Radiofrequency for benign and malign thyroid lesions

Assessing the efficacy of thyroid nodule radiofrequency ablation using patient-reported outcome measures

BACKGROUND

Radiofrequency ablation has recently emerged as an alternative treatment for thyroid nodules. Most studies are centered on volume reduction, whereas a few have assessed symptom improvement mainly with nonstandardized metrics. As experience in the United States is growing, we aim to assess the efficacy of radiofrequency ablation in treating benign thyroid nodules using the validated Patient-Reported Outcomes Measurement for Parathyroid and Thyroid Disease.

METHODS

This is a prospective study of a newly established radiofrequency ablation program at a single tertiary referral center in 2022. Patients who underwent radiofrequency ablation were evaluated using the Patient-Reported Outcomes Measurement for Parathyroid and Thyroid Disease, a validated metric ranging from 0 to 100 at baseline, 2 weeks, 3 months, and 6 months. In addition, a thyroid ultrasound was done at those intervals to assess size and volume reduction. Procedure complications were evaluated as well.

RESULTS

A total of 25 patients underwent radiofrequency ablation during the study period for a total of 32 nodules treated; 84% were female with a mean age of 51 years. The baseline mean nodule volume and largest dimension were 13 ± 11 mL and 3.4 ± 1 cm, respectively. A significant change in the Patient-Reported Outcomes Measurement for Parathyroid and Thyroid Disease compressive score was seen at 3 months (38.9 ± 26.4 to 21.0 ± 21.4; P = .004) and 6 months (32.7 ± 19.9 to 17.5 ± 21.0; P = .02) but not at 2 weeks (41.0 ± 22.7 to 36.1 ± 21.9; P = .28). Significant volume and size reductions were seen at all 3-time points. Two complications occurred.

CONCLUSION

Our initial results of the thyroid radiofrequency ablation program find that it effectively alleviates symptoms by reducing nodule size in patients with symptomatic benign thyroid nodules.

Radiofrequency ablation (RFA) compared to observation for benign thyroid nodules: emerging considerations for judicious use

PURPOSE OF REVIEW

Radiofrequency ablation (RFA) for thyroid nodules confers tangible advantages over surgery, which include promising outcomes in the context of a minimally invasive procedure and the functional benefits of organ preservation. However, the ubiquity of benign nodules worldwide may spur the risk of misuse in cases where there is negligible gain over conventional surveillance. This review summarizes new developments in RFA and examines its judicious utilization in benign nodules.

RECENT FINDINGS

RFA appears to be safe and effective for addressing compressive or cosmetic issues caused by benign functional and nonfunctional thyroid nodules. Volume regression occurs over 12 months, with some cases requiring multiple staged RFA procedures to achieve adequate shrinkage or to address regrowth. Complication rates including recurrent laryngeal nerve injury are reportedly low and are mitigated by strategic technical maneuvers, training, and experience. Consensus guidelines across international societies have emerged to better define appropriate patient candidates. Although association of overuse in analogous disciplines has been well established, no evidence of misuse in thyroid RFA has been described thus far.

SUMMARY

Compelling multi-institutional data support RFA as first-line treatment for select benign thyroid nodules. Defining the nuances of patient selection and long-term surveillance are necessary to substantiate current observed results. Given the high incidence of thyroid nodules worldwide, it is important to emphasize that the majority of benign nodules will not require any intervention. Thorough consideration and careful implementation of recommended guidelines will hopefully lead to measurable benefit and avoid financial misuse.

Effect of Hashimoto's thyroiditis on the extent of the ablation zone in early stages of ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma: a large cohort study of 772 patients

PURPOSE

To evaluate the effect of Hashimoto's thyroiditis (HT) on the extent of ablation zone in ultrasound (US)-guided radiofrequency ablation (RFA) for early stages of papillary thyroid microcarcinoma (PTMC).

METHOD

We selected 772 patients with 797 PTMCs who underwent with RFA from August 2017 to August 2020. They were subdivided into two groups as follows: (i) 216 patients (224 PTMCs) with HT in the 'HT + PTMC' group and (ii) 556 patients (573 PTMCs) with healthy thyroid in the 'PTMC' group. We assessed the extent (maximum diameter and volume) of the ablation zone by contrast-enhanced ultrasound (CEUS) immediately, one day, and 1 week following RFA.

RESULTS

The ablation zone of the 'HT + PTMC' group was smaller than that of the 'PTMC' group at 1 week of RFA (maximum diameter: 14.6 ± 3.1 mm vs. 15.2 ± 3.2 mm and volume: 0.932 ± 0.498 mL vs. 1.028 ± 0.540 mL, respectively, p < .05). However, there were no differences before, immediately, and one day post-RFA (p > .05). Life-threatening complications did not develop in any of the patients.

CONCLUSION

RFA-treated PTMCs were smaller in size in patients with HT than in those with a healthy thyroid at 1 week of RFA. However, the exact mechanism underlying this phenomenon and its clinical significance warrant further investigation.

Tracheal necrosis following thyroid radiofrequency ablation

INTRODUCTION

Radiofrequency ablation for benign thyroid nodules has a low rate of complications in experienced hands for selected indications, but tracheal necrosis is a major complication.

CASE REPORT

A 60 year-old female patient underwent percutaneous radiofrequency ablation of an unesthetic benign isthmic thyroid nodule. The procedure was performed with a cooled electrode, using the "moving shot" technique on a trans-isthmic approach, under general anesthesia. Postoperative course was complicated by dysphonia and cervical pain implicating a third-degree skin burn of the medial cervical region progressing to severe soft-tissue and cervical tracheal necrosis.

DISCUSSION

Risk factors in the present case included the general anesthesia, isthmic location and thyroid nodule volume. To avoid this kind of complication, the procedure should be performed under local anesthesia, using cooled dextrose solution hydrodissection between trachea, thyroid and skin. Ahead of radiofrequency ablation, patients should be informed of possible major complications, especially if the indication is cosmetic.

Current Status and Challenges of US-Guided Radiofrequency Ablation of Thyroid Nodules in the Long Term: A Systematic Review

BACKGROUND

US-guided minimally-invasive techniques, such as radiofrequency ablation (RFA) have emerged as an alternative treatment for benign and malignant thyroid nodules. This systematic review aims to provide an overview on the long-term outcomes of US-guided RFA in patients with benign and malignant thyroid nodules.

METHODS

We systematically searched PubMed/MEDLINE, EMBASE, and Scopus to identify articles reporting the outcomes of thyroid RFA after a follow-up of at least 3 years.

RESULTS

A total of 20 studies met the inclusion criteria and were included in the review. In patients with benign thyroid nodules, RFA significantly reduced nodule volume and this was generally maintained for the following 5 years. However, a small but not negligible proportion of nodules regrew and some of them required further treatments over time. In patients with malignant nodules, RFA has been used not only to treat differentiated thyroid cancer (DTC) neck recurrences, but also to treat papillary thyroid microcarcinoma (PTMC). In most patients with PTMC, RFA led to complete disappearance of the tumor. When it was compared to surgery, RFA was not inferior in terms of oncologic efficacy but it had a lower complication rate. However, RFA did not allow for final pathology, disease staging and accurate risk stratification.

CONCLUSIONS

US-guided RFA significantly reduces benign thyroid nodules and destroys most PTMC, and this is generally maintained for at least 5 years after the initial treatment. Further studies addressing the risk of regrowths in patients with benign thyroid nodules, as well as the risk of recurrence in patients with PTMC are needed.