Radiofrequency ablation of thyroid nodules

Abstract

The treatment goals of Image-guided intervention for thyroid nodule are the relief of symptoms by reducing the nodule volume and the maintaining of symptom free status without regrowth of treated lesion. Thus, it is basically not indicated for the nodules which are not related to the patient's discomfort even they are large. And up to now, except for few limited cases impossible to get surgery, the applications for the malignant disease and follicular neoplasm have not been established firmly. For this reason, preoperative cytopathologic and ultrasonographic evaluations are important to confirm that the target lesion is benign. Thermal ablation is one category of it and consists of radiofrequency ablation (RFA), laser ablation, microwave ablation and high-intensity-focus-ultrasound. RFA for benign thyroid nodules have been reported to have a high efficacy with a low complication rate. Its efficacy is generally evaluated by volume reduction rate. Reported short-term results are 50-80% volume reduction at 6 months, 79-90% at 2 years, and 93% at 4 years. Recurrence rates after the procedure have been reported 5.6%. All recurrent cases showed regrowth of the incompletely treated nodule margin. For this reason, it is recommended to ablate the nodule completely to minimize recurrence. The multiple sessions are needed to get the well-ablated nodule without damaging the adjacent tissues. In this presentation, we can discuss how to make a plan before and after thyroid RFA to reach more successful treatment goal, minimizing the recurrence and the complications.