Outcomes Of Radiofrequency Ablation Research Articles

Treatment strategies for solitary hepatocellular carcinoma: comparative outcomes of radiofrequency ablation vs. laparoscopic liver resection based on tumor location.

The treatment of early stage hepatocellular carcinoma (HCC) has become increasingly complex. This study evaluates the effectiveness of radiofrequency ablation (RFA) versus laparoscopic liver resection (LLR) for treating solitary hepatocellular carcinoma (HCC) ≤ 3cm, with a focus on tumor location and depth. We conducted a retrospective analysis of patients treated for solitary HCC ≤ 3cm in the right liver lobe from 2004 to 2022. Tumor depth was categorized into three zones based on proximity to portal vein branches: Zone I (near first-order branches), Zone II (adjacent to second-order branches), and Zone III (near third-order branches). Outcomes were measured using overall survival (OS) and recurrence-free survival (RFS) rates. Of the 662 patients, for Zone I, II, and III, 240 (65 LLR, 175 RFA); 174 (100 LLR, 74 RFA); and, 248 patients were treated (244 LLR, 4 RFA), respectively. Statistically significant differences in the treatment outcomes based on the tumor depth were observed. For Zone I, LLR demonstrated superior OS (p = 0.043) and RFS rates (p = 0.030) than did RFA. For Zone II, both treatments had comparable survival outcomes, with no statistically significant differences in the OS (p = 0.460) and RFS (p = 0.358). For Zone III, LLR was principally favored, due to easier surgical access and cleaner margins. This study highlighted the importance of including tumor location and depth, in addition to the tumor size and liver function, in the management of early stage HCC. A multidisciplinary approach is essential for treatment planning and optimizing survival outcomes.

Outcomes of Radiofrequency Ablation of Autonomously Functioning Nodules: Expanding the Hyperthyroidism Tool Kit

Outcomes of Radiofrequency Ablation of Autonomously Functioning Nodules: Expanding the Hyperthyroidism Tool Kit

Clinical outcome of radiofrequency ablation in elderly hepatocellular carcinoma patients over 80 years old.

603 Background: The SURF trial showed the efficacy and safety of radiofrequency ablation(RFA). However, patients over 80 years old were excluded from the study. Aims: To evaluate clinical outcomes of RFA for largest hepatocellular carcinoma (HCC) diameter ≤3 cm, and ≤3 HCC nodules in patients over 80 years. Methods: Patients who underwent RFA at our institution for initial treatment of largest HCC diameter ≤3 cm, and ≤3 HCC nodules from January 2011 to December 2023. Treatment outcome and prognosis were examined in the elderly group for cases 80 years or older and in the non-elderly group for cases under 80 years. The Cox proportional hazards model was used to analyze the factors associated with treatment outcome and prognosis. Results: Of the 518 eligible patients, 136 patients were 80 years or older. Median overall Survival (OS) was 80 (95%CI 60-96) vs. 123 (95%CI 101-NA) months (p=0.021) in the elderly vs. nonelderly group. The median recurrence-free survival was 16 (95%CI 14-22) vs. 26 (95%CI 19-30) months (p=0.023), better in the non-elderly group, Interestingly, for liver disease-related deaths, median OS was 97 (95% CI 80-NA) vs. NR (95% CI NA-NA) months (p=0.62) in the elderly vs. non-elderly group. In the multivariate analysis, factors associated with OS were ALBI grade 2 or 3 (HR 1.67, 95%CI 1.07-2.60), DCP ≥ 40mAU/ml (HR 2.08, 95%CI 1.42-3.05), persistent HCV infection (HCV non-SVR) (HR 5.45, 95%CI 3.07-9.67), nonviral liver disease (HR 4.18, 95%CI 2.31-7.55). HCC recurrence was significantly associated with male (HR 1.51, 95%CI 1.18-1.94), elderly group (HR 1.46,95%CI 1.10-1.95), PT ≥80% (HR 0.69, 95%CI 0.53-0.91), DCP ≥40mAU/ml (HR 1.37, 95%CI 1.07-1.76), and HCV non-SVR (HR 1.73, 95%CI 1.35-2.21). The factors associated with liver disease-related death were ALBI grade 2 or 3 (HR 2.16, 95% CI 1.25-3.73), DCP ≥ 40mAU/ml (HR 2.34, 95% CI 1.48-3.70) and HCV non-SVR (HR 2.22, 95% CI 1.39-3.56). Conclusions: In RFA for diameter ≤3 cm, and ≤3 HCC nodules, over 80 years was not a significant factor associated with OS or liver disease-related death. The results support that RFA would be a promising treatment option for HCC patients over 80 years.

Therapeutic outcomes and safety of radiofrequency ablation for primary papillary thyroid carcinoma: A game-changing meta-analysis.

Radiofrequency ablation (RFA) is an emerging treatment option for small, low-risk papillary thyroid carcinoma (PTC). This systematic review and meta-analysis aimed to evaluate and compare the efficacy and safety profiles of RFA for primary T1a vs. T1b PTC. PubMed, Web of Science, Embase, Google Scholar, and ScienceDirect databases were searched from inception to February 14, 2024 for studies reporting outcomes of RFA for T1a vs. T1b PTC with no known nodal or distant metastasis. The primary outcomes assessed were pooled proportions of tumor disappearance, volume reduction, complications, and recurrence. Twenty studies with 6,613 RFA-treated PTC nodules were included. The median age was 44 years, and the average follow-up was 36.4 months. The mean tumor volume and diameter were 168.9 mm3 and 0.69 cm, respectively. The pooled tumor disappearance rate was 94.3 % for all tumors, with rates of 96.1 % for T1a and 76.7 % for T1b lesions (p = 0.05). The disappearance rate increased from 61.8 % at 12 months to 91.5 % at 48 months post-RFA. The overall volume reduction rate (VRR) was 99.4 % for both T1a and T1b tumors, increasing from 36.8 % at 1 month to 99.6 % at 48 months. Tumor progression occurred in only 1.33 % of the cases overall, with low recurrence rates in both T1a (1.11 %) and T1b (4.21 %) lesions. New cancer foci and lymph node metastases were rare, observed in 0.81 % and 0.20 % of cases, respectively. The overall complication rate was 1.71 %, with transient voice change (0.44 %) and neck pain (0.30 %) being the most common. RFA is a safe and effective minimally invasive treatment option for both T1a and T1b PTC, with high tumor disappearance and volume reduction rates and low complication and recurrence rates. The low progression rates in both tumor sizes suggest that RFA is a promising alternative to surgery for selected low-risk PTC patients. Prospective studies with standardized protocols are warranted to validate these findings.

Treatment Outcomes of Radiofrequency Ablation Using the Rafaelo Technique for Internal Hemorrhoids

Objective: Hemorrhoidal disease impacts quality of life. While hemorrhoidectomy is the standard for grades 3 and 4 internal hemorrhoids, its pain is a downside. The Rafaelo technique, using radiofrequency ablation (RFA), is a promising non-excisional alternative. The present study investigated postoperative outcomes of this innovative approach. Materials and Methods: The authors conducted a single-center study performed by a single surgeon between January and December 2022. The surgical procedures were performed using a combination of intravenous sedation and perianal block. Results: Forty patients underwent the Rafaelo technique, with a mean age of 49.7±15.1 years. Among them, 24 (60%) were male, and 16 (40%) were female. Thirteen patients (32.5%) had grade 2 hemorrhoids, while 27 patients (67.5%) had grade 3 hemorrhoids. The visual analog scale (VAS) scores were consistently low within the first 24 hours after surgery with VAS 1.1±1.4 at 4 hours, 1.18±1.54 at 8 hours, and 0.58±1.04 at 12 hours. Ninety-seven-point-five percent of the patients could be discharged on the first day, and eighty-five percent resumed their daily activities after discharge. Additionally, two cases developed thrombosed hemorrhoids as the postoperative complication, which were successfully treated conservatively. The symptoms severity score significantly decreased from 4.15±1.69 preoperatively to 1.03±1.37 at two weeks and 0.00 at three months. There were no cases of recurrence within the 6-month postoperative period. Conclusion: The Rafaelo technique has demonstrated remarkable safety and effectiveness in treating grade 2 and 3 internal hemorrhoids. Notably, it minimizes postoperative pain and yields favorable outcomes at six months.

Posterior nasal nerve neurolysis in addition to radiofrequency ablation of the inferior turbinates for patients with chronic rhinitis.

This study aimed to evaluate the outcome of radiofrequency ablation of the inferior turbinates (RFIT) combined with posterior nasal nerve neurolysis (RPN3) in comparison with RFIT alone in the treatment of patients with chronic rhinitis unresponsive to pharmacological therapy. A retrospective cohort study was conducted on adult and adolescent patients with chronic rhinitis who demonstrated a poor response to medication. Patients with a total 24-hour reflective total nasal symptom score (rTNSS) of ≧5, rhinorrhea score of ≧2, and congestion score of ≧2 were included. The treatment outcomes of patients who underwent RPN3 and RFIT alone were assessed. The primary endpoint was the change from baseline in 12-h reflective total nasal symptom score (rTNSS), nasal obstruction symptom evaluation scores (NOSE), and the response rate defined as rTNSS improved ≧by 30% during follow-ups. A total of 64 patients were included (45 males, 70.3%). Overall, 49 patients underwent RPN3, and 15 patients underwent RFIT alone. The rTNSS had improved by 78.4% and 65.8% in RPN3 and RFIT groups, respectively (both p < 0.001). The NOSE score had improved by 92.89% and 86.81% in the RPN3 and RFIT groups (both p < 0.001), respectively. Patients in the RPN3 group demonstrated statistically significantly better results after three months than patients in the RFIT alone group (p < 0.05). The response rate was 98% in the RPN3 group after 3 months. The proposed RPN3 alleviated rhinitis symptoms, which demonstrated a high response rate with a superior symptom control rate than RFIT alone in chronic rhinitis with severe rhinorrhea and nasal congestion cases.

The Outcomes of Radiofrequency Ablation for Varicose Veins with Venous Leg Ulcer

The Outcomes of Radiofrequency Ablation for Varicose Veins with Venous Leg Ulcer

Short and Mid-term Outcome of Radiofrequency Ablation without Concomitant Phlebectomy/Sclerotherapy for Tributary Varicose Veins

Endovenous surgery in the treatment of varicose veins generally consists of laser or radiofrequency ablation (RFA) as endovenous thermal ablation (ETA) with a phlebectomy or foam sclerotherapy of tributary varicose veins to improve symptomatic or cosmetic problems. Nevertheless, the efficacy of their concomitant treatments is still controversial for a decade. In the guidelines of the Japanese Society of Phlebology, concomitant phlebectomy of tributary varicose veins with ETA is described that it is not recommended officially. In our hospital, RFA without concomitant phlebectomy of tributary varicose veins accounts for 74% of the RFA cases and it shows a relatively higher percentage than other institutions in Japan. The data of RFA without concomitant phlebectomy of tributary varicose veins are evenly matched in RFA with concomitant treatments in our data concerning recurrence, remnants, endovenous heat-induced thrombosis (EHIT), and complications. This article provides the conclusion that it would be acceptable to perform isolated RFA compared to RFA with concomitant phlebectomy or foam sclerotherapy of tributary varicose veins in short- and mid-term periods. In addition, concomitant treatments might contribute to rapid improvement of the short-term and better long-term outcomes, not to mention cosmetic problems that are not identified demonstrably. (This is a translation of J Jpn Coll Angiol 2022; 62: 49-54.).

Surgical and Ablation Therapies for Atrial Appendage Tachycardia in Children.

Atrial tachycardia (AT) originate from the atrial appendage present unique clinical challenges in pediatrics. It is typically persistent, frequently leading to tachycardiomyopathy, and poses significant treatment difficulties. This study aimed to collate and analyze the clinical characteristics and therapeutic outcomes of radiofrequency ablation (RFCA) and with atrial appendage resection for the treatment of AT originating from the atrial appendages in pediatric patients. This retrospective study encompassed a cohort of 70 pediatric patients diagnosed with AT originating from the atrial appendage, identified through RFCA diagnostics. The study period spanned from January 2010 to February 2022 and provided a comprehensive analysis of patient outcomes following the treatment approaches. The mean age was 6.94 ± 3.46 years with the mean weight of 26.69 ± 13.59kg. Tachycardia cardiomyopathy developed in 44.3% (31 of 70 patients) of the patients. The immediate success rate of RFCA was 72.9% (51 of 70), whereas the recurrence rate after RFCA was 25.5% (13 of 51 patients). Thirty-two (45.7%) patients underwent atrial appendage resection because of unsuccessful ablation or recurrence. These included 20 right atrial appendage (RAA) and 12 left atrial appendages resections. Following resection, sinus rhythm was achieved in all patients without recurrence. Notably, RAA aneurysms were discovered in 45.0% (9 of 20 patients) of RAA resections, representing 22.5% (9 of 40) of RAA and 57.1% (8 of 14) of RFCA failures in AT originating from the RAA. RFCA for AT originating from the atrial appendage in children has relatively low success and high recurrence rates. Electrophysiological mapping and surgical resection is a safe and effective alternative. In particular, in cases of AT originating from the RAA and unresponsive to RFCA, the possibility of an atrial appendage aneurysm should be considered.

Global Research Progress on Radiofrequency Ablation in Cardiology

Radiofrequency ablation (RFA) has become a cornerstone in treating cardiac arrhythmias, offering a minimally invasive approach to managing conditions such as atrial fibrillation, ventricular tachycardia, and other rhythm disorders. The historical evolution of RFA, from its early inception to its current state, underscores the technological advancements that have significantly enhanced its efficacy and safety. Global trends indicate a steady increase in the adoption of RFA, with notable research contributions from North America, Europe, and Asia. Comparative studies reveal outcome variability driven by differences in patient populations, procedural techniques, and healthcare infrastructures. Despite its success, RFA faces challenges, including complications related to the procedure, patient selection, and long-term efficacy. Emerging technologies, such as integrating artificial intelligence and enhanced imaging modalities, hold promise for overcoming these barriers and further refining the procedure. Gaps in current research are identified, particularly in understanding the long-term outcomes of RFA and its application in complex arrhythmias. The critical role of RFA in modern cardiology is emphasized, along with the potential for future innovations that could expand its therapeutic utility. This synthesis of the latest evidence provides valuable insights for optimizing the use of RFA in managing cardiac arrhythmias.

Learning curve for the perinatal outcomes of radiofrequency ablation for selective fetal reduction: a single-center, 10-year experience from 2013 to 2023.

To investigate the perinatal outcomes of SR using radiofrequency ablation (RFA) in MC pregnancies, identified factors affecting these outcomes, and assessed the associated learning curve. This retrospective cohort study included all consecutive MC pregnancies that required RFA from September 2013 to April 2023 at our institution. The perinatal outcomes were compared on the basis of various indications, and binary logistic regression analysis was performed to identify the risk factors for cotwin loss. Clinical datas of two periods (2013-2018 vs. 2019-2023) were compared to demonstrate the learning curve. The 107 cases composed of 40 (37.4 %) twin-twin transfusion syndrome (TTTS), 17 (15.9 %) selective intrauterine growth restriction (sFGR), 12 (11.2 %) twin reversed arterial perfusion sequence (TRAPS), 25 (23.4 %) fetal discordant anomalies, 10 (9.3 %) elective fetal reduction (EFR), and three (2.8 %) twin anemia polycythemia sequence (TAPS) cases. The overall live birth rate for cotwins was 83.2 %. The earliest gestational age at delivery was noted in the TTTS group (p=0.021). The procedure-to-delivery interval was the shortest in the TTTS group and the longest in the EFR group (p<0.001). Comparing the 2013-2018 period with the 2019-2023 period, we noted a significant increase in the live birth rate (p=0.01) and the procedure-to-delivery interval (p=0.003), mainly due to improved outcomes in TTTS cases. RFA for SR is a safe and effective method for managing complicated MC pregnancies. The type of indication affects postoperative perinatal outcomes, with TTTS showing the most adverse effects. With the increasing number of cases and accumulation of experiences with simultaneous enhancement of technique proficiency, the postprocedural outcomes can be further improved.

Radiofrequency ablation (RFA) in unresectable pancreatic adenocarcinoma: meta-analysis & systematic review.

Pancreatic adenocarcinoma remains a challenging malignancy with a poor prognosis. Radiofrequency ablation (RFA) has emerged as a potential treatment for unresectable pancreatic adenocarcinoma (UPAC) aimed at improving survival and quality of life. This meta-analysis and systematic review evaluates the outcomes of RFA in UPAC. A comprehensive search was conducted in MEDLINE, Embase, Scopus, and Cochrane Central databases from inception to October 2023. Studies included patients over 18years with UAPC undergoing RFA. Survival rates and complication rates were assessed as primary outcomes. Data were pooled using random-effects models, and heterogeneity was assessed with I2 statistics. ROBINS-I tool was used for quality assessment. Nine studies encompassing 265 patients met the inclusion criteria. The mean age was 64.5years, with 42.5% female participants. Survival analysis showed that at 30days post-RFA, the mortality rate was 3.3%. At 6months, the mortality rate was 20.9%, increasing to 50.4% at 12months. At 24months, the mortality rate was 61.9%. The pooled mean survival period at 12 and 24months was 9.18months and 14.26months, respectively. Overall, 78.4% of patients died during the follow-up period, with an overall mean survival period of 12.27months. The most common were intra-abdominal (10.1%), pancreatic (9.8%), and hepatobiliary (6.7%) complications. RFA shows potential in the management of unresectable pancreatic adenocarcinoma, with a manageable safety profile. However, the high heterogeneity and risk of bias in available studies highlight the need for well-designed randomized controlled trials to confirm these findings and establish standardized protocols.

Radiofrequency Ablation of Toxic Thyroid Nodules: An Early Experience of a Single Institution in the United States.

The field of endocrine surgery has been expanding its minimally invasive techniques to treat a wide range of thyroid pathologies. Radiofrequency ablation (RFA) is one targeted thermal therapy that has been identified as safe and effective for the treatment of benign pathologies as an alternative to surgery. We have employed RFA at our institution and are reporting our experience with this techniques safety, efficacy, and considerations in the treatment of toxic adenomas and multinodular goiters. Forty-one patients with symptomatic hyperthyroidism from toxic nodules who elected to receive ultrasound guided radiofrequency ablation in the office were followed with imaging, laboratory studies, and clinical questionnaires. Volume of thyroid nodules was recorded by ultrasound at intervals approximately 1-, 3-, 6-, and 12-months post-procedure. Solitary and multinodule lesions responded with an average volume reduction of 80.57% by 12 months following RFA. Patients achieved significant improvement in cosmetic and clinical symptoms with 35 of 41 patients sustaining remission from hyperthyroid state. Pain was the most frequently reported complication of this procedure, though it did not result in early termination of procedure of affect treatment outcomes. In our early experience, RFA is a safe and effective method for treating hyperfunctioning thyroid nodules of benign etiologies. To further validate and support these findings, expansion of this cohort and more extensive follow up will allow us to better characterize the outcomes of RFA and compare this approach to both surgical and other minimally invasive thermal ablative approaches.

Long-term outcomes of radiofrequency ablation and cyanoacrylate closure for treatment of small saphenous veins

Aim: Superficial venous insufficiency is less prevalent in the lesser saphenous vein compared to the great saphenous vein. Treating the lesser saphenous vein often presents greater challenges due to its proximity to the sural nerve and anatomical variations. This study evaluates the long-term efficacy of radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) for managing small saphenous veins and discusses our treatment approach. Material and Methods: We performed a retrospective analysis involving 137 patients (64 treated with CAC and 73 with RFA) who received treatment for small saphenous vein insufficiency at our clinic between 2014 and 2019. We assessed quality of life and clinical outcomes at 6 months, and at 1, 3, and 5 years post-treatment. Results: Our findings indicated that radiofrequency ablation showed greater improvements compared to cyanoacrylate embolization in terms of VCSS. However, over the 5-year follow-up period, recurrence rates were observed in 11 (17.1%) patients in the CAC group and 5 (6.8%) patients in the RFA group, with this difference being statistically significant (p=0.045). Conclusion: Radiofrequency ablation for treating venous insufficiency offers superior long-term quality of life benefits compared to cyanoacrylate closure, particularly after three years.

Atrial arrhythmia and heart failure in adult patients with congenital heart disease: a retrospective cohort study

BackgroundAtrial arrhythmias (AA) and heart failure (HF) are major causes of hospitalisation in adult congenital heart disease (ACHD). This study aimed to evaluate the temporal relationship between AA and HF...

Survival Outcomes of Radiofrequency Ablation for Intrahepatic Cholangiocarcinoma from the Surveillance, Epidemiology, and End Results Database: Comparison with Radiotherapy and Resection

PurposeTo determine effectiveness of radiofrequency ablation for treatment of intrahepatic cholangiocarcinoma (iCCA) using a population-based database. Materials and MethodsData were extracted from Surveillance, Epidemiology, and End Results database from 2000 to 2020 to include 194 patients who underwent ablation for iCCA. Data on patient demographics, overall survival (OS), and cancer-specific survival were retrieved. Factors associated with survival were evaluated. Comparison between ablation and surgical resection (n = 2,653) or external beam radiotherapy (n = 1,068) was performed. ResultsIn the ablation group, patients diagnosed and treated after 2010 demonstrated improved OS than that in the 2000–2009 subgroup (median OS, 32 vs 21 months; hazard ratio, 0.50; 95% CI, 0.33–0.75; P = .001). Additional factors associated with OS included tumor size (≤3 cm vs >3 cm; P = .049) and tumor stage (P < .001). For patients diagnosed after 2010, the 1-, 3-, and 5-year OS were 82.8% (95% CI, 74.8%–88.4%), 43.5% (95% CI, 33.5%–53.1%), and 23.7% (95% CI, 15.3%–33.5%), respectively. Patients with local disease (1-year OS, 87.8%; 95% CI, 78.6%–93.3%) demonstrated improved OS compared with patients with regional (1-year OS, 81.3%; 95% CI, 52.5%–93.5%) and distant disease (50.2%; 95% CI, 34.0%–78.8%; P < .001). For tumors ≤3 cm, ablation and surgical resection offered comparable survival benefits (P = .561), although both were better than radiotherapy (P < .0001). ConclusionsSurvival of patients with iCCA who underwent thermal ablation has improved over the last 10 years. For tumors ≤3 cm, ablation could be as effective as resection with careful candidate selection, and may be considered front-line compared with radiotherapy in certain patient populations. Patient selection based on tumor size and disease stage could improve survival outcomes.

Comparative efficacy of microwave ablation and radiofrequency ablation for treating metastatic liver cancer: a systematic review and meta-analysis.

This study aims at evaluating and juxtaposing the efficacy of radiofrequency ablation (RFA) and microwave ablation (MWA) for hepatic metastases treatment. We undertook an extensive literature search across the Cochrane Library, Web of Science, Embase, PubMed, CNKI, and databases for studies published up to December 2023, assessing the outcomes of RFA versus MWA in hepatic metastases treatment. Studies were included or excluded based on established criteria. Continuous variables were analyzed with the aid of the weighted mean difference (WMD) and its 95% confidence interval (CI), while the odds ratio (OR) with its 95% CI was utilized for dichotomous variables. Data were processed by use of STATA 17.0 software. Key outcomes assessed included ablation time, post-operative local tumor progression (LTP), disease-free survival (DFS), and post-operative complications (POCs). Seven studies, comprising 357 patients undergoing MWA and 452 patients undergoing RFA, fulfilled the inclusion criteria. As unveiled by the meta-analysis, RFA and MWA did not significantly differ in ablation time, DFS, and POCs. Nonetheless, MWA resulted in a strikingly reduced rate of post-operative LTP versus RFA. MWA offers superior control over post-operative LTP, suggesting better overall efficacy in hepatic metastases treatment compared with RFA. https://www.crd.york.ac.uk/prospero/, identifier CRD42023385201.

Outcomes of Radiofrequency Ablation for Autonomously Functioning Thyroid Adenomas-Mayo Clinic Experience.

Autonomously functioning thyroid nodules (AFTNs) constitute 5% to 7% of thyroid nodules and represent the second most common cause of hyperthyroidism following Graves' disease. Currently, radioactive iodine (RAI) and surgery are the standard treatment options, and both incur a risk of postprocedural hypothyroidism and other surgery and radiation-related complications. This work aimed at assessing the efficacy of radiofrequency ablation (RFA) as an alternative treatment option for resolving hyperthyroidism and the nodule volume rate reduction (VRR) and its associated adverse events. A total of 22 patients underwent RFA for a solitary AFTN. Seventy-two percent (n = 16) had subclinical hyperthyroidism, 9% (n = 2) had overt hyperthyroidism, and 18% (n = 4) were biochemically euthyroid on antithyroid medication. Average pretreatment TSH was 0.41 mIU/L (SD = 0.98) and free T4 1.29 ng/dL (SD = 0.33). Following a single RFA session, hyperthyroidism resolved in 90.9% (n = 20) and average VRR (61.13%) was achieved within 3 to 6 months following the ablation. Except for 1 nodule, none of the nodules grew during the follow-up period (16.5 months). Two patients (9%) developed transient tachycardia requiring short-term beta-blocker therapy, and 2 developed mild hypothyroidism requiring levothyroxine therapy. Two patients developed recurrent hyperthyroidism and elected to undergo lobectomy and repeat RFA respectively. No serious adverse effects were noted in this cohort. RAI and/or surgery represent the standard of care for toxic adenomas, but RFA shows excellent efficacy and safety profile. Therefore, at centers with RFA expertise, it should be considered an alternative treatment strategy, avoiding radiation and surgery-related complications.

3D ultrasound guidance for radiofrequency ablation in an anthropomorphic thyroid nodule phantom

BackgroundThe use of two-dimensional (2D) ultrasound for guiding radiofrequency ablation (RFA) of benign thyroid nodules presents limitations, including the inability to monitor the entire treatment volume and operator dependency in electrode positioning. We compared three-dimensional (3D)-guided RFA using a matrix ultrasound transducer with conventional 2D-ultrasound guidance in an anthropomorphic thyroid nodule phantom incorporated additionally with temperature-sensitive albumin.MethodsTwenty-four phantoms with 48 nodules were constructed and ablated by an experienced radiologist using either 2D- or 3D-ultrasound guidance. Postablation T2-weighted magnetic resonance imaging scans were acquired to determine the final ablation temperature distribution in the phantoms. These were used to analyze ablation parameters, such as the nodule ablation percentage. Further, additional procedure parameters, such as dominant/non-dominant hand use, were recorded.ResultsNonsignificant trends towards lower ablated volumes for both within (74.4 ± 9.1% (median ± interquartile range) versus 78.8 ± 11.8%) and outside of the nodule (0.35 ± 0.18 mL versus 0.45 ± 0.46 mL), along with lower variances in performance, were noted for the 3D-guided ablation. For the total ablation percentage, 2D-guided dominant hand ablation performed better than 2D-guided non-dominant hand ablation (81.0% versus 73.2%, p = 0.045), while there was no significant effect in the hand comparison for 3D-guided ablation.Conclusion3D-ultrasound-guided RFA showed no significantly different results compared to 2D guidance, while 3D ultrasound showed a reduced variance in RFA. A significant reduction in operator-ablating hand dependence was observed when using 3D guidance. Further research into the use of 3D ultrasound for RFA is warranted.Relevance statementUsing 3D ultrasound for thyroid nodule RFA could improve the clinical outcome. A platform that creates 3D data could be used for thyroid diagnosis, therapy planning, and navigational tools.Key PointsTwenty-four in-house-developed thyroid nodule phantoms with 48 nodules were constructed.RFA was performed under 2D- or 3D-ultrasound guidance.3D- and 2D ultrasound-guided RFAs showed comparable performance.Real-time dual-plane imaging may offer an improved overview of the ablation zone and aid electrode positioning.Dominant and non-dominant hand 3D-ultrasound-guided RFA outcomes were comparable.Graphical

Treatment outcomes in patients with papillary thyroid cancer undergoing radiofrequency ablation of metastatic lymph nodes.

Lymph node metastases in papillary thyroid cancer (PTC) increases recurrence risk and negatively impact survival. Traditional treatments like re-operation and radioactive iodine (RAI) have downsides. Radiofrequency ablation (RFA) is an emerging non-surgical therapeutic option, but there is seldom data on its efficacy and safety specifically for metastatic lymph nodes. We aimed to evaluate clinical outcomes of RFA applied to cervical lymph nodes in patients with PTC metastasis in North American population. This was a single-institution retrospective analysis of 68 PTC patients with lymph nodes who underwent percutaneous RFA from January 2020 to December 2022. Volume reduction ratio (VRR), changes in thyroglobulin (Tg) levels, lymph node regrowth rate, and complications were assessed. Treatment response and outcomes were analyzed. Median lymph node maximum diameter was 12.9 mm and median volume was 0.27 mL at baseline. After RFA, median VRR was 79.5% [interquartile range (IQR), 50-89.7%]. Post-RFA, Tg to an average of 0.2 ng/mL (IQR, 0-0.6 ng/mL). In the 19 patients (27.9%) with undetectable Tg after RFA, median VRR was 86% (IQR, 73-94%). Quantitative Tg decrease strongly correlated with VRR percentage (r=0.82, P<0.001). Lymph node regrowth was seen in 5 patients (7.4%) over median 18 months follow-up. Only one patient experienced transient thermal injury associated with Horner's syndrome and symptoms resolved within 1 month. In patients with PTC and metastatic cervical lymph nodes, RFA provided marked volume reduction and meaningful biochemical response without major complications. Excellent radiographic control was achieved in most patients. RFA demonstrates early promise as an emerging non-surgical therapeutic option for PTC patients with metastatic lymph nodes.