM) was found in three (30.0%, pN1a). Occult PTCs were observed in three cases (30.0%).

CONCLUSIONS

Our findings suggest that low-risk small PTCs can be completely treated with rigorous RFA, which does not affect subsequent surgical management, if necessary. RFA may be a treatment option, but occult PTCs and clinically negative LNMs may be overlooked. Long-term follow-up data are necessary to further identify its efficacy.

KEY POINTS

• RFA can completely treat low-risk small PTC. • RFA does not affect the subsequent surgical management if necessary. • Because occult PTCs and clinically negative LNMs may be overlooked by RFA, long-term follow-up data are necessary to further identify its efficacy.

Thermal Ablation for the Management of Papillary Thyroid Microcarcinoma in the Era of Active Surveillance and Hemithyroidectomy

PURPOSE OF REVIEW

Thermal ablation presents a therapeutic option other than active surveillance and immediate surgery for patients with low-risk papillary thyroid microcarcinomas (PTMC). Here, we have reviewed the current oncologic outcome of thermal ablation in PTMC cases and compared it with active surveillance and surgery.

RECENT FINDINGS

Thermal ablation in PTMC cases revealed no tumor progression for pooled 5-year follow-up data. This oncologic outcome of thermal ablation was comparable to that of immediate surgery with less morbidity. Additionally, no patient who underwent thermal ablation received delayed surgery during the follow-up period due to anxiety. However, active surveillance has indicated that a substantial proportion (range, 8-32%) of patients underwent surgery mainly due to anxiety. In a subset of PTMC patients who are high-risk surgical candidates or who refuse surgery, especially those who have failed or are reluctant to pursue active surveillance, thermal ablation can be a good option.

Pathology confirmation of the efficacy and safety of microwave ablation in papillary thyroid carcinoma

BACKGROUND

The incidence of papillary thyroid carcinoma (PTC) has rapidly increased in recent years. Microwave ablation (MWA) was proposed as an alternative treatment for PTC. This study aimed to investigate the efficacy and safety of MWA by exploring the postoperative pathology results of post-ablation lesions in patients with PTC.

METHODS

This study retrospectively analyzed data from 12 patients who underwent thyroid surgery after MWA treatment for primary PTC between January 2015 and November 2021 in six hospitals.

RESULTS

The average age of the 12 patients (8 female) was 45.3 ± 9.7 years. There was one patient with PTC (size > 1 cm) and 11 patients with micro-PTC (size ≤ 1 cm), of which eight patients had unifocal micro-PTC and three patients had multifocal micro-PTC. A total of 17 tumor foci with mean size of 6.2 ± 2.6 mm were treated by MWA. The median interval time between MWA and surgery was 6.6 months (range: 0.4-21.9 months). Intraoperatively, adherence to the anterior cervical muscle group was observed in three cases (3/12). Upon postoperative pathologic examination, all the post-ablation lesions of the eight unifocal micro-PTC and two multifocal micro-PTC showed no residual carcinomas. Outside the ablation zone, PTCs were detected in three cases, including two of the eight patients with unifocal micro-PTC and one of the three patients with multifocal micro-PTC. Cervical lymph node metastases were detected in seven patients (7/12).

CONCLUSION

MWA was feasible for the treatment of primary unifocal low-risk micro-PTC (T1aN0M0) with good efficacy and safety. However, the use of MWA for treating PTC (size > 1 cm) and multifocal micro-PTC remains controversial.

Radiofrequency ablation and thyroid nodules: updated systematic review

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.

Five-year follow-up results of thermal ablation for low-risk papillary thyroid microcarcinomas: systematic review and meta-analysis

OBJECTIVES

Confidence in long-term treatment results of thermal ablation for papillary thyroid microcarcinoma (PTMC) is required in comparison with active surveillance. The objective of this meta-analysis is to report 5-year follow-up results of thermal ablation for PTMC.

METHODS

Ovid MEDLINE and EMBASE databases were searched through May 30, 2020, for studies reporting outcomes in patients with PTMC treated with thermal ablation and followed up for at least 5 years. Data were extracted and methodological quality was assessed independently by two radiologists according to the PRISMA guidelines.

RESULTS

Three studies, involving 207 patients with 219 PTMCs, met the inclusion criteria through database searches. None of these patients experienced local tumor recurrence, lymph node metastasis, or distant metastasis or underwent delayed surgery during a mean pooled 67.8-month follow-up. Five new tumors appeared in the remaining thyroid gland of four patients, with four of these tumors successfully treated by repeat thermal ablation. The pooled mean major complication rate was 1.2%, with no patient experiencing life-threatening or delayed complications.

CONCLUSIONS

Thermal ablation is an excellent local tumor control method in patients with low-risk PTMC, with low major complication rates at 5 years.

KEY POINTS

• No local tumor recurrence, lymph node metastasis, or distant metastasis was noted by thermal ablation during follow-up of 5 years and none underwent delayed surgery. • The pooled mean major complication rate was 1.2%.

Residual tumor and central lymph node metastasis after thermal ablation of papillary thyroid carcinoma: A case report and review of literature

BACKGROUND

Debate exists regarding the use of thermal ablation (TA) to treat papillary thyroid carcinoma (PTC). Some studies have recommended TA as a new, efficient and safe technology for PTC. In this article, we report one case of a residual tumor and central lymph node metastasis (CLNM) after TA for PTC.

CASE SUMMARY

A 63-year-old female underwent bilateral ultrasound (US)-guided radiofrequency ablation for PTC. Three months later, she was diagnosed as thyroid cancer with suspected CLNM by US and contrast-enhanced computed tomography. The subsequent fine-needle aspiration (FNA) biopsies were negative. Due to her strong personal preference, she underwent total thyroidectomy and central lymph node dissection. Local tissue adhesion and a difficult dissection were noted during the operation. The pathology of the frozen sections during the operation was still negative. The final pathology results of paraffin-embedded sections revealed residual tumor cells at the edge of the PTC and CLNM.

CONCLUSION

TA may lead to a residual tumor in patients with PTC. Follow-up using US and FNA biopsy may not be adequate to evaluate the residual tumor. TA should be carefully considered in PTC treatment.

Surgery After Ultrasound-Guided Radiofrequency Ablation for Papillary Thyroid Carcinoma in 21 Patients: A Retrospective Study from a Single Center in China

BACKGROUND Radiofrequency ablation (RFA) is used to treat various cancers, but its use in thyroid cancer remains controversial. The aim of this study was to investigate surgical findings after RFA for papillary thyroid cancer (PTC). MATERIAL AND METHODS The study included 21 patients (average age 44.9±13.3 years) who had biopsy-confirmed thyroid cancer treated with RFA in multiple hospitals. Surgery was done in the First Hospital of China Medical University. RESULTS The 21 patients had a total of 32 thyroid nodules that were treated with RFA. Twenty-eight nodules were malignant, and 4 nodules were benign. Before RFA, 17 of the malignant nodules were >1 cm and 11 were ≤1 cm. Among the 28 malignant nodules, post-ablation lesions adhered to or invaded the structures surrounding the thyroid in 17 (60.7%), 19 (67.9%), and 22 (78.6%) nodules evaluated with ultrasound, contrast-enhanced computed tomography, and intraoperatively, respectively. Based on pathology results, 7 (33.3%) of the 21 patients had bilateral cancer. Ten (47.6%) of the 21 patients had central lymph node metastasis and 2 (9.5%) had lateral lymph node metastasis. For 5 (15.6%) of the 32 nodules, the fine-needle aspiration results were not consistent with the postoperative pathological results. Five (23.8%) of the 21 patients with lymph node metastasis had clinically negative (CN0) lesions. CONCLUSIONS RFA for PTC primary lesions may be incomplete and leave residual lymph node metastasis, even in lesions ≤1 cm. RFA should be recommended with caution in the treatment of operable patients with primary PTC.

US-guided Microwave Ablation of Low-Risk Papillary Thyroid Microcarcinoma: Longer-Term Results of a Prospective Study

BACKGROUND

Papillary thyroid microcarcinoma (PTMC) has become a main cause of the extremely high incidence of thyroid carcinoma. This study aimed to evaluate the longer-term effectiveness of ultrasound (US)-guided microwave ablation (MWA) for treatment of low-risk PTMC with a large population.

METHODS

This prospective study was approved by ethics committee of our institution. MWA was performed under US-guidance for 119 unifocal PTMC patients without clinically cervical or distant metastasis. The target ablation zone exceeded the tumor edge judged by contrast-enhanced US to avoid marginal residue and recurrence. US and thyroid function evaluation were followed at 1, 3, 6, and 12 months after treatment and every 6 to 12 months thereafter. Any adverse event associated with MWA was evaluated.

RESULTS

The follow-up duration after MWA was 37.2 ± 20.9 months (range 12-101 months). Tumor volume decreased significantly from 1.87 ± 1.03 mL immediately after MWA to 0.01 ± 0.04 mL at the final evaluation (P < 0.001), with a mean volume reduction ratio of 99.4 ± 2.2% and 107 cases (93.9%) got complete remission. A patient was detected with cervical lymph node metastasis at 26-month follow-up and underwent 1 additional MWA treatment successfully. No distant metastasis was observed. All the acquired histological pathology results confirmed the absence of residual or recurrent tumor cells after MWA. No delayed complications associated with MWA were encountered for all patients.

CONCLUSIONS

Percutaneous MWA is technically feasible for complete PTMC destruction and showed well longer-term effectiveness; thus, it seems to be an effective nonsurgical therapy to complement the current recommendation for selected low-risk PTMC patients.

Efficacy and safety of radiofrequency, microwave and laser ablation for treating papillary thyroid microcarcinoma: a systematic review and meta-analysis

Background: To evaluate the efficacy and safety of radiofrequency ablation (RFA), microwave ablation (MWA) and laser ablation (LA) for treating papillary thyroid microcarcinoma (PTMC).Materials and methods: PUBMED and EMBASE were searched for studies on the efficacy and safety of RFA, MWA and LA for treating PTMC. The standard mean difference of the tumor volume before and after therapy and the proportion of complete disappearance, local recurrence, distant metastasis and complications were assessed using both fixed or random-effects modeling. Heterogeneity among studies was determined using the Q statistic for the pooled estimates and the inconsistency index I².Results: A total of 12 eligible studies, including a sample size of 1187 patients and 1284 PTMCs, were used. RFA, MWA and LA all showed a significant reduction in tumor volume of PTMCs (p < 0.05). Though MWA demonstrated superior efficacy over the other two therapies for volume reduction, the differences were not statistically significant. Additionally, the pooled proportion of complete disappearance after RFA was the highest (76.2%), and the pooled proportion of recurrence for RFA was the lowest (0.01%) among the three therapeutic methods, but no significant difference was detected. There was no event of distant metastasis during the follow-up in all of these studies. Few major complications were encountered; the pooled proportion of complications for RFA (1.73%), MWA (6.0%) and LA (0.92%) was low, revealing no significant differences (p > 0.05).Conclusion: RFA, MWA and LA are acceptable treatments to manage PTMCs in terms of efficacy and safety for non-surgical candidates.

Thermal Ablation for Small Papillary Thyroid Cancer: A Systematic Review

Background: Although clinical studies indicate that thermal ablation is effective in treating low-risk papillary thyroid microcarcinomas (PTMCs), the effectiveness of this treatment in patients with low-risk PTMC has not yet been systematically evaluated. Methods: Ovid-MEDLINE and EMBASE databases were searched for studies published through May 1, 2019, which report the efficacy of thermal ablation in patients with low-risk PTMCs. Data were extracted and methodological quality was assessed independently by two radiologists according to PRISMA guidelines. Results: This systematic review identified 503 low-risk PTMCs in 470 patients treated by thermal ablation from 9 studies. During follow-up, no patient experienced local tumor recurrence or distant metastasis, whereas two patients (0.4%) experienced lymph node (LN) metastasis. One patient (0.2%) developed a new PTMC, which was successfully treated by additional ablation. Five patients (1.1%) underwent delayed surgery after ablation, including the two patients with LN metastasis and three additional patients with unknown etiology. Conclusions: Thermal ablation is an excellent local tumor control method in patients with low-risk PTMCs. Strict inclusion criteria and technical expertise are required to obtain favorable results.

Surgical Confirmation of Incomplete Treatment for Primary Papillary Thyroid Carcinoma by Percutaneous Thermal Ablation: A Retrospective Case Review and Literature Review

BACKGROUND

Recently, thermal ablation has been proposed for treating primary papillary thyroid carcinoma (PTC), triggering an extensive debate. This study aimed to analyze surgical outcomes of post-ablation cases to investigate the effectiveness and safety of thermal ablation in primary PTC.

METHODS

Primary PTC patients treated with thermal ablation were retrospectively searched for from the authors' medical record database prior to August 2017. The surgical patients met the following criteria: (i) primary PTC treated with thermal ablation, (ii) findings suspicious for malignancy of the post-ablation lesions on ultrasound or malignancy confirmed by cytology, or with clinical evidence of cervical lymph node metastasis (LNM), (iii) written informed consent for surgery, (iv) preference for definite diagnosis of the post-ablation lesions for the patients without evidence for malignant findings, and (v) tolerance of a thyroidectomy and without severe illness. Moreover, a systematic review of the literature was made to analyze relevant cases.

RESULTS

Twelve patients with an average age of 41.0 ± 13.6 years constituted the Fudan University Shanghai Cancer Center cohort in this study. Twenty-two foci with a mean size of 1.3 ± 0.7 cm were ablated percutaneously under ultrasound guidance. Residual PTCs were confirmed in all cases by histopathology, and LNM was present in 66.7% (8/12) of the patients. Intraoperatively, adhesion of the post-ablation lesions with the strap muscles was observed in six cases. Strap muscles were found to be cauterized in five cases, and notably the recurrent laryngeal nerve was involved in one case. Furthermore, seven relevant studies from Korea, Italy, and China were retrospectively reviewed, and incomplete ablation of primary PTC and omission of LNM by thermal ablation were observed frequently.

CONCLUSIONS

Surgical therapy demonstrated incomplete ablation of primary PTC and omission of LNM by thermal ablation in this cohort of patients. Thermal ablation should be recommended with caution as treatment of operable patients with primary PTC.

Update on the role of ultrasound guided radiofrequency ablation for thyroid nodule treatment

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.

Ultrasound-guided percutaneous laser ablation of unifocal T1N0M0 papillary thyroid microcarcinoma: Preliminary results

OBJECTIVES

To evaluate the efficacy and safety of percutaneous laser ablation (PLA) for unifocal T1N0M0 papillary thyroid microcarcinoma(PTMC).

METHODS

A retrospective study was conducted in 30 patients with single PTMC which was diagnosed by fine-needle aspiration biopsy (FNAB). PLA was performed for proper time to achieve adequate ablation zones. The extent of ablation was assessed by contrast-enhanced ultrasound (CEUS) immediately and 7 days after PLA. Complications were recorded. The size and volume of the ablation area and thyroid hormones were measured, and clinical evaluations were performed at 1, 3, 6 and12 months, and every half year thereafter.

RESULTS

The procedure was well tolerated without serious complications. Of the 30 patients, 29 were treated successfully under local anaesthesia in a single session. Only one incomplete ablation was detected by immediate CEUS after PLA, and a second ablation was performed. At the last follow-up, ten (33.3 %) ablation zones had disappeared, and 20 (66.67 %) ablation zones remained as scar-like lesions. No regrowth of treated tumours, local recurrence or distant metastases were detected.

CONCLUSIONS

During the short-term follow-up period, ultrasound-guided PLA appears to be effective and safe for treating solitary T1N0M0 PTMC in selected patients who are ineligible for surgery.

KEY POINTS

• Ultrasound is a useful tool in percutaneous laser ablation (PLA). • PLA is safe for treating papillary thyroid microcarcinoma. • PLA is effective for single papillary thyroid microcarcinoma.

Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance?

The incidence of differentiated thyroid cancer is increasing greatly in high-income countries. Roughly 50% of this increase is attributable to the identification of intrathyroidal papillary thyroid microcarcinomas. Since mortality associated with these tumours remains low and stable, the increasing diagnosis has led to concerns about overdiagnosis and overtreatment. Management of papillary thyroid microcarcinomas should take into account the reported absence of mortality when diagnosed in the absence of lymph node metastases and distant metastases, as shown even in recent studies promoting active surveillance; a low recurrence rate of 1-5%; and the risk of permanent complications from surgery that cannot be decreased to less than 1-3%, even in high-volume tertiary care centres with experienced surgeons. On the basis of these data, active surveillance with curative intent, in which active treatment is delayed until the cancer shows signs of significant progression to avoid side-effects of treatment, should be considered in properly selected patients.

Radiofrequency ablation of low-risk small papillary thyroidcarcinoma: preliminary results for patients ineligible for surgery

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.

Radiofrequency ablation for benign thyroid nodules

Benign thyroid nodules are an extremely common occurrence. Radiofrequency ablation (RFA) is gaining ground as an effective technique for their treatment, in case they become symptomatic. Here we review what are the current indications to RFA, its outcomes in terms of efficacy, tolerability, and cost, and also how it compares to the other conventional and experimental treatment modalities for benign thyroid nodules. Moreover, we will also address the issue of treating with this technique patients with cardiac pacemakers (PM) or implantable cardioverter-defibrillators (ICD), as it is a rather frequent occurrence that has never been addressed in detail in the literature.

Needle track tumor seeding after radiofrequency ablation of a thyroid tumor

A 19-year-old female underwent two radiofrequency ablation procedures for a thyroid tumor that was proven to be nodular hyperplasia versus a follicular neoplasm by fine-needle aspiration. Two years after the last follow-up, the thyroid mass had grown and a newly developed mass was detected in the platysma muscle. After surgery, the thyroid mass was revealed to be a solid papillary thyroid carcinoma, and the subplatysmal mass was tumor seeding.

Combination therapy of temporary tracheal stenting and radiofrequency ablation for multinodular thyroid goiter with airway compression

We report a case of multinodular thyroid goiter in an 80-year-old man who successfully underwent tracheal stent placement for respiratory distress caused by the thyroid goiter and following two radiofrequency (RF) ablation sessions performed for thyroid volume reduction. This sequential treatment allowed elective stent removals four weeks after the second RF ablation session because the thyroid volume had been progressively reduced. Combination therapy of temporary airway stenting and RF ablation for the treatment of thyroid goiter has two advantages, i.e., immediate reliefs of dyspnea with airway stenting and reductions of the thyroid volume with RF ablation, and thus, allowing symptom reliefs even after the stent removals.

Use of radiofrequency ablation in benign thyroid nodules: a literature review and updates

Successful thermal ablation using radiofrequency has been reported in various tumors including liver or kidney tumors. Nonsurgical minimally invasive ablative therapy such as radiofrequency ablation (RFA) has been reported to be a safe and efficient treatment option in managing symptomatic cold thyroid nodules or hyperfunctioning thyroid nodules. Pressure and cosmetic symptoms have been shown to be significantly improved both in the short and long terms after RFA. For hyperfunctioning thyroid nodules, RFA is indicated for whom surgery or radioiodine are not indicated or ineffective or for those who refuse surgery or radio-iodine. Improvement of thyroid function with decreased need for antithyroid medications has been reported. Complication rate is relatively low. By reviewing the current literature, we reported its efficacy and complications and compared the efficacy of RFA relative to other ablative options such as ethanol ablation and laser ablation.