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Noel JE, Sinclair CF. Radiofrequency Ablation for Benign Thyroid Nodules. J Clin Endocrinol Metab 2023; 109:e12-e17. [PMID: 37401778 DOI: 10.1210/clinem/dgad357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Indexed: 07/05/2023]
Abstract
CONTEXT Thermal ablative techniques of the thyroid have recently gained clinical traction as a therapeutic alternative that provides symptomatic relief and confers potential advantages over surgery. A truly multidisciplinary technique, thyroid ablation is currently performed by endocrinologists, interventional radiologists, otolaryngologists, and endocrine surgeons. Radiofrequency ablation (RFA), specifically, has seen widespread adoption, particularly in the treatment of benign thyroid nodules. This review summarizes current evidence on the application of RFA in benign thyroid nodules, and provides a start to finish overview of procedural preparation, performance, and outcomes. EVIDENCE ACQUISITION A narrative review of literature focusing on RFA in the treatment of benign nodular disease was performed. Emphasis was placed on consensus statements, best practice guidelines, multi-institutional studies, and systematic reviews to summarize key concepts in candidacy, techniques, expectations, and outcomes. FINDINGS RFA is increasingly recognized as a first-line treatment strategy in the management of symptomatic nonfunctional benign thyroid nodules. It can also be considered in functional thyroid nodules with small volumes or in patients ineligible for surgery. A targeted and efficacious technique, RFA results in gradual volume reduction that preserves the function of the surrounding thyroid parenchyma. Proper procedural technique, proficiency in ultrasound, and experience in ultrasound-guided procedures are instrumental to maintaining low complication rates and achieving successful ablation outcomes. CONCLUSIONS In pursuit of a personalized approach, physicians across disciplines are increasingly incorporating RFA into their treatment algorithms, most commonly for benign nodules. As with any intervention, thoughtful selection and implementation ensure a safe procedure with optimal patient benefit.
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Affiliation(s)
- Julia E Noel
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Catherine F Sinclair
- Department of Otolaryngology-Head & Neck Surgery, Monash University Melbourne, Clayton, VIC 3800, Australia , and Mount Sinai School of Medicine: Icahn School of Medicine at Mount Sinai, New York, NY 10019, USA
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Hu QL, Kuo JH. Choice in Ablative Therapies for Thyroid Nodules. J Endocr Soc 2023; 7:bvad078. [PMID: 37377617 PMCID: PMC10291258 DOI: 10.1210/jendso/bvad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Indexed: 06/29/2023] Open
Abstract
Ultrasound-guided ablation procedures have been growing in popularity and offer many advantages compared with traditional surgery for thyroid nodules. Many technologies are available, with thermal ablative techniques being the most popular currently though other nonthermal techniques, such as cryoablation and electroporation, are gaining interest. The objective of the present review is to provide an overview of each of the currently available ablative therapies and their applications in various clinical indications.
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Affiliation(s)
- Q Lina Hu
- Correspondence: Q. Lina Hu, MD, MS, Division of GI/Endocrine Surgery, Columbia University, 161 Fort Washington Avenue, 8th floor, New York, NY 10032, USA.
| | - Jennifer H Kuo
- Division of GI/Endocrine Surgery, Columbia University, New York, NY 10032, USA
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Stan MN, Papaleontiou M, Schmitz JJ, Castro MR. Nonsurgical Management of Thyroid Nodules: The Role of Ablative Therapies. J Clin Endocrinol Metab 2022; 107:1417-1430. [PMID: 34953163 PMCID: PMC9016471 DOI: 10.1210/clinem/dgab917] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 12/02/2022]
Abstract
CONTEXT After a thorough evaluation most thyroid nodules are deemed of no clinical consequence and can be observed. However, when they are compressive, toxic, or involved by papillary thyroid carcinoma surgery or radioactive iodine (RAI) (if toxic) are the treatments of choice. Both interventions can lead to hypothyroidism and other adverse outcomes (eg, scar, dysphonia, logistical limitation with RAI). Active surveillance might be used for papillary thyroid microcarcinoma (PTMC) initially, but anxiety leads many cases to surgery later. Several ablative therapies have thus evolved over the last few years aimed at treating these nodules while avoiding described risks. CASES We present 4 cases of thyroid lesions causing concern (compressive symptoms, thyrotoxicosis, anxiety with active surveillance of PTMC). The common denominator is patients' attempt to preserve thyroid function, bringing into focus percutaneous ethanol injection (PEI) and thermal ablation techniques (radiofrequency ablation [RFA] being the most common). We discuss the evidence supporting these approaches and compare them with standard therapy, where evidence exists. We discuss additional considerations for the utilization of these therapies, their side-effects, and conclude with a simplified description of how these procedures are performed. CONCLUSION Thermal ablation, particularly RFA, is becoming an attractive option for managing a subgroup of solid thyroid nodules, while PEI has a role in managing thyroid cysts and a select group of PTMC. Their role in the algorithm of thyroid nodule management is still being refined and technical expertise will be essential to reproduce the reported results into everyday practice.
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Affiliation(s)
- Marius N Stan
- Correspondence: Marius N. Stan, Division of Endocrinology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Role of Thyroid RFA in the Treatment of Autonomously Functioning Thyroid Nodules. Tech Vasc Interv Radiol 2022; 25:100823. [DOI: 10.1016/j.tvir.2022.100823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Orloff LA, Noel JE, Stack BC, Russell MD, Angelos P, Baek JH, Brumund KT, Chiang FY, Cunnane MB, Davies L, Frasoldati A, Feng AY, Hegedüs L, Iwata AJ, Kandil E, Kuo J, Lombardi C, Lupo M, Maia AL, McIver B, Na DG, Novizio R, Papini E, Patel KN, Rangel L, Russell JO, Shin J, Shindo M, Shonka DC, Karcioglu AS, Sinclair C, Singer M, Spiezia S, Steck JH, Steward D, Tae K, Tolley N, Valcavi R, Tufano RP, Tuttle RM, Volpi E, Wu CW, Abdelhamid Ahmed AH, Randolph GW. Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association. Head Neck 2021; 44:633-660. [PMID: 34939714 DOI: 10.1002/hed.26960] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The use of ultrasound-guided ablation procedures to treat both benign and malignant thyroid conditions is gaining increasing interest. This document has been developed as an international interdisciplinary evidence-based statement with a primary focus on radiofrequency ablation and is intended to serve as a manual for best practice application of ablation technologies. METHODS A comprehensive literature review was conducted to guide statement development and generation of best practice recommendations. Modified Delphi method was applied to assess whether statements met consensus among the entire author panel. RESULTS A review of the current state of ultrasound-guided ablation procedures for the treatment of benign and malignant thyroid conditions is presented. Eighteen best practice recommendations in topic areas of preprocedural evaluation, technique, postprocedural management, efficacy, potential complications, and implementation are provided. CONCLUSIONS As ultrasound-guided ablation procedures are increasingly utilized in benign and malignant thyroid disease, evidence-based and thoughtful application of best practices is warranted.
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Affiliation(s)
- Lisa A Orloff
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Julia E Noel
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Brendan C Stack
- Department of Otolaryngology - Head & Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Marika D Russell
- Department of Otolaryngology - Head & Neck Surgery, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Jung Hwan Baek
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kevin T Brumund
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA
| | - Feng-Yu Chiang
- Department of Otolaryngology - Head and Neck Surgery, E-Da Hospital, School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Mary Beth Cunnane
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Louise Davies
- The Section of Otolaryngology, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Andrea Frasoldati
- Department of Endocrinology and Metabolism, Arcispedale Santa Maria Nuova IRCCS-ASL, Reggio Emilia, Italy
| | - Anne Y Feng
- Department of Otolaryngology - Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Ayaka J Iwata
- Department of Otolaryngology - Head & Neck Surgery, Kaiser Permanente, Santa Clara, California, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jennifer Kuo
- Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Celestino Lombardi
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mark Lupo
- Thyroid & Endocrine Center of Florida, Sarasota, Florida, USA
| | - Ana Luiza Maia
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center, Research Institute, Tampa, Florida, USA
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | | | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Kepal N Patel
- Department of Surgery, New York University, New York, New York, USA
| | - Leonardo Rangel
- Division of Otorhinolaryngology - Head and Neck Surgery, State University of Rio de Janeiro, Rio de Janiero, Brazil
| | - Jonathon O Russell
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Shin
- Department of Otolaryngology - Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maisie Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - David C Shonka
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Amanda S Karcioglu
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA.,Clinician Educator, Pritzker School of Medicine, Chicago, Illinois, USA
| | - Catherine Sinclair
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai West Hospital, New York, New York, USA
| | - Michael Singer
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Stefano Spiezia
- Endocrine Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Jose Higino Steck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Campinas, Campinas, Brazil
| | - David Steward
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kyung Tae
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Neil Tolley
- Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK
| | | | - Ralph P Tufano
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Michael Tuttle
- Endocrine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erivelto Volpi
- Oncology Center, Oswaldo Cruz German Hospital, Sao Paulo, Brazil
| | - Che Wei Wu
- Department of Otolaryngology - Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Amr H Abdelhamid Ahmed
- Department of Otolaryngology - Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology - Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Mauri G, Papini E, Bernardi S, Barbaro D, Cesareo R, De Feo P, Deandrea M, Fugazzola L, Gambelunghe G, Greco G, Messina C, Monti S, Mormile A, Negro R, Offi C, Palermo A, Persani L, Presciuttini F, Solbiati LA, Spiezia S, Stacul F, Viganò M, Sconfienza LM. Image-guided thermal ablation in autonomously functioning thyroid nodules. A retrospective multicenter three-year follow-up study from the Italian Minimally Invasive Treatment of the Thyroid (MITT) Group. Eur Radiol 2021; 32:1738-1746. [PMID: 34751793 DOI: 10.1007/s00330-021-08289-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/12/2021] [Accepted: 07/29/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To report the results of a multicenter retrospective evaluation of the clinical outcomes of thermal ablation (TA) in a large series of autonomously functioning thyroid nodules (AFTN) with a follow-up protracted up to 3 years. METHODS Patients treated with single TA for an AFTN in Italy were included. Changes in nodule volume, TSH values, and ongoing anti-thyroid therapy were assessed at the 2-, 6-, 12-, 24-, and 36-month follow-up controls. Complications and need of any additional therapy after TA were also registered. RESULTS A total of 361 patients (244 females, 117 males, median age 58 years, IQR 46-70 years) were included. Nodule volume was significantly reduced at all time points (p < 0.001) (median volume reduction 58% at 6-month and 60% at 12-month). Serum TSH values increased significantly at all time points. After TA, anti-thyroid therapy was withdrawn in 32.5% of patients at 2 months, in 38.9% at 6 months, and in 41.3% at 12 months. A significant difference in the rate of patients who withdrawn medical therapy at 12 months was registered between small (< 10 mL) (74%), medium (49%), or large (> 30 mL) nodules (19%). A single major complication occurred (0.25%). Additional treatments were needed in 34/361 (9.4%) of cases including 4 (1.1%) surgical treatment. CONCLUSIONS Image-guided thermal ablation offers a further safe and effective therapeutic option in patients with AFTN. Clinical outcomes are significantly more favorable in small than in large size AFTN. KEY POINTS • Thermal ablations (TA) can be safely and effectively used in patients with autonomously functioning thyroid nodules (AFTN). • TA results in a clinically significant nodule volume reduction that is paralleled by TSH level normalization and anti-thyroid drug therapy discontinuation (after TA anti-thyroid therapy was withdrawn in 41.3% at 12 months). • Clinical outcomes after TA are more favorable in small nodules, and when a large amount of thyroid nodule tissue is ablated.
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Affiliation(s)
- Giovanni Mauri
- Dipartimento Di Oncologia Ed Emato-Oncologia, Università Degli Studi Di Milano, Milan, Italy.
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), via Ripamonti 435, Milan, Italy.
| | - Enrico Papini
- Dipartimento Di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Stella Bernardi
- UCO Medicina Clinica, Ospedale Di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
- Dipartimento Di Scienze Mediche, Università Degli Studi Di Trieste, Trieste, Italy
| | | | - Roberto Cesareo
- Unit of metabolic diseases, S. M. Goretti Hospital, Latina, Italy
| | | | | | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milano, Italy
- Department of Patophysiology and Transplantation, Università Degli Studi Di Milano, Milano, Italy
| | | | | | | | - Salvatore Monti
- UOC Di Endocrinologia, Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | | | | | - Chiara Offi
- Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Andrea Palermo
- Unit of endocrinology and Diabetes, Campus Bio-Medico university, Roma, Italy
| | - Luca Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milano, Italy
- Department of Medical Biotechnology and Translational Medicine, Università Degli Studi Di Milano, Milano, Italy
| | | | - Luigi Alessandro Solbiati
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Stefano Spiezia
- Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Fulvio Stacul
- SC Radiologia, Ospedale Maggiore, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Marco Viganò
- Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milano, Italy
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7
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Kim HJ, Cho SJ, Baek JH, Suh CH. Efficacy and safety of thermal ablation for autonomously functioning thyroid nodules: a systematic review and meta-analysis. Eur Radiol 2020; 31:605-615. [PMID: 32816198 DOI: 10.1007/s00330-020-07166-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/29/2020] [Accepted: 08/06/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although thermal ablation has been regarded as an alternative treatment option for autonomously functioning thyroid nodules (AFTNs), the efficacy of this treatment in patients with AFTNs has not yet been systematically evaluated. In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of thermal ablation in the treatment of AFTN, and identify the factors affecting the effectiveness of the treatment. METHODS Ovid-MEDLINE and Embase databases were searched for studies reporting the efficacy and safety of thermal ablation for patients with AFTN published up until January 6, 2020. Data extraction and quality assessment were performed by two radiologists according to PRISMA guidelines. The primary and secondary outcomes were to yield the pooled proportions of thyroid-stimulating hormone (TSH) normalization and pooled estimates of volume reduction rate (VRR), respectively. Subgroup analyses were performed to identify factors affecting the treatment efficacy. RESULTS This systematic review identified 411 AFTNs treated by thermal ablation in 391 patients in 14 studies. TSH normalization was achieved in 71.2% of patients and the volume reduction rate was 69.4% at a mean follow-up period of 12.8 months. No patients experienced hypothyroidism or a life-threatening complication during follow-up. Subgroup analyses according to nodule volume did not find a significant difference in TSH normalization (p = 0.54) or VRR (p = 0.94). CONCLUSIONS Thermal ablation is an effective and safe treatment method for patients with AFTNs. The nodule volume did not affect the efficacy of thermal ablation, and this result should be considered in future thermal ablation guidelines. KEY POINTS • Thermal ablation has good efficacy and safety in the treatment of autonomously functioning thyroid nodule. • The efficacy of thermal ablation was not affected by nodule volume.
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Affiliation(s)
- Hyun Jin Kim
- Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, 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: 226] [Impact Index Per Article: 56.5] [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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Cesareo R, Palermo A, Pasqualini V, Manfrini S, Trimboli P, Stacul F, Fabris B, Bernardi S. Radiofrequency Ablation on Autonomously Functioning Thyroid Nodules: A Critical Appraisal and Review of the Literature. Front Endocrinol (Lausanne) 2020; 11:317. [PMID: 32528412 PMCID: PMC7256164 DOI: 10.3389/fendo.2020.00317] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/24/2020] [Indexed: 01/23/2023] Open
Abstract
Background: Thyroid nodules are an extremely common occurrence, as their prevalence in the general population is estimated to range between 50 and 70%. Some of these nodules are autonomously functioning such that they can cause hyperthyroidism over time. In this case, surgery and radioiodine represent the standard of care. Nevertheless, patients might have contraindications or be unwilling to undergo these treatments. Minimally-invasive ultrasound-guided techniques, such as laser and radiofrequency ablation (RFA), have been recently introduced into clinical practice as an alternative treatment for symptomatic benign thyroid nodules. Due to their efficacy and tolerability, these techniques have become increasingly available and their usage has been extended also to autonomously functioning thyroid nodules (AFTN). Methods: In this narrative review, we will describe the studies reporting the therapeutic effects of RFA on AFTN, the studies reporting how RFA compares to the other treatment modalities, as well as the current indications for the use of RFA in patients with AFTN. For this purpose, a comprehensive literature search was independently conducted by three investigators on PubMed, EMBASE, and the Cochrane Library from inception up to February 2020 to identify published articles concerning the effects of RFA on AFTN. Results and Conclusions: Current consensus statements and guidelines support the notion that RFA should be regarded as a first-line therapy for non-functioning benign thyroid nodules, while it remains a valid second-line option for AFTN treatment in case of contraindications or patient unwillingness to undergo surgery or radioiodine.
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Affiliation(s)
- Roberto Cesareo
- Unit of Metabolic Diseases, S. M. Goretti Hospital, Latina, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | | | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Disease, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università di Lugano (USI), Lugano, Switzerland
| | - Fulvio Stacul
- Unit of Radiology (Maggiore Hospital), ASUGI, Trieste, Italy
| | - Bruno Fabris
- Unit of Medicina Clinica (Cattinara Hospital), ASUGI, Trieste, Italy
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Stella Bernardi
- Unit of Medicina Clinica (Cattinara Hospital), ASUGI, Trieste, Italy
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- *Correspondence: Stella Bernardi
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Gitto S, Bisdas S, Emili I, Nicosia L, Pescatori LC, Bhatia K, Lingam RK, Sardanelli F, Sconfienza LM, Mauri G. Clinical practice guidelines on ultrasound-guided fine needle aspiration biopsy of thyroid nodules: a critical appraisal using AGREE II. Endocrine 2019; 65:371-378. [PMID: 30903569 DOI: 10.1007/s12020-019-01898-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/11/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE To appraise the quality of current guidelines on fine needle aspiration biopsy (FNAB) of thyroid nodules for adults using the AGREE II quality assessment tool. METHODS We conducted an online search for guidelines on FNAB of thyroid nodules published between 2013 and October 2018. They were evaluated by four independent reviewers previously trained to apply the AGREE II instrument, which is organized into items and domains. A fifth independent reviewer calculated scores for each domain and guideline as well as inter-appraiser agreement. RESULTS Six sets of guidelines were included, respectively, provided by the American Thyroid Association (ATA), the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME), the Korean Society of Thyroid Radiology (KSThR), the European Thyroid Association (ETA), the American College of Radiology (ACR) and the Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency (KSR/NECA). Five out of the six guidelines (ATA, AACE/ACE/AME, ETA, ACR and KSR/NECA) reached a high level of overall quality, having at least five domain scores >60%. An average level of overall quality was achieved in one case (KSThR recommendations). Inter-appraiser agreement ranged from moderate to excellent. CONCLUSIONS Overall, the quality of guidelines on FNAB of thyroid nodules is satisfactory when evaluated using the AGREE II instrument.
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Affiliation(s)
- Salvatore Gitto
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milano, Italy.
| | - Sotirios Bisdas
- Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
- Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, London, UK
| | - Ilaria Emili
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milano, Italy
| | - Luca Nicosia
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milano, Italy
| | | | - Kunwar Bhatia
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Ravi K Lingam
- Department of Radiology, Northwick Park & Central Middlesex Hospitals, London North West University Healthcare NHS Trust, London, UK
| | - Francesco Sardanelli
- Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Giovanni Mauri
- Divisione di Radiologia Interventistica, IRCCS Istituto Europeo di Oncologia, Milano, Italy
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11
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Mauri G, Pacella CM, Papini E, Solbiati L, Goldberg SN, Ahmed M, Sconfienza LM. Image-Guided Thyroid Ablation: Proposal for Standardization of Terminology and Reporting Criteria. Thyroid 2019; 29:611-618. [PMID: 30803397 DOI: 10.1089/thy.2018.0604] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Image-guided tumor ablation is commonly performed in clinical practice. Trying to standardize terminology and data collection to enable a more reliable comparison among the different studies, in 2003, a document entitled "Image-Guided Tumor Ablation: Proposal for Standardization of Terms and Reporting Criteria" was published by the International Working Group on Image-Guided Tumor Ablation. Since then, ablations have evolved significantly, with the development of new technology and techniques and applications. This has included benign thyroid nodules, and their ablation has become increasingly accessible, not only among radiologists but also among other specialists involved in thyroid care, including endocrinologists and surgeons. This has resulted in further inhomogeneity in how data are presented and reported among different studies, resulting in a need for standardization to homogenize language and data reporting on the topic. Summary: In February 2018 in Milano, Italy, a meeting involving specialists concerned with minimally invasive treatments of thyroid lesions was organized, and the Italian Working Group on Minimally Invasive Treatments of the Thyroid was founded with the aim of establishing a collaborative network among all clinicians working in this field. The first work of this group is to present a proposal for standardization of terminology and reporting criteria on image-guided ablations to treat benign thyroid nodules. Conclusion: This proposal was drafted with the goal of providing guidance for standardized reporting of results in studies regarding image-guided thyroid ablations. We encourage adoption of this terminology worldwide, anticipating that this will facilitate improved communication and understanding within the field and stimulate further discussion on the topic over the next years.
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Affiliation(s)
- Giovanni Mauri
- 1 Divisione di Radiologia Interventistica, IEO, IRCCS Istituto Europeo di Oncologia, Milan, Italy
| | - Claudio Maurizio Pacella
- 2 Dipartimento di Diagnostica per Immagini and Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Enrico Papini
- 3 Dipartimento di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Luigi Solbiati
- 4 Dipartimento di Scienze Biomediche, Humanitas University, and Dipartmento di Radiologia, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Shraga Nahum Goldberg
- 5 Department of Radiology, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
- 6 Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Muneeb Ahmed
- 6 Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Luca Maria Sconfienza
- 7 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
- 8 IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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12
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Cervelli R, Mazzeo S, Boni G, Boccuzzi A, Bianchi F, Brozzi F, Santini P, Vitti P, Cioni R, Caramella D. Comparison between radioiodine therapy and single-session radiofrequency ablation of autonomously functioning thyroid nodules: A retrospective study. Clin Endocrinol (Oxf) 2019; 90:608-616. [PMID: 30657603 DOI: 10.1111/cen.13938] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/11/2019] [Accepted: 01/13/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare the efficacy of Radioiodine (RI) and Radiofrequency ablation (RFA) in the treatment of autonomously functioning thyroid nodules (AFTNs). End-points: nodule volume reduction (NVR) and thyroid function normalization. DESIGN, PATIENTS AND MEASUREMENTS Twenty-two patients (2:20 M:F; 51.9 ± 13.9 years) affected by 25 AFTNs, treated by RFA were retrospectively compared with 25 patients (8:17 M:F; 57.2 ± 12.8 years) affected by a single AFTN treated by RI. Both group showed analogous characteristics as to age, gender, toxic/pretoxic phase and pretreatment nodule volume (calculated by the ellipsoid formula). Thyroid hormone levels and autoimmune thyroid profile were assessed before treatment. A fixed RI activity of 555 MBq (15 mCi) was administered. RFA was performed with an 18G, single-tipped electrode, by the "modified moving shot technique." Thyroid hormones were assessed and the nodule post-treatment volume calculated 12 months after treatment. RESULTS No statistical difference was found between the post-treatment NVR by comparing RI and RFA (P = 0.69). The volume reduction rates were 68.4 ± 28.9% and 76.4 ± 16.9% after RI and RFA, respectively. As to the thyroid function, 5/25 patients developed clinical hypothyroidism after RI. After RFA, all the 22 patients silenced their AFTN and normalized the thyroid hormones. Subclinical hypothyroidism was recorded in two patients after both RI and RFA. Thus, the functional therapeutic success, defined as the restoration of euthyroidism, was achieved in 18/25 (72%) patients treated by RI and in 20/22 (90.9%) treated by RFA. CONCLUSIONS No statistical difference in NVR was found between RI and RFA. All patients responded to RI but 5/25 were "over-treated" developing hypothyroidism. RFA was effective in all patients with no case of post-treatment clinical hypothyroidism. No radiation exposure and lower risk of post-treatment hypothyroidism might make RFA the favourite option especially for young patients.
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Affiliation(s)
- Rosa Cervelli
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Salvatore Mazzeo
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Boni
- Department of Nuclear medicine, University of Pisa, Pisa, Italy
| | - Antonio Boccuzzi
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | | | - Federica Brozzi
- Department of Nuclear medicine, University of Pisa, Pisa, Italy
| | - Pierina Santini
- Department of Nuclear medicine, University of Pisa, Pisa, Italy
| | - Paolo Vitti
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Cioni
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
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13
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Papini E, Pacella CM, Solbiati LA, Achille G, Barbaro D, Bernardi S, Cantisani V, Cesareo R, Chiti A, Cozzaglio L, Crescenzi A, De Cobelli F, Deandrea M, Fugazzola L, Gambelunghe G, Garberoglio R, Giugliano G, Luzi L, Negro R, Persani L, Raggiunti B, Sardanelli F, Seregni E, Sollini M, Spiezia S, Stacul F, Van Doorne D, Sconfienza LM, Mauri G. Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid (MITT) group. Int J Hyperthermia 2019; 36:376-382. [PMID: 30909759 DOI: 10.1080/02656736.2019.1575482] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Benign thyroid nodules are a common clinical occurrence and usually do not require treatment unless symptomatic. During the last years, ultrasound-guided minimally invasive treatments (MIT) gained an increasing role in the management of nodules causing local symptoms. In February 2018, the Italian MIT Thyroid Group was founded to create a permanent cooperation between Italian and international physicians dedicated to clinical research and assistance on MIT for thyroid nodules. The group drafted this list of statements based on literature review and consensus opinion of interdisciplinary experts to facilitate the diffusion and the appropriate use of MIT of thyroid nodules in clinical practice. (#1) Predominantly cystic/cystic symptomatic nodules should first undergo US-guided aspiration; ethanol injection should be performed if relapsing (level of evidence [LoE]: ethanol is superior to simple aspiration = 2); (#2) In symptomatic cystic nodules, thermal ablation is an option when symptoms persist after ethanol ablation (LoE = 4); (#3) Double cytological benignity confirmation is needed before thermal ablation (LoE = 2); (#4) Single cytological sample is adequate in ultrasound low risk (EU-TIRADS ≤3) and in autonomously functioning nodules (LoE = 2); (#5) Thermal ablation may be proposed as first-line treatment for solid, symptomatic, nonfunctioning, benign nodules (LoE = 2); (#6) Thermal ablation may be used for dominant lesions in nonfunctioning multinodular goiter in patients refusing/not eligible for surgery (LoE = 5); (#7) Clinical and ultrasound follow-up is appropriate after thermal ablation (LoE = 2); (#8) Nodule re-treatment can be considered when symptoms relapse or partially resolve (LoE = 2); (#9) In case of nodule regrowth, a new cytological assessment is suggested before second ablation (LoE = 5); (#10) Thermal ablation is an option for autonomously functioning nodules in patients refusing/not eligible for radioiodine or surgery (LoE = 2); (#11) Small autonomously functioning nodules can be treated with thermal ablation when thyroid tissue sparing is a priority and ≥80% nodule volume ablation is expected (LoE = 3).
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Affiliation(s)
- Enrico Papini
- a Dipartimento di Endocrinologia , Ospedale Regina Apostolorum , Albano Laziale , Italy
| | - Claudio Maurizio Pacella
- b Dipartimento di Imaging Diagnostico e Radiologia Interventistica , Ospedale Regina Apostolorum , Albano Laziale , Italy
| | - Luigi Alessandro Solbiati
- c Humanitas University, Pieve Emanuele , Milan , Italy.,d Humanitas Clinical and Research Center IRCCS , Rozzano , Italy
| | - Gaetano Achille
- e Unità Operativa ORL, IRCCS Oncologico "Giovanni Paolo II" , Bari , Italy
| | - Daniele Barbaro
- f U.O. Endocrinologia ASL Nordovest Toscana , Toscana , Italy
| | - Stella Bernardi
- g Azienda Sanitaria Universitaria Integrata Trieste , Trieste , Italy.,h Università degli Studi di Trieste , Trieste , Italy
| | - Vito Cantisani
- i Policlinico Umberto I, Università Sapienza , Roma , Italy
| | - Roberto Cesareo
- j Thyroid and metabolic bone diseases center, Ospedale Santa Maria Goretti , Latina , Italy
| | - Arturo Chiti
- c Humanitas University, Pieve Emanuele , Milan , Italy.,d Humanitas Clinical and Research Center IRCCS , Rozzano , Italy
| | - Luca Cozzaglio
- d Humanitas Clinical and Research Center IRCCS , Rozzano , Italy
| | - Anna Crescenzi
- k UOC Anatomia Patologica, Policlinico Universitario Campus Bio-Medico , Roma , Italy
| | | | | | - Laura Fugazzola
- n Istituto Auxologico Italiano IRCCS , Milano , Italy.,o Università degli Studi di Milano , Milano , Italy
| | | | - Roberto Garberoglio
- q Ospedale Città della Salute Torino, Dipartimento Universitario di Endocrinologia e Malattie Metaboliche , Torino , Italy
| | - Gioacchino Giugliano
- r Department of Head and Neck , Istituto Europeo di Oncologia, IRCCS , Milano , Italy
| | - Livio Luzi
- o Università degli Studi di Milano , Milano , Italy.,s IRCCS Policlinico San Donato, UOC Endocrinologia e Malattie Metaboliche , San Donato Milanese , Italy
| | | | - Luca Persani
- n Istituto Auxologico Italiano IRCCS , Milano , Italy.,o Università degli Studi di Milano , Milano , Italy
| | | | - Francesco Sardanelli
- o Università degli Studi di Milano , Milano , Italy.,v IRCCS Policlinico San Donato , San Donato Milanese , Italy
| | - Ettore Seregni
- w Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Stefano Spiezia
- x Unità Operativa di Chirurgia Endocrina ed Ecoguidata , Ospedale del Mare, ASL Napoli1 centro , Napoli , Italy
| | - Fulvio Stacul
- g Azienda Sanitaria Universitaria Integrata Trieste , Trieste , Italy
| | | | - Luca Maria Sconfienza
- o Università degli Studi di Milano , Milano , Italy.,z IRCCS Istituto Ortopedico Galeazzi , Milano , Italy
| | - Giovanni Mauri
- aa Division of Interventional Radiology , IEO, European Institute of Oncology IRCCS , Milan , Italy
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14
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Negro R, Greco G. Quality of life and outcomes in patients with a large toxic adenoma undergoing laser ablation plus radioiodine vs lobectomy. Int J Hyperthermia 2018; 36:191-195. [PMID: 30556434 DOI: 10.1080/02656736.2018.1549335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Patients with toxic adenomas (TAs) that are too large to undergo radioactive iodine (RAI) treatment aimed at resolving hyperthyroidism and/or relieving mechanical pressure symptoms are referred to surgery. This prospective study aimed to assess the outcomes of combining laser ablation (LA) plus RAI vs lobectomy to treat large TAs in terms of clinical efficacy and the health-related quality of life (HRQoL). PATIENTS AND METHODS Patients with TAs of volumes greater than 20 mL and a calculated therapeutic activity exceeding 600 Mbq were randomly assigned to undergo LA + RAI (Group A) or lobectomy (Group B). The HRQoL was assessed using 12-item Short Form Health Survey questionnaire before and 6 months after treatment. RESULTS Twenty-seven patients entered the study. After completing treatment, patients in Group A showed a TA reduction by a mean of 68% compared to baseline. Two of 14 patients (14.3%) in Group A and 2 of 13 (15.4%) in Group B became subclinically hypothyroid, whereas the remaining patients were euthyroid. HRQoL significantly improved in both groups after treatment. CONCLUSIONS For patients with large TAs, a combination of LA and RAI is a feasible alternative to surgery. Similar to surgery, LA + RAI resolves the mechanical discomfort induced by nodule pressure and effectively treats the hyperthyroidism. This procedure also avoids the potential complications associated with surgery while guaranteeing a similar HRQoL benefit.
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Affiliation(s)
- Roberto Negro
- a Division of Endocrinology , "V. Fazzi" Hospital, Piazza F. Muratore , Lecce , Italy
| | - Gabriele Greco
- a Division of Endocrinology , "V. Fazzi" Hospital, Piazza F. Muratore , Lecce , Italy
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15
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Mauri G, Nicosia L, Della Vigna P, Varano GM, Maiettini D, Bonomo G, Giuliano G, Orsi F, Solbiati L, De Fiori E, Papini E, Pacella CM, Sconfienza LM. Percutaneous laser ablation for benign and malignant thyroid diseases. Ultrasonography 2018; 38:25-36. [PMID: 30440161 PMCID: PMC6323312 DOI: 10.14366/usg.18034] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive image-guided thermal ablation is becoming increasingly common as an alternative to surgery for the treatment of benign thyroid nodules. Among the various techniques for thermal ablation, laser ablation (LA) is the least invasive, using the smallest applicators available on the market and enabling extremely precise energy deposition. However, in some cases, multiple laser fibers must be used simultaneously for the treatment of large nodules. In this review, the LA technique is described, and its main clinical applications and results are discussed and illustrated.
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Affiliation(s)
- Giovanni Mauri
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Luca Nicosia
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Paolo Della Vigna
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Gianluca Maria Varano
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Daniele Maiettini
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Guido Bonomo
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | | | - Franco Orsi
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Luigi Solbiati
- Department of Radiology, Humanitas University, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Elvio De Fiori
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Enrico Papini
- Endocrinology Department, Regina Apostolorum Hospital, Albano Laziale, Italy
| | - Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Rome, Italy
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
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