Laser Ablation For Thyroid Nodules Research Articles

Laser ablation for thyroid nodules has come to age—a review

: Benign thyroid nodules are traditionally treated with thyroidectomy when they become symptomatic. Surgery is expensive, results in scarring, and frequently requires subsequent thyroid hormone replacement. For these reasons, in 2000, a feasibility study proposed ultrasound (US)-guided laser ablation (LA) as a minimally invasive treatment for thyroid lesions. During the following 20 years, US-guided thermal ablation techniques performed with laser, radiofrequency, microwaves, and high-intensity focused US have become available for clinical practice. Clinical outcomes have demonstrated a nearly similar efficacy and safety of these techniques, but LA still appears as the less complicated and invasive procedure. LA results, in most cases, in a clinically significant volume decrease paralleled by improvement of local symptoms. Volume reduction is stable over the years, complications are rare, and cosmetic damage or thyroid function changes are nearly absent. LA may also be considered for small size hyperfunctioning thyroid nodules. In these cases, thyroid function normalization may be obtained with no irradiation or chance of hypothyroidism. Due to the efficacy and minimal cost of ethanol injection LA remains as a second-line treatment for cystic lesions which relapse after US-guided ethanol ablation. The use of LA and other minimally invasive techniques for non-surgical management of papillary thyroid microcarcinoma (PTMC) represents a rapidly evolving area. Currently, LA may be considered for patients with low-risk PTMC, mainly if they are surgically at risk, with short life expectation, and if they refuse surgery or active surveillance.

Ultrasound guided percutaneous laser ablation of thyroid nodules

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Thyroid: Laser ablation of thyroid nodules is rapid, safe and effective.

Thyroid: Laser ablation of thyroid nodules is rapid, safe and effective.

Outcomes and Risk Factors for Complications of Laser Ablation for Thyroid Nodules: A Multicenter Study on 1531 Patients.

Image-guided laser ablation therapy (LAT) of benign thyroid nodules demonstrated favorable results in randomized trials with fixed modalities of treatment. The aim of this retrospective multicenter study was to assess the effectiveness, tolerability, and complications of LAT in a large consecutive series of patients from centers using this technique in their routine clinical activity. Clinical records of 1534 consecutive laser-treated nodules in 1531 patients from eight Italian thyroid referral centers were assessed. Inclusion criteria were as follows: solid or mixed nodules with fluid component up to 40%; benign cytological findings; and normal thyroid function. LAT was performed with a fixed-power protocol, whereas the number of applicators and illumination times were different according to target size. From one to three illuminations with pullback technique and with a total energy delivery based on the nodule volume were performed during the same session. Patients were evaluated during LAT, within 30 days, and 12 months after the procedure. Total number of treatments was 1837; 1280 (83%) of nodules had a single LAT session. Mean nodule volume decreased from 27 ± 24 mL at baseline to 8 ± 8 mL 12 months after treatment (P < .001). Mean nodule volume reduction was 72% ± 11% (range 48%-96%). This figure was significantly greater in mixed nodules (79% ± 7%; range 70%-92%) because they were drained immediately before laser illumination. Symptoms improved from 49% to 10% of cases (P < .001) and evidence of cosmetic signs from 86% to 8% of cases (P < .001). Seventeen complications (0.9%) were registered. Eight patients (0.5%) experienced transitory voice changes that completely resolved at the ear-nose-throat examination within 2-84 days. Nine minor complications (0.5%) were reported. No changes in thyroid function or autoimmunity were observed. Real practice confirmed LAT as a clinically effective, reproducible, and rapid outpatient procedure. Treatments were well tolerated and risk of major complications was very low.

Abstract #1260: Outcomes, Side Effects and Risk Factors for Complications of Ultrasound-Guided Laser Ablation for Thyroid Nodules. A Multicenter Study on 1531 Patients

Abstract #1260: Outcomes, Side Effects and Risk Factors for Complications of Ultrasound-Guided Laser Ablation for Thyroid Nodules. A Multicenter Study on 1531 Patients

Management of Thyroid Lesions

: Percutaneous image-guided thermal ablation is a nonsurgical treatment in benign and malignant thyroid lesions. Laser ablation of thyroid nodules is a minimally invasive procedure to treat benign thyroid lesions including cold nodules or single nodules within a multinodular goiter. The technique consists of the destruction of the tissue by the insertion therein of optical fibers which convey the light energy, causing a complete and irreversible necrosis. In many clinical trials, laser ablation has demonstrated a good efficacy for the shrinkage of benign cold thyroid nodules. Laser ablation has been tested for the palliative treatment of poorly differentiated thyroid carcinomas, local recurrences, or distant metastases. Laser ablation therapy is indicated for the shrinkage of benign cold nodules in patients with local pressure symptoms who are at high surgical risk. The treatment should be performed only by well trained operators and after a careful cytological evaluation. Laser ablation does not seem to be consistently effective in the long-term control of hyperfunctioning thyroid nodules and is not an alternative treatment to 131I therapy. Laser ablation may be considered for the cytoreduction of tumor tissue prior to external radiation therapy or chemotherapy of local or distant recurrences of thyroid malignancy that are not amenable to surgical or radioiodine treatment.

The administration of anesthetic in the thyroid pericapsular region increases the possibility of side effects during percutaneous laser photocoagulation of thyroid nodules

Nodular thyroid disease is very frequent in iodine-deficient areas affecting at least 50% of the population. Percutaneous laser ablation (LA) represents an effective method and an alternative to conventional surgery. Since the first description of the LA methodology for thyroid nodules, various studies have suggested some modifications to increase the percentage of volume reduction of the nodules. One of these alternatives involves the injection of anesthetic in the pericapsular thyroid space with detachment of the capsule itself from the surrounding tissue. The aim of this study was to retrospectively evaluate whether using local anesthetic during LA is more effective in reducing volume size of treated nodules, and whether it causes fewer side effects than using no local anesthesia. A retrospective analysis was conducted on 100 LA procedures performed on 100 patients between January 2009 and December 2011. The patients were divided into two groups: Group A (n = 50) received Lidocaine around the capsule of the thyroid nodule and Group B (n = 50) did not receive any local anesthetic treatment. Before treatment, the median volume size of the nodules of the two groups was similar. The results of our study demonstrate that the injection of local anesthetic does not help reduce nodule volume and that side effects (fever and pain) increase about threefold in the early hours following LA treatment. Thus, we do not recommend local anesthesia before LA of thyroid nodules.

Ultrasound-Guided Interstitial Laser Ablation for Thyroid Nodules Is Effective Only at High Total Amounts of Energy

According to cross-sectional surveys, the prevalence of nontoxic nodular goiter appears to be higher in the adult population. Surgical intervention is indicated for the following: (a) progressive goiter growth, (b) compression of organs such as the trachea and esophagus, and (c) significant aesthetic disfigurement. Ultrasound-guided laser photocoagulation for the treatment of benign thyroid nodules is a viable alternative to traditional surgery. However, studies that have appeared in literature since the introduction of ultrasound-guided laser photocoagulation for the treatment of benign thyroid nodules report contradictory data concerning the energy required for nodule ablation. The aim of the present trial was to evaluate retrospectively the efficacy of percutaneous laser thermal ablation in 2 groups of patients, one treated with low, and the other with high, total amount of energy. Forty euthyroid patients were treated with 1 session of percutaneous laser photocoagulation treatment at low (median = 71 J/mL; 20 patients) and high (median = 578 J/mL; 20 patients) energy. The volume of the nodules was measured by the same investigator, blinded for treatment, using the ellipsoid formula before treatment, at 2, 4, 8, and 30 weeks, and every 6 months for 3 years thereafter. Thyroid nodule ablation is effective over time only if a sufficient amount of energy (>400-500 J/mL for the nodular tissue to be treated) is given, although it incurs proportionate side effects. Percutaneous laser thermal ablation is a viable alternative to traditional surgery for the treatment of benign nodular thyroid disease only if a sufficient amount of energy is delivered.

Radiofrequency Ablation for an Autonomously Functioning Thyroid Nodule

Radiofrequency Ablation for an Autonomously Functioning Thyroid Nodule