Percutaneous Laser Ablation Research Articles

Post-traumatic AV Fistula of the Hand Successfully Treated With Percutaneous Endovascular Laser Ablation: Report of a Case.

Acquired arteriovenous fistula (AVF) in the hand can occur after trauma, fracture, or surgery. It is a rare condition, and only a few cases have been reported in the literature. Clinically they appear as palpable or painful lesions that persist long after the local hematoma has resolved. We report a case of a young patient presenting with long-standing and invalidating pain of the hand caused by a post-traumatic AVF, treated with percutaneous endovascular laser ablation.

SAT493 Laser Ablation For Benign Thyroid Nodules: A Way To Treat And Still Preserve The Thyroid

Abstract Disclosure: N. Kalara: None. D.L. Bignoli: None. C.M. Acosta: None. A. Manzano: None. Introduction: Thyroid nodules in adults have a prevalence of 3-7% based on palpation and 20-76% based on ultrasound examination. The majority of which are benign but some increase in size causing compressive symptoms or cosmetic concerns, thus, needing treatment. Laser ablation (LA) is a safe, non-surgical approach for the management of benign thyroid nodules now approved in the US. Nodule reduction is achieved through laser induced cytoreduction and tissue coagulation. Two benign FNA biopsies 3-6 months apart and a nodule size of more than 2.5 cm are some of the inclusion criteria for LA. We present a case of a benign thyroid nodule causing compressive symptoms where LA was done since the patient declined surgery. Case description: 76-year-old female with a history of type 2 diabetes mellitus, hypertension, and multinodular goiter for many years presented with concerns of neck fullness and discomfort for the past 6 months. Thyroid ultrasound confirmed a large dominant right complex nodule of 2.8 x 1.13 x 3 cm with a volume of 5 ml. Thyroid function test showed Thyroid stimulating hormone (TSH) 1.2 mIU/mL (0.40-4.50) and free T4 1.24 ng/dl (0.9-1.7). Two FNA biopsies done 3 months apart in the past were Bethesda II. Given the compressive symptoms due to a multinodular gland thyroidectomy was discussed as a treatment option with the patient which she declined. Hence, LA was discussed as an option for the largest nodule. The procedure was performed without complications. The nodule received 1450 Joules at 6 watts using one Elesta laser fiber. At the end of 2 months post-LA, thyroid ultrasound showed a significant reduction of the nodule with a current size of 1.5 x 1 x 1.6 cm and 1.4ml volume. She continued to be clinically and biochemically euthyroid with a total volume reduction close to 70% and complete resolution in compressive symptoms. Conclusion: Percutaneous laser ablation is a non-surgical, minimally invasive procedure to treat benign thyroid nodules that is now accessible in the US with promising results and a good safety profile. It is covered by insurance in various states. In our case the patient refused surgical intervention, thus, laser ablation was done that resulted in the resolution of her compressive symptoms without any complications. More awareness regarding the laser ablation procedure and its availability for patients is needed, especially in cases where preservation of the thyroid gland is desired. Reference: 1. Gambelunghe G, Stefanetti E, Avenia N, De Feo P. Percutaneous Ultrasound-Guided Laser Ablation of Benign Thyroid Nodules: Results of 10-Year Follow-Up in 171 Patients. J Endocr Soc. 2021 May 5;5(7):bvab081. doi: 10.1210/jendso/bvab081. PMID: 34159286; PMCID: PMC8212682. Presentation Date: Saturday, June 17, 2023

Efficacy and safety of ultrasound-guided percutaneous laser ablation in the treatment of unifocal papillary thyroid microcarcinoma

Efficacy and safety of ultrasound-guided percutaneous laser ablation in the treatment of unifocal papillary thyroid microcarcinoma

Ultrasound-guided percutaneous laser ablation of tributary varicose veins using a slim-type radial fiber.

This study presents the efficacy of ultrasound-guided percutaneous laser ablation of tributary varicose veins using a slim-type radial 2-ring fiber. One thousand consecutive patients who underwent endovenous laser ablation (EVLA) of incompetent saphenous veins were included. The tributary varicose veins were punctured with a 16G venule needle and ablated with a 1470nm laser system and a slim-type radial 2-ring fiber with a diameter of 1.27mm. The EVLA was performed with a power of 5W and linear endovenous energy density of around 30J/cm. Percutaneous varicose ablation was safely performed in 939 legs with an average of 5.9 times punctures per leg. No skin burn or nerve injury was observed after varicose ablation. Ultrasonography revealed complete occlusion of the treated veins 1month after EVLA. This study suggests that percutaneous varicose ablation with a slim-type radial 2-ring fiber is a safe and effective alternative to cover the weak point of ambulatory phlebectomy.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

Prospective Observational Study of Pain Severity and Pain Interference Outcomes Following Percutaneous MRI-guided Laser Ablation or Cryoablation for Focal Painful Peripheral, Soft Tissue Vascular Malformations: 12-month Outcomes

Background: Percutaneous image-guided thermal ablation has emerged as a treatment option for vascular malformations (VM). However, prospective data on intermediate to long-term effectiveness with uniform follow-up are lacking. Purpose: To prospectively evaluate the 12-month pain severity and pain interference outcomes following percutaneous MRI-guided laser ablation and cryoablation of focal painful, peripheral soft tissue VM. Materials and Methods: Participants undergoing clinically indicated MRI-guided laser ablation and cryoablation for focal painful (worst pain ≥4 out of 10 on Visual Analog Scale), peripheral soft tissue vascular malformations (VM) were enrolled in an IRB-approved prospective, observational study after giving informed consent. Participants completed the Brief Pain Inventory questionnaire prior to ablation and 1, 3, 6, and 12-month postablation. Differences in pain severity and interference outcomes from baseline on a 0 to 10 scale were compared using a paired t-test. Results: Seventeen participants (15 female; mean age 28.3 ± 9.3 years) underwent 24 MRI-guided and monitored ablation sessions including laser (n = 21), cryoablation (n = 2), or both (n = 1) for treatment of painful slow-flow (n = 16) or high-flow (n = 1) VM. Median maximal VM diameter was 5.7 cm (range 1.1 to 31.0 cm). Mean (±SD) preablation worst pain score was 7.9 ± 1.4. There was a significant decrease in worst pain at 1-month postablation (–3.5 ± 2.9; P = .0007) that was sustained at 3 (–3.4 ± 3.2; P = .0007), 6 (–4.2 ± 3.6; P = .0003), and 12 months (–3.6 ± 3.9; P = .002), with similar results for average, current, and least pain scores. There was a significant improvement in pain interference outcomes at 12-month postablation: general activity (P = .018), walking ability (P = .008), work (P = .003), sleep (P = .007), and enjoyment of life (P = .033). Conclusions: These data suggest that MRI-guided and monitored thermal ablation is safe and provides early and sustained significant improvements in pain severity and pain interference outcomes during the first year of follow-up in participants with focal painful peripheral soft tissue VM.

A 5-year follow-up study on the efficacy and safety of ultrasound-guided laser ablation in elderly patients with papillary thyroid microcarcinoma: A retrospective, single-center study from China.

The aim of this study is to evaluate the long-term efficacy and safety of ultrasound-guided percutaneous laser ablation (PLA) for the treatment of elderly patients with papillary thyroid microcarcinoma (PTMC). From September 2015 to April 2017, 38 elderly patients with PTMC confirmed through fine-needle aspiration biopsy (FNAB) were treated with PLA. Before the treatment, the location and volume of the nodule together with the patients' symptoms were evaluated. Twenty-four hours after the treatment, contrast-enhanced ultrasound (CEUS) was performed to evaluate the completeness of the ablation. To evaluate the volume of the ablation area and recurrence or metastasis, ultrasound examination was performed at 1, 3, 6, and 12 months after the treatment and every 6 months thereafter. FNAB was performed for any suspicious recurrence or metastasis lesions. The ablation of all the 38 patients was all achieved completely as confirmed by CEUS. No obvious complications were found. The success rate of single ablation was 100%. The average follow-up time was 64.58 ± 5.29 months (60-78 months). By the time of the last follow-up, 31 (81.58%) ablation lesions disappeared completely and seven (18.42%) ablation lesions showed scar-like changes. The volume of nodules was 40.69 ± 16.45 mm3 before operation, which decreased to 0.22 ± 0.76 mm3 by the end of 42 months, and all nodules disappeared 4 years after ablation (P < 0.01). At 6, 12, 18, 24, 30, 36, and 42 months after ablation, the average volume reduction rates (VRRs) were 12.09%, 31.21%, 50.9%, 72.06%, 84.79%, 95.65%, and 100%, respectively. Of all the patients enrolled, one patient (2.6%) had local recurrence and was treated with PLA again. No regrowth of treated nodule or lymph node metastasis and distant metastases was detected. Ultrasound-guided PLA is effective and safe for the treatment of elderly patients with PTMC who are ineligible for surgery.

PSAT372 Percutaneous Polidocanol Injection as an Alternative Treatment Differentiated Thyroid Cancer Oligometastases

Abstract Introduction Differentiated thyroid cancer (DTC) presents central lymph node metastasis in 20-50% and lateral in 12-81% of patients and ipsilateral recurrence after lateral neck dissection occur in 8-26%. The treatment of choice is surgical reintervention with subsequent administration of radioiodine. Treatment with radioactive iodine together with surgical reintervention aimed at compartments dissection provides variable remission rates in some cases of only 30-50%. Surgical reintervention carries a greater risk of complications such as recurrent laryngeal nerve injury, secondary postoperative hypoparathyroidism and morbidity associated with fibrosis formation in the surgical bed. Due to the complications, minimal invasive techniques (MIT) have been described for the treatment of unresectable and/ or proliferative oligomestastases, such as percutaneous ethanol injection (PEI), radiofrequency ablation, microwave ablation and laser ablation. PEI is described for the ablation for thyroid cysts, thyroid and parathyroid adenomas and cervical lymph node metastases. It´s used in the treatment of lesions smaller than 10 mm2 and represents a berry picking type intervention. It requires multiple sessions and can cause pain due to extravasation, skin necrosis, laryngeal necrosis, and damage to the recurrent laryngeal nerve. PEI´s greatest limitation is the uneven and unpredictable ablation area. Guidelines don´t contemplate it as the first line of MIT, highlighting thermal ablation`s (TA) usefulness, however it´s mentioned to consider its selection according to resources availability. After stating the inconveniences with PEI and difficulties related to the TA availability, in our center we have used polidocanol as a safer and more effective alternative to ethanol. Percutaneous polidocanol injection (PPI) requires fewer sessions and lower dose, and its administration technique is like PEI. PPI is described only as an alternative treatment for PEI recurrent pure cysts. Objective Determine the efficacy of PPI for DTC oligometastasis treatment. Study Design: An experimental, prospective, comparative, and analytical study. Patients older than 18 years were selected, with oligometastasis due to DTC in whom ablation with polidocanol 3% was performed, considering therapeutic efficacy the disappearance of the treated node and reduction of thyroglobulin. Results 27 patients were studied, a total of 60 lymph nodes. 22 women and 5 men, age 47.0±14.2 years, all with papillary thyroid cancer and structural incomplete response, with a cumulative RAI dose of 50±176 mCi, Thyroglobulin without stimulation was 3.06±2.9 ng/dl. Number of sessions was 1 in 71.4%. Mean polidocanol 3% used was 1.9±1.28ml. Follow-up time was 7.8±4.9 months. Initial tumor volume 5.9±1.3 ml, tumor volume at follow-up 0.88± 0.21, (p=0.00), control thyroglobulin was 0.55±0.8.1 (p=0.10). Remission was modified in 52.4%, reduction in 42.9%, stability in 4.8% No patient documented progression. Conclusion Polidocanol is safe and effective so it should be considered for the treatment of oligometastasis in DTC, in selected cases when thermal ablation techniques are lacking. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Percutaneous MR Imaging–Guided Laser Ablation for the Treatment of Symptomatic Cervicofacial Vascular Malformations

PurposeTo evaluate the safety and effectiveness of percutaneous magnetic resonance (MR) imaging–guided laser ablation for the treatment of symptomatic soft tissue vascular malformations (VMs) in the face and neck. Materials and MethodsAn institutional review board–approved retrospective review was undertaken of all consecutive patients who underwent MR imaging–guided and monitored laser ablation for treatment of symptomatic, cervicofacial soft tissue VM. Preablation and postablation MR imaging findings were independently reviewed. Preablation and postablation VM sizes were documented. Preablation T2 signal characteristics and enhancement patterns as well as postablation change in both signal and enhancement were semiquantitatively assessed. Changes in VM size were compared using a paired t test. ResultsThirteen patients (women, 9; age, 14.5–69.5 years) with 13 VMs were treated for moderate-to-severe pain (n = 4), swelling/mass effect (n = 8), or predominantly cosmesis (n = 1) with 22 total ablation sessions. The baseline maximum VM diameter was 5.7 cm ± 4.2. At baseline, all VMs (100%) demonstrated variable T2-weighted signal hyperintensity and enhancement. For painful VM, the baseline pain score was 8 ± 1. Clinical follow-up was available for 10 patients. Of patients with available follow-up, 3 (100%) treated for moderate-to-severe pain and 7 (100%) treated for swelling/mass effect reported subjective complete or partial symptomatic relief. The patient treated predominantly for cosmetic reasons was lost to follow-up. Two patients (15.4%) experienced minor adverse events by the Society of Interventional Radiology standards. There were no major adverse events. ConclusionsMR imaging–guided and monitored percutaneous laser ablation is safe and effective for the treatment of symptomatic, cervicofacial VMs.

The value of ultrasound guided laser ablation in papillary thyroid recurrence carcinoma: A retrospective, single center study from China.

ObjectiveThe efficacy and safety of ultrasound-guided percutaneous laser ablation (PLA) for treating recurrent papillary thyroid cancer nodules (RPTCNs).MethodsA retrospective study was conducted in 43 patients with single recurrent thyroid cancer which was diagnosed by fine needle aspiration biopsy (FNAB). The extent of ablation was assessed by contrast-enhanced ultrasound (CEUS) 24h after PLA. At baseline (before ablation), 6, and 12 months, and every 6 months thereafter, the following were recorded: nodule maximum diameter, volume reduction rate (VRR), complications, and side effects.ResultAll 43 patients were successfully treated with PLA without serious complications. All patients underwent CEUS 24 hours after PLA treatment, and all achieved complete ablation. The success rate of single ablation was 100%. The average follow-up time was 23.47 ± 6.50 months, 12 ~ 36 months. At the last follow-up, 32 (74.4%) ablation lesions disappeared completely and 11 (25.6%) ablation lesions showed scar-like changes. No lymph node metastasis was found during follow-up. The maximum diameter and volume of nodules decreased from 5.1 ± 1.4 mm, 86.22 ± 20.46 mm3 before operation to 0.73 ± 1.1 mm, 1.02 ± 1.92 mm3 at the end of observation (P < 0.01). The average volume reduction rates (VRR) at 6, 12, 18, 24, 30 and 36 months after ablation were 11.92%, 60.64%, 82.26%, 90.96%, 93.7% and 97.79% respectively. No regrowth of treated nodule and distant metastases were detected. One patient (2.3%) had local recurrence and was treated with PLA again.ConclusionUltrasound-guided PLA appears to be effective and safe for treating unifocal RPTCNs in selected patients who are ineligible for surgery, which is suitable for clinical application and promotion.

The feasibility and efficacy of ultrasound-guided percutaneous laser ablation for multifocal papillary thyroid microcarcinoma

ObjectiveThe aim of this study was to evaluate the feasibility and efficacy of percutaneous laser ablation (PLA) for patients with multifocal papillary thyroid microcarcinoma (PTMC).Materials and methodsA cohort of patients who underwent ultrasound (US)-guided PLA for primary PTMC were enrolled in this study. The patients were divided into a multifocal PTMC (multi-PTMC) group and a unifocal PTMC (uni-PTMC) group. Before PLA, conventional US and contrast-enhanced ultrasound (CEUS) were performed to evaluate the PTMC and cervical lymph nodes. The operation time, energy, power, amount of isolation liquid, and complications during PLA were recorded. Patients were followed up at 2 days, 1 month, 3 months, and 6 months, and every 6 months after that. Volume reduction rate (VRR), local tumor recurrence, and lymph node metastasis after PLA were observed.ResultsThe study included 12 patients with 26 PTMCs and 60 patients with 60 PTMCs. The operation time, total energy, and amount of isolation liquid in the multi-PTMC group were more than those in the uni-PTMC group (p = 0.000, 0.007, and 0.020, respectively). The mean follow-up durations in multi-PTMC and uni-PTMC groups were 19.75 ± 11.46 months (6–36 months) and 16.33 ± 10.01 months (4–40 months), with a similar VRR of the ablated lesions in the two groups. One and three cases with newly developed PTMCs were observed in the multi-PTMC group and the uni-PTMC group during follow-up, respectively. There was no regrowth of treated lesions, lymph node metastasis, or distant metastasis. At the end of the follow-up, all the ablated lesions in the two groups completely disappeared or only remained scar strips.ConclusionPLA is a safe and effective technique for treating multifocal PTMC, which might be an alternative technique for patients who are not eligible or are unwilling to undergo surgery.

Minimalno invazivne metode za lečenje tiroidnih nodusa i karcinoma

Thyroid nodules (TN) are present in about half of the population. About 5% of all nodules are malignant. Image-guided methods for the treatment of TN are becoming a significant alternative to surgery. Percutaneous ethanol ablation (PEA) is effective in the treatment of thyroid cysts, and neck lymph node metastases. Percutaneous laser ablation (PLA) significantly reduces the size of the nodules and improves subjective symptoms. The adverse effects of PEA are rare, transitory, and mild. Radiofrequency ablation (RFA) is effective for nodules of all sizes and compositions. The major complications of RFA are rare and transient. Microwave ablation is also effective in the treatment of thyroid nodules with rare major complications. High-intensity focused ultrasound (HIFU) is a transcutaneous method. It is effective in the treatment of thyroid nodules, and complications are rare. Graves' hyperthyroidism was also treated with HIFU. As thermal ablation (TA ) methods are becoming more popular in 2020, the European Thyroid Association published clinical practice guidelines for the use of image-guided ablation in benign thyroid nodules. A meta-analysis showed that low-risk papillary thyroid microcarcinoma recurrences after TA treatment are rare, as are complications. As the TA methods are acceptable for the treatment of the low-risk papillary thyroid carcinoma European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe issued clinical practice guidelines for the use of minimally invasive treatments in malignant thyroid lesions. Image-guided treatments for thyroid nodules and cancer are here to stay. Their use will expand and become part of routine clinical practice.

Long-Term Follow-Up of Single-Fiber Multiple Low-Intensity Energy Laser Ablation Technique of Benign Thyroid Nodules.

AimThe short-term and long-term efficacy of different thermal percutaneous ablation techniques remains a topical issue. Our group implemented percutaneous laser ablation (LA), a moving-shot technique to increase efficiency and reduce costs and variability of LA by applying multiple lower-intensity energy illuminations (MLIEI) covering the nodular volume (V) through changes in position of a single laser fiber within the thyroid nodule. The aim of the present study was to evaluate the efficacy of the single-fiber LA-MLIEI during a 5-year follow-up and to identify possible predictors of the final outcome.Methods Prospective study: Thirty outpatients (23 women and seven men) with benign symptomatic thyroid nodules were assigned to single-fiber LA-MLIEI, between 2012 and 2015. A single LA session was performed under real-time ultrasound (US) guidance using a 1,064-nm continuous-wave laser at 3 W. A 400-µm optical fiber was inserted through a 21-gauge needle, and 3–10 illuminations were performed per nodule, administering between 400 and 850 J/illumination. The total administered energy was calculated on the initial V of the nodule and the estimated ablation area. US evaluation was performed after LA-MLIEI at 1 week and 1, 3, 6, and 12 months and after that annually up to 5 years. Clinical symptoms, laboratory thyroid function during follow-up, and acute and chronic complications of treatment were registered.ResultsOn follow-up, 67% (n: 20) were responders to single-fiber LA-MLIEI, while 33% (n: 10) were non-responders. The responder group initiated V reduction (ΔV) at 1 month, with remission of symptoms, and presented a 50% ΔV at 3 months of treatment; the maximum response was achieved at 24 months and remained stable until the end of the study. The non-responder group presented a ΔV of less than 50% at 12 months; though a tendency to >50% ΔV was observed at 24–36 months, there was subsequent regrowth, and 40% of this group required surgery. ΔV was positively correlated with the total administered energy/V (J/V) and inversely with nodule V. No severe adverse effects were observed. Thyroid function remained normal in all patients. Remission of symptoms occurred rapidly after 1 month.ConclusionsLA with multiple fractional discharges employing a single fiber in a unique session is a safe and inexpensive technique that allows rapid reduction of thyroid nodules, with a stable response up to 5 years, similarly to what has been reported with the conventional LA. Total nodule volume appears as a predictive factor of the reduction.

The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia.

Background: Transurethral resection of the prostate (TURP) is regarded as the “gold standard” for the treatment of benign prostatic hyperplasia (BPH) in elderly men. However, ~15% of patients who had undergone TURP had intraoperative and postoperative complications, such as bleeding, urinary incontinence and urethral stricture. Transperineal percutaneous laser ablation (TPLA) is a method that places the optical fibre directly into the prostate with the guidance of ultrasound imaging, and the percutaneous transperineal approach is performed distal to the urethra and rectum to protect these structures and reduce urethral or postoperative infection. Several studies on TPLA for BPH treatment have been reported recently; however, high-quality randomised controlled trial (RCT) to evaluate its efficacy, safety, and long-term follow up remain absent.Methods: This study is a multicentre, open-label RCT to assess the efficacy and safety of TPLA vs. TURP to treat BPH. We hypothesise that the TPLA has non-inferior efficacy to TURP in the International Prostate Symptom Score (IPSS) at 3 months changing from the baseline and lower incidence of post-surgery complications. One hundred and fourteen patients with BPH will be recruited at 19 sites and randomly assigned at 1:1 to TPLA or TURP groups. The patients will be followed up at 1, 3, 6, 12, and 24 months after the procedure.Discussion: The study will be the first multicentre clinical trial including 16 participating centres in China, Italy, Switzerland, and Poland with relatively large sample size 114. By comprehensively compare the safety and efficacy of TPLA with TURP in patients with BPH, especially concerning the improvement of lower urinary tract symptoms (LUTS) and complication incidence, the study will help to illustrate the clinical value of TPLA and provide a beneficial alternative treatment for BPH patients.Clinical Trial Registration: The study has been registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn), identifier [ChiCTR1900022739].

Fiber-optic laser energy for pulmonary artery denervation: results of an experimental study

Abstract Background/Introduction Pulmonary artery denervation (PADN) is an interventional procedure aiming to modulate and correct pulmonary artery (PA) pressure. New technologies and energy sources are being tested currently. However, the effects of laser energy on the PA wall are unknown. Purpose To assess the acute effects and impact of laser energy for PADN procedure in normotensive sheep by applying different power settings and session times. Methods A total of 10 normotensive Katumsky sheep were included in the experiment. Percutaneous vascular access was performed under general anesthesia. A fiberoptic open-irrigated non-steerable catheter was introduced via a femoral vein through a steerable sheath. Laser applications were applied in the PA trunk and the proximal areas of the right and left PA under fluoroscopic guidance with a 5mm distance between points in the anterior, posterior and lateral walls. Applications were delivered with power 10–30W, 10–35s in duration; irrigation flow 40ml/min. After the procedure, experimental animals were euthanized and underwent an autopsy. PA samples were obtained regardless of the absence of visible laser-related lesions for histological analysis (hematoxylin staining) and immunohistochemical labelling (S100). Results A total of 108 ablation sessions were performed, 33 in the right PA, 30 in the left PA and 42 in the PA trunk. During macroscopic examination, laser-related lesions described as irregular brown hemorrhage spots and rough defects observed in the PA endothelium were not homogenous in all experimental animals. Thermal injuries either in the left or right lung lobes were identified in 5 (50%) experimental animals when using 30W during 10–20sec. In 5 (50%) sheep no collateral lung injuries were identified when using 10–20W from 20–35s. A total of 64 PA fragments underwent microscopic examination, acute thermal tissue lesions were observed in all experimental animals despite the absence of laser-related lesions in the PA endothelium; dissection, edema, disruption trough tunica layers, hemorrhage and necrosis at different depth walls. The most frequent nerve damage was obtained with 20W ablation: 5/8 PAs vs, 1/6 with 10–15W and 1/14 with 25–30W (P=0.01). At the same time, there was no difference in intima necrosis between the groups (1/6, 2/8 and 4/14 for 10–15, 20 and 25–30W groups, respectively). Conclusion(s) Percutaneous PA laser ablation is feasible, reduction of perivascular nerve expression is seen most frequently, when 20W/20–35 s ablation is performed. PA lesions may differ in depth and characteristics, and perivascular nerve damage might be seen in cases with preserved intima. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant of the Ministry of Science and Higher Education of the Russian Federation

Percutaneous MR Imaging-Guided Laser Ablation and Cryoablation for the Treatment of Pediatric and Adult Symptomatic Peripheral Soft Tissue Vascular Anomalies

PurposeTo evaluate the safety and effectiveness of percutaneous magnetic resonance (MR) imaging-guided laser ablation and cryoablation for the treatment of symptomatic soft tissue vascular anomalies (VAs) of the trunk and extremities. Materials and MethodsAn institutional review board-approved retrospective review was undertaken of all pediatric and adult patients who underwent MR imaging-guided and monitored laser ablation and/or cryoablation for the treatment of symptomatic peripheral soft tissue VA. Preablation and postablation MR imaging was independently reviewed. Pain scores on the visual analog scale (0 to 10) and self-reported subjective symptomatic improvement were assessed. Change in VA size and pain scores were compared using a paired t test. ResultsThirty patients (24 females; age, 10–75 years) with 34 VAs were treated for moderate to severe pain (n = 27) or swelling/mass effect (n = 3) with 60 total ablation sessions. The baseline maximum VA diameter was 9.5 cm ± 8.6. At baseline, all VAs (100%) demonstrated variable T2-weighted signal hyperintensity and enhancement. The baseline pain score was 6.4 ± 1.6. Clinical follow-up was available for 23 patients. At a mean follow-up time of 12.2 months ± 10.1, 19 of 20 (95%) patients treated for pain and 2 of 3 (67%) patients treated for swelling/mass effect reported partial or complete symptomatic relief. There was a significant decrease in the postablation pain scores (−5.7 ± 1.0, P < .001) and maximum VA size (−2.3 cm ± 2.7, P = .004), with >50% reduction in VA T2 signal (59%) and enhancement (73%). Nine of 30 (30%) patients experienced minor complications. ConclusionsMR imaging-guided and monitored percutaneous laser ablation and cryoablation appear to be safe and effective for the treatment of symptomatic peripheral soft tissue VAs.

Long-Term Efficacy of Ultrasound-Guided Percutaneous Laser Ablation for Low-Risk Papillary Thyroid Microcarcinoma: A 5-Year Follow-Up Study.

Objective To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous laser ablation (PLA) for the treatment of low-risk papillary thyroid microcarcinoma (PTMC). Methods From June 2012 to May 2015, 105 patients with solitary, pathologically confirmed PTMC lesions were treated with ultrasound-guided PLA. Nodule location, nodule volume, thyroid function, and clinical symptoms were evaluated before ablation. Contrast-enhanced ultrasound (CEUS) was performed 1 h after treatment to evaluate whether the ablation was complete. Ultrasound examination was performed at 1, 3, 6, and 12 months after ablation and every 6 months thereafter to determine the size of the ablation area and search for recurrence in the thyroid parenchyma and lymph node metastasis. Thyroid function was examined before and 1 month after ablation. Fine needle aspiration biopsy was performed for any suspicious metastatic lymph nodes and recurrent lesions in the thyroid. Results All 105 lesions were completely inactivated after one ablation, making the success rate for single ablation 100%. The average ablation time was 2.78 ± 1.05 min, and the average ablation energy was 505 ± 185 J. All patients could tolerate and complete the ablation. No serious complications occurred during the treatment; only minor side effects such as pain and local discomfort were reported. The volume reduction rates were −781.14 ± 653.29% at 1 h posttreatment and −268.65 ± 179.57%, −98.39 ± 76.58%, 36.78 ± 30.32%, 75.55 ± 21.81%, 96.79 ± 10.57%, and 100% at 1, 3, 6, 12, 18, and 24 months after ablation, respectively. This rate remained 100% at the later follow-up times. Overall, 28 (26.67%), 74 (70.48%), 96 (91.43%), and 103 (100%) were completely absorbed by 6, 12, 18, and 24 months after PLA. One patient developed another lesion 12 months after ablation, and two patients had central cervical lymph node metastasis 24 months after ablation. Conclusion PLA is a safe and effective alternative clinical treatment for low-risk PTMC.

Ultrasound-Guided Percutaneous Laser Ablation of the Thyroid Gland in a Swine Model: Comparison of Ablation Parameters and Ablation Zone Dimensions.

To compare laser ablation (LA) zone dimensions at two predetermined energy parameters to cover a theoretical 10 mm zone + 2 mm margin in a thyroid swine model. Approval of the Institutional Animal Care and Use Committee was obtained. After hydrodissection, an ultrasound-guided LA (Elesta Echolaser X4 with Orblaze technology, 1064nm) was performed in the periphery of the thyroid in 10 swine. Two cohorts were established to ablate a region of 10mm diameter with 2mm margin based on manufacturer's ex vivo data (n= 5 at 3W/1400J and n= 5 at 3W/1800J). The ablation zone was measured on contrast-enhanced computed tomography (CT)and compared to the pathological specimen. Euthanasia was performed 48 hours following ablation. All ablations in the 3W/1800J group achieved a diameter of 12 mm ± 1 mm in three dimensions. In the 3W/1400J group, 1 ablation reached 12 mm ± 1 mm in 2 dimensions and 4 ablations reached this size in one dimension. Maximum diameter was higher in the 3W/1800J compared to the 3W/1400J group, both on histology (1.46 cm ± 0.05 vs. 1.1 cm ± 0.0, p< 0.01) and CT (1.52 cm ± 0.04 vs. 1.18 cm ± 0.04, p< 0.01). Similar results were obtained regarding volumes, both on histology (1.12 mL ± 0.13 vs. 0.57 mL ± 0.06, p< 0.01) and CT (1.24 mL ± 0.13 vs. 0.59 mL ± 0.07, p< 0.01). Histology showed coagulation necrosis and correlated well with CT measurements. Optimal parameters to obtain a LA zone of 10 mm with 2 mm margin utilizing a single needleare 3W/1800J.

Percutaneous laser ablation of metastatic lymph nodes, role of minimally invasive thyroid treatment in center of reference of endocrine surgery.

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

Percutaneous Ultrasound-Guided Laser Ablation of Benign Thyroid Nodules: Results of 10-Year Follow-Up in 171 Patients.

ContextPercutaneous, ultrasound-guided laser ablation is effective in nodular thyroid disease.ObjectiveThe aim of this study was to evaluate the long-term (10-year) efficacy and safety of laser ablation in the treatment of benign thyroid nodules.MethodsFrom 2009 to 2010, 171 patients received a single session of laser ablation. Evaluation of nodule volume was performed before treatment, at 6 months, and every year.ResultsTechnique efficacy was achieved in 92% of patients at 1 year. Median nodule volume significantly decreased from 16.7 mL (range, 11.0-97.0 mL) at baseline to 5.0 mL (range, 4.1-32.0 mL) at 1 year, a volume reduction ratio (VRR) of 68%. The benefit of the treatment was durable (P < 0.001 vs baseline at all timepoints), with a VRR of 59% after 10 years. No cases of nodule regrowth > 50% were observed at 1 year, although such cases did occur after 4 years (n = 3; 1.7% of the overall cohort) and 7 years (n = 8; 4.7%). There were no further cases of regrowth beyond 7 years. When patients were stratified according to baseline nodule volume (< 15 mL, 15-25 mL, or > 25 mL), durable results were observed across all 3 categories, with the largest, most prolonged effect observed in patients with nodules < 15 mL. Treatment was well tolerated, with only minor, transient complications of fever and local pain, and 98% of patients willing to recommend the treatment.ConclusionPercutaneous, ultrasound-guided laser ablation of benign thyroid nodules provides long-term benefits and the treatment is well tolerated.