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Jin X, Feng Y, Zhu R, Qian L, Yang Y, Yu Q, Zou Z, Li W, Liu Y, Qian Z. Temperature control and intermittent time-set protocol optimization for minimizing tissue carbonization in microwave ablation. Int J Hyperthermia 2022; 39:868-879. [PMID: 35858640 DOI: 10.1080/02656736.2022.2075041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The charring tissue formation in the ablated lesion during the microwave ablation (MWA) of tumors would induce various unwanted inflammatory responses. This paper aimed to deliver appropriate thermal dose for effective ablations while preventing tissue carbonization by optimizing the treatment protocol during MWA with the set combinations of temperature control and pulsed microwave energy delivery. MATERIAL AND METHODS The thermal phase transition of ex vivo porcine liver tissues were recorded by differential scanning calorimetry (DSC) to determine the temperature threshold during microwave output control. MWA was performed by an in-house built system with the ease of microwave output parameter adjustment and real-time temperature monitoring. The effects of continuous and pulsed microwave deliveries as well as various intermittent time-set of MWA were evaluated by measuring the dimensions of the coagulation zone and the carbonization zone. RESULTS The DSC scans demonstrated that the ex vivo porcine liver tissues have been in a state of endothermic heat during the heating process, where the maximum absorbed heat occurred at the temperature of 105 °C ± 5 °C. The temperature control during MWA resulted in effective coagulative necrosis while preventing tissue carbonization, after setting 100 °C as the upper threshold temperature and 60 °C as the lower threshold. Both the numerical simulation and ex vivo experiments have shown that, upon the optimization of the time-set parameters in the periodic intermittent pulsed microwave output, the tissue carbonization was significantly diminished. CONCLUSION This study developed a straight-forward anti-carbonization strategy in MWA by modulating the pulsing mode and intermittent time. The programmed protocols of intermittent pulsing MWA have demonstrated its potentials toward future expansion of MWA technology in clinical application.
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Affiliation(s)
- Xiaofei Jin
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yu Feng
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Roujun Zhu
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Lu Qian
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yamin Yang
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Qindong Yu
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zhihan Zou
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Weitao Li
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yangyang Liu
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zhiyu Qian
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
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Agyekum EA, Fu JH, Xu FJ, Ren YZ, Akortia D, Chen Q, Qian XQ, Wang Y, Wang X. Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules. Front Oncol 2021; 11:761005. [PMID: 34868975 PMCID: PMC8637803 DOI: 10.3389/fonc.2021.761005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/28/2021] [Indexed: 12/07/2022] Open
Abstract
Thyroid nodules are commonly encountered in health care practice. They are usually benign in nature, with few cases being malignant, and their detection has increased in the adult population with the help of ultrasonography. Thyroidectomy or surgery is the first-line treatment and traditional method for thyroid nodules; however, thyroidectomy leaves permanent scars and requires long-term use of levothyroxine after surgery, which makes patients more reticent to accept this treatment. Thermal ablation is a minimally-invasive technique that have been employed in the treatment of benign and malignant thyroid nodules nodules, and have been shown to be effective and safe. Several studies, including long-term, retrospective, and prospective studies, have investigated the use of ablation to treat benign thyroid nodules and malignant thyroid nodules, including papillary thyroid carcinoma. Here, we review the recent progress in thermal ablation techniques for treating benign and malignant nodules, including their technicalities, clinical applications, pitfalls and limitations, and factors that could affect treatment outcomes. Special in-depth elaboration on the recent progress of the application of thermal ablation therapy in malignant thyroid nodules.
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Affiliation(s)
- Enock Adjei Agyekum
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China.,School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jian-Hua Fu
- Department of Interventional Radiology, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Fei-Ju Xu
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Yong-Zhen Ren
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Debora Akortia
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Qing Chen
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Xiao-Qin Qian
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Yuguo Wang
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Xian Wang
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
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3
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Sharma RK, Kuo JH. Complications of RFA for Thyroid Nodules: Prevention and Management. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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4
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Yang CC, Hsu Y, Liou JY. Efficacy of Ethanol Ablation for Benign Thyroid Cysts and Predominantly Cystic Nodules: A Systematic Review and Meta-Analysis. Endocrinol Metab (Seoul) 2021; 36:81-95. [PMID: 33677930 PMCID: PMC7937837 DOI: 10.3803/enm.2020.833] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/10/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Ultrasound-guided minimally invasive procedures are widely used to treat thyroid diseases. The objective of this study was to assess the efficacy and safety of ethanol ablation (EA) in comparison with other non-surgical options in the treatment of benign thyroid cystic nodules. METHODS We conducted a systematic search of studies on EA for thyroid cystic nodules, mainly in the Ovid-MEDLINE and Embase, Web of Science, and Cochrane databases. The standardized mean difference (SMD) of the volume reduction ratio (VRR) after EA versus other non-surgical treatments comprised the primary outcome, whereas the odds ratio (OR) of therapeutic success rates between the two groups comprised the secondary outcome. RESULTS The meta-analysis included 19 studies (four randomized controlled trials and 15 non-randomized studies) with 1,514 participants. The cumulative VRR of EA was 83.908% (95% confidence interval [CI], 79.358% to 88.457%). EA had a significantly higher pooled VRR (SMD, 0.381; 95% CI, 0.028 to 0.734; P=0.030), but not a significantly higher pooled therapeutic success rate (OR, 0.867; 95% CI, 0.132 to 5.689; P=0.880), than other forms of non-surgical management including radiofrequency ablation (RFA), polidocanol sclerotherapy, and simple aspiration with or without saline flush. However, the VRR and therapeutic success rate were not significantly different between EA and RFA. Major complications were recorded only in six patients (0.53%) with self-limiting dysphonia. CONCLUSION The role of EA as the first-line treatment for benign thyroid cysts and predominantly cystic nodules is supported by its high effectiveness and good safety profile compared to other currently available non-surgical options.
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Affiliation(s)
- Cheng-Chun Yang
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Yung Hsu
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Jyun-Yan Liou
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
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5
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Lin AN, Lin WC, Cheng KL, Luo SD, Chiang PL, Chen WC, Chen YS, Wang CK, Kan NN, Su YY. Radiofrequency Ablation a Safe and Effective Treatment for Pediatric Benign Nodular Thyroid Goiter. Front Pediatr 2021; 9:753343. [PMID: 34900863 PMCID: PMC8662624 DOI: 10.3389/fped.2021.753343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/29/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose: To evaluate the effectiveness of radiofrequency ablation (RFA) for benign thyroid nodules in pediatric patients. Materials and Methods: Twelve pediatric patients (11 female, 1 male; mean age 15.54 ± 2.8 years, range 10-19 years) with benign thyroid nodules (mean longest diameter 4.1 ± 1.4 cm, range 1.5-5.9 cm) treated by RFA from 2017 to 2020 were evaluated. The inclusion criteria for RFA therapy were (i) age < 20 years; (ii) benign cytological confirmation by 2 separate ultrasound guided fine-needle aspiration cytology (FNAC) or core needle biopsies; (iii) pressure symptoms or cosmetic problems caused by thyroid nodules; (iv) absence of any sonographic suspicious feature; and (v) follow-up for >6 months. Under local anesthesia, RFA was performed with the use of an RF generator and an 18-gauge internally cooled electrode. Volume changes in nodules on follow-up ultrasonography (US), changes in symptomatic and cosmetic scores, and complications arising during or after RFA were evaluated. Results: Mean follow-up period was 24.9 ± 13.9 months (range 6-43 months). At the last follow-up visits, volume of the nodule had decreased significantly (15.34 ± 11.52 mL vs. 4.07 ± 4.99 mL; P < 0.05), whereas volume reduction rate was 74.31% ± 19.59%. Both cosmetic and compressive symptoms were also significantly improved (2.91 ± 0.79 vs. 0.92 ± 0.67 and 1.5 ± 1.93 vs. 0.17 ± 0.39; P < 0.05). The mean number of ablation sessions was 1.4 ± 0.6 (range 1-3 sessions), and one of the patients suffered from transient vocal cord palsy which was spontaneously resolved 53 days later. Conclusions: RFA is a safe and effective treatment for benign thyroid nodules in pediatric patients, and can thus serve as an alternative treatment for thyroidectomy.
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Affiliation(s)
- An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kai-Lun Cheng
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Sheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Na-Ning Kan
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yan-Ye Su
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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6
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Kim JH, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, Choi YJ, Chung SR, Ha EJ, Hahn SY, Jung SL, Kim DS, Kim SJ, Kim YK, Lee CY, Lee JH, Lee KH, Lee YH, Park JS, Park H, Shin JH, Suh CH, Sung JY, Sim JS, Youn I, Choi M, Na DG. 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology. Korean J Radiol 2018; 19:632-655. [PMID: 29962870 PMCID: PMC6005940 DOI: 10.3348/kjr.2018.19.4.632] [Citation(s) in RCA: 363] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023] Open
Abstract
Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology (KSThR) developed recommendations for the optimal use of radiofrequency ablation for thyroid tumors in 2012. As new meaningful evidences have accumulated, KSThR decided to revise the guidelines. The revised guideline is based on a comprehensive analysis of the current literature and expert consensus.
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Affiliation(s)
- Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea
| | - Hye Shin Ahn
- Department of Radiology and Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea
| | - Seon Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan 48101, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul 03181, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul 06351, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Dae Sik Kim
- Department of Radiolgy, Incheon Medical Center, Incheon 22532, Korea.,Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea
| | - Soo Jin Kim
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea.,Department of Radiology, New Korea Hospital, Kimpo 10086, Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kwang Hwi Lee
- Department of Radiology, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, UAE
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul 04763, Korea
| | - Hyesun Park
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul 06351, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jin Yong Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam 13590, Korea
| | - Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul 03181, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul 04554, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea.,Department of Radiology, GangNeung Asan Hospital, Gangneung 25440, Korea
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7
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Barile A, Quarchioni S, Bruno F, Ierardi AM, Arrigoni F, Giordano AV, Carducci S, Varrassi M, Carrafiello G, Caranci F, Splendiani A, Di Cesare E, Masciocchi C. Interventional radiology of the thyroid gland: critical review and state of the art. Gland Surg 2018; 7:132-146. [PMID: 29770309 DOI: 10.21037/gs.2017.11.17] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thyroid nodules are a common incidental finding during a routinely ultrasound (US) exam unrelated to the thyroid gland in the healthy adult population with a prevalence of 20-76%. As treated before with surgery, in the last years new minimally invasive techniques have been developed as an alternative to surgery. The aim of this review, based on newly revised guidelines, is to provide some information regarding the basic principles, indications, materials, techniques, and results of mini-invasive procedures or treatments for thyroid nodules. We performed a narrative review including both newest and representative papers and guidelines based on the different procedures of ablation techniques developed in the last years for the diagnosis and the treatment of thyroid nodules. All examined papers referred very good results in term of volume nodule reduction, improvement in related symptoms and cosmetic problems, with a very low rate of complications and side effects for all the minimally invasive technique analyzed. Obviously, some differents between technique based on different kind of thyroid nodules and different indication were found. In conclusion, many thyroid nodules nowadays could be treated thanks to the advent of new mini-invasive technique that are less expensive and present a lower risk of major complications and side effects compared to surgery.
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Affiliation(s)
- Antonio Barile
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Simone Quarchioni
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | | | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Aldo Victor Giordano
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Sergio Carducci
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Marco Varrassi
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Giampaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Ferdinando Caranci
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
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8
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Wang JF, Wu T, Hu KP, Xu W, Zheng BW, Tong G, Yao ZC, Liu B, Ren J. Complications Following Radiofrequency Ablation of Benign Thyroid Nodules: A Systematic Review. Chin Med J (Engl) 2018; 130:1361-1370. [PMID: 28524837 PMCID: PMC5455047 DOI: 10.4103/0366-6999.206347] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: This systematic review examined whether radiofrequency ablation (RFA) is a safe treatment modality for benign thyroid nodules (BTNs). Data Sources: PubMed, Embase, and the Cochrane Library database were searched for articles that (a) targeted human beings and (b) had a study population with BTNs that were confirmed by fine-needle aspiration cytology and/or core needle biopsy. Study Selection: Thirty-two studies relating to 3409 patients were included in this systematic review. Results: Based on literatures, no deaths were associated with the procedure, serious complications were rare, and RFA appears to be a safe and well-tolerated treatment modality. However, a broad spectrum of complications offers insights into some undesirable complications, such as track needle seeding and Horner syndrome. Conclusions: RFA appears to be a safe and well-tolerated treatment modality for BTNs. More research is needed to characterize the complications of RFA for thyroid nodules.
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Affiliation(s)
- Jin-Fen Wang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Tao Wu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Kun-Peng Hu
- Department of General Surgery, Linnan Hospital, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510530, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, Endocrinology Unit, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Bo-Wen Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Ge Tong
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Zhi-Cheng Yao
- Department of General Surgery, Linnan Hospital, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510530, China
| | - Bo Liu
- Department of General Surgery, Linnan Hospital, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510530, China
| | - Jie Ren
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
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9
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Cesareo R, Palermo A, Pasqualini V, Cianni R, Gaspa G, Manfrini S, Pacella CM. Radiofrequency ablation for the management of thyroid nodules: A critical appraisal of the literature. Clin Endocrinol (Oxf) 2017; 87:639-648. [PMID: 28718950 DOI: 10.1111/cen.13422] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/13/2017] [Accepted: 07/11/2017] [Indexed: 11/28/2022]
Abstract
The majority of benign thyroid nodules are asymptomatic, remain stable in size and do not require treatment. However, a minority of patients with growing nodules may have local symptoms or cosmetic concerns, and thus demand surgical therapy. The timely use of ultrasound-guided, minimally invasive thermal therapies has changed the natural history of benign, enlarging thyroid nodules (TNs). These procedures produce persistent shrinkage of TNs and an improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first-line treatment for thyroid cysts, while in solid cold nodules, laser and radiofrequency ablation (RFA) have proven to be very effective and safe techniques in producing significant volume reduction that remains stable over several years. In particular, RFA seems to be suited for the management of small and medium nodules, while larger nodules may require repeated RFA treatments, and could be difficult to treat if they extend into the chest. RFA is performed in outpatient clinics and has a lower risk of complications compared to surgery. However, to date, there is still no unanimous consensus on the percutaneous treatment of benign nodules using such minimally invasive thermal techniques. In this review, we critically revise the literature to identify patients who are more likely to benefit from RFA treatment as an alternative to surgery.
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Affiliation(s)
- Roberto Cesareo
- Thyroid Disease Center, "S. M. Goretti" Hospital, Latina, Italy
| | - Andrea Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | | | - Roberto Cianni
- Department of Radiology, "S. M.Goretti" Hospital, Latina, Italy
| | - Gianluigi Gaspa
- Department of Food Science and Nutrition, University Campus Bio-Medico, Rome, Italy
| | - Silvia Manfrini
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
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10
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Park HS, Baek JH, Choi YJ, Lee JH. Innovative Techniques for Image-Guided Ablation of Benign Thyroid Nodules: Combined Ethanol and Radiofrequency Ablation. Korean J Radiol 2017; 18:461-469. [PMID: 28458598 PMCID: PMC5390615 DOI: 10.3348/kjr.2017.18.3.461] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 10/16/2016] [Indexed: 12/31/2022] Open
Abstract
In the treatment of benign thyroid nodules, ethanol ablation (EA), and radiofrequency ablation (RFA) have been suggested for cystic and solid thyroid nodules, respectively. Although combining these ablation techniques may be effective, no guidelines for or reviews of the combination have been published. Currently, there are three ways of combining EA and RFA: additional RFA is effective for treatment of incompletely resolved symptoms and solid residual portions of a thyroid nodule after EA. Additional EA can be performed for the residual unablated solid portion of a nodule after RFA if it is adjacent to critical structures (e.g., trachea, esophagus, and recurrent laryngeal nerve). In the concomitant procedure, ethanol is injected to control venous oozing after aspiration of cystic fluid prior to RFA of the remaining solid nodule.
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Affiliation(s)
- Hye Sun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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11
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Park JS, Seo DW, Song TJ, Park DH, Lee SS, Lee SK, Kim MH. Endoscopic ultrasound-guided ablation of branch-duct intraductal papillary mucinous neoplasms: Feasibility and safety tests using porcine gallbladders. Dig Endosc 2016; 28:599-606. [PMID: 26856542 DOI: 10.1111/den.12628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/19/2016] [Accepted: 02/03/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Radiofrequency ablation (RFA) and ethanol ablation are accepted methods of tissue destruction for treating cystic tumors. The aim of the present study was to evaluate the feasibility, efficacy, and safety of endoscopic ultrasound (EUS)-guided ablation using normal porcine gallbladders as a substitute model for branch-duct intraductal papillary mucinous neoplasms (BD-IPMN). METHODS Six adult mini pigs were included in this prospective study. EUS-guided RFA with or without ethanol ablation of the gallbladder was carried out using a prototype 18-gauge endoscopic RFA electrode, and RFA and ethanol ablation were done in a single session. Outcomes were assessed in terms of macroscopic and microscopic evaluations of the treated gallbladders. RESULTS The prototype RFA electrode was used for ablation of the mucosa, aspiration of the internal contents of the gallbladder, and ethanol injection. RFA plus ethanol lavage resulted in a greater mean percentage of denuded gallbladder mucosa (97.5%) than RFA alone (55.8%). Effects of ablation extending to the cystic duct and partially denuded cystic duct mucosae were detected in five of the six pigs. There were no major procedure-related adverse events. CONCLUSIONS EUS-guided ablation of the gallbladder mucosa was feasible and effective in the porcine model. Additional studies will be required to fully assess the risk of procedure-related damage to the main pancreatic duct before using this technique in a clinical setting.
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Affiliation(s)
- Jin-Seok Park
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Dong-Wan Seo
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Do Hyun Park
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang Soo Lee
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sung Koo Lee
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Myung-Hwan Kim
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Fuller CW, Nguyen SA, Lohia S, Gillespie MB. Radiofrequency ablation for treatment of benign thyroid nodules: systematic review. Laryngoscope 2013; 124:346-53. [PMID: 24122763 DOI: 10.1002/lary.24406] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/11/2013] [Accepted: 08/26/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To summarize the literature published to date on the use of radiofrequency ablation (RFA) in the treatment of benign thyroid nodules, to evaluate the effectiveness of this treatment, and to attempt an evaluation of factors that may influence treatment outcome. STUDY DESIGN Systematic review with meta-analysis. METHODS Systematic literature search was performed by two separate authors in four commonly used literature databases. Trials included in meta-analysis included only those presenting prospective data. Meta-analysis compared pretreatment values to post-treatment outcomes. RESULTS Of 46 full-text articles identified, nine articles satisfied inclusion criteria. Two of these articles were randomized controlled trials comparing RFA to placebo or to some other treatment. One article was a randomized controlled trial comparing one RFA treatment to two treatments. The remaining six articles were noncontrolled, prospective observational studies. All analyzed outcomes showed statistically significant improvements from baseline to final follow-up, including reduction in nodule size, improvement of symptom and cosmetic scores, and withdrawal from methimazole. Improvement in nodule size remained significant in both "hot" and "cold" nodule subgroups. Twelve adverse events were identified across all studies out of 306 total treatments. Two of these events qualified as significant adverse events. None of these events resulted in hospitalization or death. CONCLUSIONS Radiofrequency ablation is a safe and effective treatment for symptomatic thyroid nodules that are confirmed benign. However, the paucity of level 1 evidence comparing RFA to surgical or to other nonsurgical treatment modalities is concerning.
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Affiliation(s)
- Colin W Fuller
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Shin JH, Baek JH, Ha EJ, Lee JH. Radiofrequency ablation of thyroid nodules: basic principles and clinical application. Int J Endocrinol 2012; 2012:919650. [PMID: 23133449 PMCID: PMC3485526 DOI: 10.1155/2012/919650] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 10/09/2012] [Indexed: 12/24/2022] Open
Abstract
Radiofrequency (RF) ablation has been gaining popularity as a minimally invasive treatment for benign thyroid nodules regardless of the extent of the solid component. RF ablation of benign nodules demonstrated volume reductions of 33-58% after one month and 51-85% after six months, while solving nodule-related clinical problems. RF ablation has recently shown positive short-term results for locoregional control as well as symptom improvement in patients with recurrent thyroid cancers. This paper reviews the basic physics, indications, patient preparation, devices, procedures, clinical results, and complications of RF ablation.
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Affiliation(s)
- Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
- *Jung Hwan Baek:
| | - Eun Ju Ha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
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