Ablation Of Thyroid Nodules Research Articles

Thyroid Radiofrequency Ablation-Thermal Effects on Recurrent Laryngeal Nerve Using Continuous Intraoperative Neuromonitoring Animal Model.

When performing radiofrequency ablation for thyroid nodules, it is essential to avoid thermal injury to the recurrent laryngeal nerve. This porcine animal model study used continuous intraoperative neuromonitoring to investigate the thermal safety parameters of thyroid radiofrequency ablation. Porcine animal study. University animal laboratory. Twelve piglets were tested at different radiofrequency power levels, and the real-time electromyography signal changes were recorded under continuous intraoperative neuromonitoring. The spread heat study (8 piglets) included spontaneous recovery tests and cold water irrigation tests to investigate the safety distance from the recurrent laryngeal nerve to the active tip during 5-second activation with standard stimulation patterns. The residual heat study (4 piglets) investigated the safety cooling durations by touching the recurrent laryngeal nerve with the tip after a 5-second activation. In the spread heat study, substantial signal attenuation events were observed at an spread heat distance of 2, 3, 5, and 5 mm when the power was set as 10, 20, 30, and 50 W, respectively. No signal recovery could be observed in 20 minutes with or without cold water irrigation in the injured recurrent laryngeal nerve area. The residual heat study shows the residual thermal effect of the tip is minimal, and no substantial signal attenuation event was observed at all experiments. This innovative study established the thermal safety parameters for radiofrequency ablation in a porcine model at various power levels, which can potentially assist operators in delineating a precise ablation field and providing effective thyroid ablation treatment safely.

Cervical plexus block enhanced pain control for unilateral thermal ablation of thyroid nodules.

Despite being minimally invasive, thermal ablation (TA) of thyroid nodules may still cause significant pain during and shortly afterwards. Conventional analgesia relies on perithyroidal local anesthesia (PLA) with or without sedation. The use of cervical plexus block (CPB) has been extensively studied in thyroidectomy, but never studied in TA of the thyroid gland. This study examined whether adding ultrasound-guided CPB to PLA and sedation could further reduce post-operative pain in unilateral TA of thyroid nodules. Consecutive patients aged ≥18 years undergoing unilateral radiofrequency ablation (RFA) or microwave ablation (MWA) of thyroid nodules were reviewed. Group I patients did not receive CPB, and Group II patients received CPB by bupivacaine injection between the sternocleidomastoid muscle (SCM) and prevertebral fascia on the treatment side. Pain was charted immediately and 4 hours after ablation using a numeric rating scale (NRS) of 0-10. The Quality-of-Recovery-9 (QoR9) questionnaire was completed. Over an 18-month period, 100 patients underwent unilateral thyroid ablation (Group I, n=50; Group II, n=50). Comparable baseline patient demographics, nodule characteristics, ablation parameters were noted (P>0.05). Significantly lower immediate NRS {1 [0-3] vs. 4 [1.3-6], P<0.001}, 4-hour NRS {1 [0-3] vs. 2 [0-4], P=0.04}, and more zero immediate NRS (44% vs. 14%, P=0.001) was observed in Group II. Total QoR9 scores were comparable {16 [12-17] vs. 15 [12-17], P=0.72}. No adverse events occurred. All patients were discharged within the same day. Adding ultrasound-guided CPB further enhanced pain control following unilateral TA of thyroid nodules, without compromising quality of recovery or same-day discharge.

Risk factors for recurrent laryngeal nerve injury in microwave ablation of thyroid nodules: A multicenter study

Background and purposeThis study aimed to investigate the risk factors for recurrent laryngeal nerve (RLN) injury after microwave ablation (MWA) of thyroid nodules and to identify factors influencing the recovery time of post-procedure hoarseness. Materials and methodsWe retrospectively analyzed data from patients who underwent MWA for thyroid nodules at five hospitals between November 2018 and July 2022. Patients were divided into malignant and benign nodule groups. Variables analyzed included nodule size and location, the shortest distance from nodules to the thyroid capsule and tracheoesophageal groove (TEG-D), and ablation parameters. Univariate and multivariate analyses were performed to identify risk factors. Kaplan-Meier and Cox analyses were used to evaluate the recovery time of hoarseness after MWA. ResultsThe study included 1,216 patients (mean age 44 ± 12 [SD] years; 901 women) with 602 malignant nodules and 614 benign nodules. The posterior capsule distance (PCD) and TEG-D were identified as independent influencing factors for hoarseness in all patients (P = 0.014, OR = 0.068; P < 0.001, OR = 0.005; AUC = 0.869). TEG-D was a significant risk factor for hoarseness, with safe thresholds identified at 4.9 mm for malignant nodules and 2.2 mm for benign nodules. Among patients who developed hoarseness, those in the close-distance group (TEG-D≤2 mm) had a longer recovery time compared to the distant-distance group. TEG-D was an independent factor influencing recovery time (P = 0.008, HR = 11.204). ConclusionClinicians should consider several factors, particularly TEG-D and PCD, when assessing the risk of RLN injury before MWA. TEG-D was a vital independent factor influencing recovery time. SummaryClinicians should pay attention to several influencing factors for RLN injury before MWA and TEG-D was an independent influencing factor for recovery time of hoarseness after MWA.

Incomplete ablation of thyroid cancer: Achilles’ Heel?

BackgroundIn recent years, the incidence of thyroid nodules has increased significantly. There are various ways to treat thyroid nodules, and ablation therapy is one of the important ways to treat thyroid nodules. However, there are many complications and deficiencies in the current ablation treatment of thyroid nodules, especially the incomplete ablation of thyroid cancer nodules, which limits the further application of ablation technology.Case SummaryIn this paper, we report two cases of incomplete ablation of thyroid nodules, one of which underwent surgical treatment due to anxiety after ablation, and the postoperative pathology confirmed that there was still residual papillary thyroid carcinoma, and the other patient underwent an operation after ablation, but visited our medical institution again due to cervical lymph node metastasis in a short period of time, and after radical cervical lymph node dissection, pathology confirmed multiple cervical lymph node metastasis. Radionuclide therapy was performed after surgery, and two patients are currently receiving endocrine suppression therapy, and their condition is stable with no signs of recurrence.ConclusionThe incomplete ablation of thyroid cancer nodules limits the development of ablation therapy, making ablation treatment a double-edged sword. Guidelines and expert consensus can guide their development, but they need to evolve with the times, and a multidisciplinary diagnostic team can help screen the most suitable patients. Only by using this technology more standardly, using the most appropriate technology, and treating the most suitable patients, can benefit more and more patients.

Microwave Thermal Ablation of Thyroid Nodules with the MONTREAL Technique: Preliminary Clinical Results.

Ultrasound-guided percutaneous Microwave Thermoablation (MWA) is an increasingly popular minimally invasive therapy for the treatment of benign thyroid nodules due to its remarkable heating velocity and resilience to heat sinking. We present a cohort of 26 patients (17 F, 9M, mean age 56.2yy) with 20 goiters (mean volume 34.9cc, min 6.5cc-max 84cc) and 6 autonomously functioning nodules (AFTNs, mean volume 11.6cc, min 3.5cc-max 24cc) treated with MWA, using the moving shot technique and a novel energy delivery algorithm (MONTREAL), based on intra-operative real-time reflectivity measurements: each moving shot was automatically terminated when reflectivity was observed to ramp up. 17G or 18G internally cooled 2.45 GHz applicators were used (AMICA-PROBE, HS HOSPITAL SERVICE SpA), operated at 15-30W. On average, each treatment deposited 9.9±5.5kJ during 696±325s, through 26.7±14.4 moving shots: the mean moving shot duration was 28.1±9.0s, yielding a mean ablation time per unit nodule volume of 34.3±19.1s/cc. No mild nor severe complications were recorded. Post-MWA ultrasound follow-up showed a mean volume reduction ratio of 59.1±10.2% [min 44% - max 80%] at 3 months and of 70.1±8.5% [min 53% - max 91%] at 6 months, with slightly better outcomes in the AFTNs sub-group (volume reduction of 65.3±10.2%/76.0±4.0% at 3/6 months and, in all cases, normal TSH values at 3 months upon pharmacological therapy suspension). MWA treatments of benign nodules with the MONTREAL technique appeared to be safe, fast, and effective. Further research is warranted to confirm these preliminary results.

A novel guided approach to radiofrequency ablation of thyroid nodules: the Toronto Sunnybrook experience.

Thyroid nodules are extremely common being detected by ultrasonography in up to 67% of the population, with current surgical tenet maintaining that lobectomy is required for large symptomatic benign nodules or autonomously functionally nodules resulting in a risk of hypothyroidism or recurrent laryngeal nerve injury even in high volume centres. The introduction of radiofrequency ablation (RFA) has allowed thermal ablation of both benign and autonomously functioning thyroid nodules with minimal morbidity. The moving shot technique is the most well-established technique in performing RFA of thyroid nodules, and has proven to be safe, efficacious, accurate and successful amongst experienced clinicians. The purpose of this article to propose the use of a novel guide when performing RFA of thyroid nodules in clinical practice utilizing the moving shot technique. The technique proposed of RFA involves the use of a 10MHz linear ultrasound probe attached to an 18G guide which provides robust in line visualisation of a 7cm or 10cm radiofrequency probe tip (STARmed, Seoul, Korea) utilizing the trans isthmic moving shot technique. A geometric analysis of the guide has been illustrated diagrammatically. The use of an 18G radiofrequency probe guide (CIVCO Infiniti Plus™ Needle Guide) maintains in line visualisation of the radiofrequency probe over a cross-sectional area up to 28cm2, facilitating efficient and complete ablation of conceptual subunits during RFA of thyroid nodules. Radiofrequency ablation of thyroid nodules can be performed safely and effectively using the novel radiofrequency probe guide proposed which we believe potentially improves both accuracy and overall efficiency, along with operator confidence in maintaining visualisation of the probe tip, and hence we believe provides a valuable addition to the armamentarium of clinicians wishing to embark on performing RFA of thyroid nodules.

A 6-year single-center prospective follow-up study of the efficacy of radiofrequency ablation for thyroid nodules.

Radiofrequency ablation (RFA) is an alternative modality for thyroid nodules (TNs) and many studies have also confirmed its favorable efficacy and safety. The scope of RFA increases in clinical practice and the aim of our study was to evaluate the efficacy of RFA. We conducted a prospective study to evaluate the efficacy of RFA for thyroid nodules between January 2017 and December 2022 at our institution. We assessed the change in nodal volume, volume reduction ratio (VRR), technique effective (TE) rate, complete ablation (CA) rate, and nodal regrowth rate and time after RFA. We performed RFA for 1703 patients with TNs between January 2017 and December 2022, of which a total of 970 eligible patients were enrolled in the study. The preoperative volume of TNs was 6.23 ± 8.11ml, with 821 benign and 149 malignant nodules. The post-RFA TE and adjusted TE rate were 80% and 88.8%, respectively. CA was achieved in 145 (14.9%) patients with a mean time of 18.32± 12.98 months; nodal regrowth occurred in 15 (1.5%) patients with a mean time of 29.80 ± 12.47 months. TNs volume and VRR changed significantly at years 1 and 2 after RFA and stabilized after 5 years. A serious postoperative adverse event occurred in one patient with cervical sympathetic chain injury resulting in Horner's syndrome. A transient or permanent damage of the recurrent laryngeal nerve could not be evaluated due to the lack of postoperative laryngoscopy, and this is a significant limitation of the study. The expanded RFA indications were also effective for TNs, with no significant change in long-term efficacy.

US-guided percutaneous ablation of thyroid nodules with 177LU-MAA (LUTMA) - Feasibility study

PurposeThe main purpose is to evaluate the safety, and efficacy of 177Lutetium labeled macroaggregated albumin (LUTMA) ablation of thyroid nodules. Materials and methodsPatients with confirmed benign nodules who were not candidate or did not accept surgery were enrolled. Under ultrasonography (USG) guidance, LUTMA which was produced in our department, was administered into the nodules. Nodule volumes were assessed via USG before the injection and at 1-week, 1-month, and 3-months post-treatment. We calculated the volume reduction rates (VRRs) for these intervals. To detect extranodular activity leakage, patients underwent SPECT/CT imaging at one hour, 24 h, and one week post-injection. ResultsFifteen patients (male: 12, female: 3) with benign thyroid nodules were eligible to join this study. These nodules were categorized as cystic (n = 9), solid (n = 3), or mixed (n = 3). Median nodules volume was 6.59 ml (range: 0.56–55 ml). Predicted absorbed dosee to the nodules varied between 10–1036 Gy. The VRRs at 3 months was 85% for all nodule types with gradual increases over time: 0%–92%, 20%–97%, and 28%–98% at 1 week, 1 month, and 3-months, respectively. The median VRR of cystic nodules was 89% (range: 81%–98%) at 3-months. It is significantly higher than solid ones (P = .009). None of the patients experienced adverse reactions or discomfort during the injection or follow-up. ConclusionLUTMA treatment significantly reduces the volume of benign thyroid nodules, offering relief from disease-associated symptoms and cosmetic concerns. It emerges as a promising alternative to surgical and other local treatments for benign thyroid nodule ablation. Clinical significationLUTMA is a novel theranostic radiopharmaceutical which is promising in local ablative treatment of benign thyroid nodules.

Analysis of trends in radiofrequency ablation in a tertiary care center practice.

Radiofrequency ablation (RFA) for thyroid nodules has recently been introduced into the United States healthcare system landscape. Little is known about the process of incorporating this procedure into existing clinical practice. A retrospective chart review of a single institution was conducted to examine referral patterns and decision-making after the introduction of RFA into an endocrine surgery-focused practice. Patient demographics and thyroid-specific data were recorded. Two reviewers abstracted and coded reasons for the noncompletion of RFA. Two-sample t tests were used to compare groups; linear regression was used to assess trends and practice patterns. Chart review identified 451 patients referred for consideration of RFA from January 2020 to December 2022. Only 255 (56.5%) went on to receive the treatment. There was no significant difference in nodule volume between treated and nontreated groups (18.5 vs. 14.9 cm3, p = 0.07). Concern for malignancy on genetic testing, size (too large/too small), recommendation for Ethanol ablation, and multinodular disease without target nodules were the most common reasons for physician deferral. Of patients who declined to proceed, 46% opted to undergo surgical excision. Linear regression showed that referral numbers significantly increased with time; however, the proportion of patients receiving treatment decreased yearly, primarily because of higher rates of physician deferral. This study reflects the complex decision-making in offering minimally invasive thyroid nodule ablation. Despite a greater number of referrals over time, physician criteria became increasingly selective. Optimal candidacy in RFA is an evolving determination requiring patient and physician input to guide ideal practice patterns.

Editorial Comment: Beyond the Scalpel—Embracing Thermal Ablation for Thyroid Nodules in Interventional Radiology

Editorial Comment: Beyond the Scalpel—Embracing Thermal Ablation for Thyroid Nodules in Interventional Radiology

Thermal Ablation of Thyroid Nodules, From the AJR "How We Do It" Special Series.

Ablation has been shown to be an effective option for treatment of well-selected patients with thyroid nodules, particularly benign nodules, and thermal ablation is being increasingly used for this purpose. The general approach to thermal ablation of the thyroid will be familiar to interventional radiologists who perform ablation in other tissues; however, thermal ablation of the thyroid has additional unique considerations. In this review, we provide evidence-based and real-world guidance on the performance of thermal ablation for the treatment of patients with thyroid nodules, drawing on our collective experience and clinical practice. We describe patient selection, ablation modalities, equipment, general procedural approach, additional technical considerations, and postprocedural follow-up. We discuss various clinical scenarios; give tips on performing specific portions of the procedure and highlight a range of relevant anatomic, biochemical, and clinical factors, as a guide for interventional radiologists in establishing a successful thyroid ablation practice.

Radiofrequency Ablation of Thyroid Nodules Does Not Impact Subsequent Surgical Outcomes

Radiofrequency Ablation of Thyroid Nodules Does Not Impact Subsequent Surgical Outcomes

Protect the recurrent laryngeal nerves in US-guided microwave ablation of thyroid nodules at Zuckerkandl tubercle: a pilot study

BackgroundTo evaluate the safety and efficacy of US-guided microwave ablation in patients with thyroid nodules at Zuckerkandl tubercle.Methods103 consecutive patients with thyroid nodules at Zuckerkandl tubercle (ZTTN) were enrolled in this study from November 2017 to August 2021. Prior to the surgery or US-guided microwave ablation (MWA), preoperative ultrasound visualization of the recurrent laryngeal nerve (RLN) and ZTTN was performed, the size and the position relationship between them were observed. Patients were followed up at 1, 3, 6, and 12 months after MWA and the volume reduction rates (VRR) of the thyroid nodules were analyzed.ResultsAll patients successfully had the RLN and ZTTN detected using ultrasound before surgery or ablation with a detection rate of 100%. For the 103 patients, the majority of ZTTN grades were categorized as grade 2, with the distance from the farthest outside of ZTTN to the outer edge of thyroid ranging between 6.0 and 10.0 mm. The position relationship between ZTTN and RLN was predominantly type A in 98 cases, with type D observed in 5 cases. After MWA, the median nodule volume had significantly decreased from 4.61 (2.34, 8.70) ml to 0.42 (0.15, 1.41) ml and the VRR achieved 84.36 ± 13.87% at 12 months. No nodules regrew throughout the 12-month follow-up period. Of the 11 patients experienced hoarseness due to RLN entrapment before ablation, 7 recovered immediately after separation of the RLN and ZTTN during MWA, 2 recovered after one week, and the other 2 recovered after two months.ConclusionsThe RLN is closely related to ZTTN and mainly located at the back of ZTTN. The RLN can be separated from ZTTN by hydrodissection during MWA. US-guided MWA is a safe and effective treatment for ZTTN.

Radiofrequency ablation for thyroid nodules in Ecuador: a cross-sectional study

ObjectivesTo describe the demographic characteristics and clinical outcomes following the first cohort of patients with Bening Thyroid Nodule (BTN) and (Papillary Thyroid Microcarcinoma) (PTMC) treated with Radiofrequency Ablation (RFA)in Ecuador.MethodsSingle-center, cross-sectional study. We included adults undergoing RFA for BTN and PTMC between July 2019 and May 2022. Descriptive statistics and the Wilcoxon signed-rank test were used to compare some pre- and post-intervention outcomes.ResultsWe included 44 patients with 36 BTNs and eight PTMCs. The median age was 45.80 years (IQR 16–79 years), and most patients had normal thyroid function (72.72%). The median follow-up time was 7.80 months (IQR1.0-34.0). Nodules were primarily solid (43.21%) or predominantly solid (56.81%). The pre-RFA median volume in the benign lesions group was 10.30 ml (IQR 1.86–18.97). After ablation, the 1-month, 3-month, 6-month, and 12-month median volumes were 6.90 (IQR 0.48–10.15; p < 0.01) mL, 5.72 (IQR 0.77–7.25; p = 0.045); 0.98 (IQR 0.25–3.64; p < 0.01), and 0.11 (IQR 0.07–11.26; p = 0.026), respectively. The volume rate reduction was 47.20%, 72.20%, 74.00%, and 96.20% at 1, 3, 6, and 12-month follow-ups, respectively. The pre-RFA median volume in the PTMC group was 0.25 ml (IQR 0.19–0.48). After ablation, the 1-month, 3-month, and 6-month mean volumes were 0.19 (range 0.12–0.31; p = 0.120) mL, 0.10 (IQR 0.05–0.15; p = 0.13), and 0.01 (IQR 0.005–0.04; p = 0.364), respectively.ConclusionsIn this first report from Ecuador, we found that RFA may be a feasible alternative for treating benign and malignant thyroid nodules in the short term. Long-term data are needed to evaluate oncologic outcomes in PTMC patients.

Progress in research on ablation of thyroid nodules.

The incidence of thyroid nodules is rising annually. Surgical treatment is effective, but often results in significant trauma, recurrent laryngeal nerve injury, hypoparathyroidism, and other complications. Recent years have seen significant breakthroughs in thyroid nodule ablation for treating thyroid diseases, although its application remains controversial. The objective was to review the development history and current research status of thyroid nodule ablation to provide a reference for future studies. The literature on thyroid nodule ablation was reviewed, analysing its advantages and disadvantages. The therapeutic effect of thyroid nodule ablation in treating benign thyroid lesions is noteworthy, but issues such as lax treatment indications and excessive medical treatment persist. Initial success has been achieved in treating thyroid malignant lesions, particularly papillary thyroid microcarcinoma (PTMC). However, the curative effect requires further follow-up verification.

Radiofrequency ablation of thyroid nodules: a clinical review of treatment complications.

Radiofrequency ablation (RFA) is a minimally invasive ablative modality for the treatment of thyroid nodules. Reports of RFA use have demonstrated an impressive safety profile and excellent volume reduction rates between 60-90%. Given its increased popularity in the United States as well as globally, numerous recent works have been published and a discussant of relevant complications incorporating recent insight may assist practitioners in minimizing complications and optimizing patient outcomes. Herein, we provide a comprehensive and updated review of the reported complications and side effects following RFA, summarizing their frequency and clinical presentation. We also describe a means of minimizing such complications and/or side effects. Overall, the safety profile of RFA is impressive and superior to that of thyroid surgery. The overall risk of complication is reportedly 2-3%. The risk of permanent complication or severe injury is very unlikely, below 1%. Complications are infrequent, but may be nerve-related, endocrine-related, or iatrogenic-related, and consequences of localized heat delivery. The vast majority of complications related to RFA can be managed conservatively, without need for invasive measures. This review will assist surgeons and clinicians in recognizing and treating the various complications and side effects in clinical practice.

Current guidelines for the application of radiofrequency ablation for thyroid nodules: a narrative review.

Thyroid nodules are frequently incidentally found on physical exam or imaging for an unrelated work-up. Although surgery remains the gold standard for treating symptomatic benign and/or malignant thyroid nodules, radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option for high risk patients and those who decline surgery. The novel application of RFA to treat thyroid disease was originally described for symptomatic, benign thyroid nodules. Since then, several studies have tried to expand its indication to treat primary and recurrent well-differentiated thyroid cancer. The high success rates and the low complication profile, has allowed for quick adoption of RFA as a treatment option for well-selected patients with benign thyroid nodules and locoregional recurrent thyroid malignancy. As such, multidisciplinary guidelines and consensus statements were developed to standardize indications, techniques, outcome measures, and follow-up to ensure the best patient care. This article summarizes the current indications and recommendations to help guide clinicians on how best to effectively and safely utilize RFA to treat thyroid disease. A PubMed/MEDLINE search between 2000-2022 using a combination of "radiofrequency ablation", "RFA", "thyroid nodule", and "guidelines" was conducted. The inclusion criteria were articles published in English which offered recommendations on RFA use for thyroid nodules. For symptomatic, benign thyroid nodules, RFA is effective at significantly reducing nodule volume. For large nodules, multiple RFA sessions may be needed to achieve clinically significant volume reduction. Patients undergoing RFA for autonomously functioning thyroid nodules may see symptomatic relief but success rates are variable. RFA may serve a curative or palliative role in recurrent well-differentiated thyroid cancers. There is little data describing the use of RFA for primary well-differentiated thyroid cancer >1 cm and the role of RFA for thyroid microcarcinomas remains controversial. RFA is a safe minimally invasive technique and may be considered, in appropriate circumstances, a first-line treatment option for benign thyroid nodules. Practices adopting RFA will likely increase as more clinicians become familiar with this technique, highlighting the importance of developing standardized guidelines.

Publications on ultrasound-guided thermal ablation for thyroid nodules from 2000 to 2022: a bibliometric analysis

Background Thyroid nodules are increasingly treated with minimally invasive surgery. Thermal ablation could efficiently treat patients with benign thyroid nodules, recurrent thyroid cancer, and low-risk papillary thyroid carcinoma. This research aims to explore the research field of thermal ablation for thyroid nodules using bibliometric analysis. Methods The web of science core collection (WoSCC) database was utilized from its inception to 1 October 2022, to collect research articles and reviews on ultrasound-guided thermal ablation for thyroid nodules. We applied the R package ‘bibliometrix’ to summarize the main findings, calculate the occurrences of the top keywords and visualize the international collaboration networks. The co-authorship and co-occurrence analyses were conducted with VOSviewer software. CiteSpace was used to identify the top references and keywords with the highest citation bursts. Results A total of 820 publications from 32 countries were retrieved. The annual number of related publications showed an increasing trend. China, Italy, and Korea were the most contributing countries. The University of Ulsan College of Medicine in Korea was the most productive institution, and Jung Hwan Baek published the maximum number of articles. The International Journal of Hyperthermia was the most productive journal. ‘Papillary thyroid micro-carcinoma (PTMC)’ and ‘association guideline’ were the most frequently used keywords in the field of thermal ablation for thyroid nodules, which indicated the potential hot research topics and frontiers in the future. Conclusion This bibliometric study conducts a comprehensive analysis of publications on thermal ablation for thyroid nodules, which aids investigators in discovering potential research directions.

SAT480 Diagnosing Dysphagia Due to Thyroid Nodules by Thyroid Ultrasound and the Effectiveness of Radiofrequency Ablation

Abstract Disclosure: Z. Idrees: None. M. Morkos: None. Objective: Thyroid nodules can cause dysphagia by direct esophageal compression. Diagnosis of esophageal compression during thyroid ultrasound has not been described. Radiofrequency ablation of thyroid nodules may be able to treat the compressive symptoms. Methods: We present a case series of four patients who presented with dysphagia due to compressive nodular goiter. Thyroid ultrasound was performed by a certified endocrinologist (Endocrine Certification in Neck Ultrasound) who assessed esophageal compression. Nodules were treated with thyroid radiofrequency ablation (RFA). Symptom score, ranging from zero (no symptoms) to ten (severe symptoms), was used to assess the severity of dysphagia before and one month after the procedure. Results: We report four patients who presented with symptomatic thyroid nodules, complaining of dysphagia at the level of the lower neck. Initial symptom scores were 10, 7, 8, and 2 respectively. Thyroid ultrasound demonstrated esophageal compression in all patients due to the culprit responsible nodules and two thyroid biopsies were done to rule out malignancy. Three patients declined surgery and preferred RFA, while the fourth was a poor surgical candidate. RFA was conducted in each by one endocrinologist. The culprit nodules were targeted for RFA, except in case two which was retrosternal. Therefore, a more superficial same-sided nodule was ablated in case two with the goal of reducing mass effect on that side. All the patients reported improvement in their dysphagia and decline in symptom score a month after the procedure to 0, 4, 2, and 0 respectively. Thyroid US demonstrated improvement of esophageal compression one-month after the procedure. No complications were noted. Conclusion: Thyroid ultrasound is a valuable tool in diagnosing dysphagia due to esophageal compression caused by thyroid nodules and in monitoring the response to therapy. Thyroid RFA is a minimally invasive and effective tool for treating symptomatic thyroid nodules. Presentation Date: Saturday, June 17, 2023

General principles for the safe performance, training and adoption of ablation techniques for benign thyroid nodules: An American Thyroid Association Statement.

The primary goal of this interdisciplinary consensus statement is to provide a framework for the safe adoption and implementation of ablation technologies for benign thyroid nodules. This consensus statement is organized around three key themes: i. safety of ablation techniques and their implementation, ii. optimal skillset criteria for proceduralists performing ablative procedures, and iii. defining expectations of success for this treatment option given its unique risks and benefits. Ablation safety considerations in pre-procedural, peri-procedural and post-procedural settings are discussed including clinical factors related to patient selection and counselling, anesthetic and technical considerations to optimize patient safety, peri-procedural risk mitigation strategies, post-procedural complication management and safe follow-up practices. Prior training, knowledge and steps that should be considered by any physician who desires to incorporate thyroid nodule ablation into their practice are defined and discussed. Examples of successful clinical practice implementation models of this emerging technology are provided. Thyroid ablative procedures provide valid alternative treatment strategies to conventional surgical management for a subset of patients with symptomatic benign thyroid nodules. Careful patient and nodule selection are critical to the success of these procedures as is extensive pre-procedural patient counselling. Although these emerging technologies hold great promise, they are not without risk and require development of a unique skillset and environment for optimal, safe performance and consistent outcomes.