Korean J Radiol.  2017 ;18(4):615-623. 10.3348/kjr.2017.18.4.615.

Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques

  • 1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea. radbaek@naver.com
  • 2Department of Radiology, Vascular & Interventional Radiology Section, University of Virginia Health System, Charlottesville, VA 22908-0170, USA.


Radiofrequency ablation (RFA) is a well-known, effective, and safe method for treating benign thyroid nodules and recurrent thyroid cancers. Thyroid-dedicated devices and basic techniques for thyroid RFA were introduced by the Korean Society of Thyroid Radiology (KSThR) in 2012. Thyroid RFA has now been adopted worldwide, with subsequent advances in devices and techniques. To optimize the treatment efficacy and patient safety, understanding the basic and advanced RFA techniques and selecting the optimal treatment strategy are critical. The goal of this review is to therefore provide updates and analysis of current devices and advanced techniques for RFA treatment of benign thyroid nodules and recurrent thyroid cancers.


Radiofrequency ablation; Thyroid nodules; Technique; Ultrasound; Thermal ablation

MeSH Terms

Catheter Ablation/instrumentation/*methods
Neoplasm Recurrence, Local
Thyroid Neoplasms/diagnostic imaging/surgery
Thyroid Nodule/diagnostic imaging/*surgery


  • Fig. 1 Unidirectional ablation electrode. A. Longitudinal view. B. Transverse view. Active tip is partially insulated, so that it creates half-moon-shaped ablation zone. Red: ablation zone, white: non-insulated portion, black: insulated portion.

  • Fig. 2 Perithyroidal lidocaine injection. Collected lidocaine appears as anechoic band (arrows) separating thyroid gland and strap muscle.

  • Fig. 3 Ablation of feeding artery. A. Before thyroid RFA, main feeding artery from superior thyroid artery is identified on Doppler study. B. After ablation of main feeding artery, no more vascular signal is seen on Doppler study, suggesting complete ablation of vessels. RFA = radiofrequency ablation

  • Fig. 4 Artery-first ablation technique. Intranodular linear echogenicities (arrows) spreading to periphery of target nodule can be seen, which may be microbubbles filling arterioles.

  • Fig. 5 Artery-first ablation technique. After ablation of feeding artery, wedge-shaped hypoechoic change (arrows) can be seen. This wedge-shaped hypoechoic area represents infarction in area supplied by feeding artery.

  • Fig. 6 Hydrodissection technique. A. Needle of syringe with 5% dextrose (arrow) is inserted posterior to recurrent tumor. B. 5% dextrose is slowly injected (arrows) between target tumor and adjacent critical structures including trachea, esophagus and recurrent laryngeal nerve.

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1. Spiezia S, Garberoglio R, Milone F, Ramundo V, Caiazzo C, Assanti AP, et al. Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid. 2009; 19:219–225.
2. Faggiano A, Ramundo V, Assanti AP, Fonderico F, Macchia PE, Misso C, et al. Thyroid nodules treated with percutaneous radiofrequency thermal ablation: a comparative study. J Clin Endocrinol Metab. 2012; 97:4439–4445.
3. Cesareo R, Pasqualini V, Simeoni C, Sacchi M, Saralli E, Campagna G, et al. Prospective study of effectiveness of ultrasound-guided radiofrequency ablation versus control group in patients affected by benign thyroid nodules. J Clin Endocrinol Metab. 2015; 100:460–466.
4. Jeong WK, Baek JH, Rhim H, Kim YS, Kwak MS, Jeong HJ, et al. Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. Eur Radiol. 2008; 18:1244–1250.
5. Ugurlu MU, Uprak K, Akpinar IN, Attaallah W, Yegen C, Gulluoglu BM. Radiofrequency ablation of benign symptomatic thyroid nodules: prospective safety and efficacy study. World J Surg. 2015; 39:961–968.
6. Long B, Li L, Yao L, Chen S, Yi H, Ye X, et al. Combined use of radioiodine therapy and radiofrequency ablation in treating postsurgical thyroid remnant of differentiated thyroid carcinoma. J Cancer Res Ther. 2015; 11:Suppl. C244–C247.
7. Lim HK, Baek JH, Lee JH, Kim WB, Kim TY, Shong YK, et al. Efficacy and safety of radiofrequency ablation for treating locoregional recurrence from papillary thyroid cancer. Eur Radiol. 2015; 25:163–170.
8. Dupuy DE, Monchik JM, Decrea C, Pisharodi L. Radiofrequency ablation of regional recurrence from well-differentiated thyroid malignancy. Surgery. 2001; 130:971–977.
9. Kim JH, Yoo WS, Park YJ, Park DJ, Yun TJ, Choi SH, et al. Efficacy and safety of radiofrequency ablation for treatment of locally recurrent thyroid cancers smaller than 2 cm. Radiology. 2015; 276:909–918.
10. Zhang M, Luo Y, Zhang Y, Tang J. Efficacy and safety of ultrasound-guided radiofrequency ablation for treating low-risk papillary thyroid microcarcinoma: a prospective study. Thyroid. 2016; 26:1581–1587.
11. Kim JH, Baek JH, Sung JY, Min HS, Kim KW, Hah JH, et al. Radiofrequency ablation of low-risk small papillary thyroidcarcinoma: preliminary results for patients ineligible for surgery. Int J Hyperthermia. 2017; 33:212–219.
12. Sun J, Liu X, Zhang Q, Hong Y, Song B, Teng X, et al. Papillary thyroid carcinoma treated with radiofrequency ablation in a patient with hypertrophic cardiomyopathy: a case report. Korean J Radiol. 2016; 17:558–561.
13. Na DG, Lee JH, Jung SL, Kim JH, Sung JY, Shin JH, et al. Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations. Korean J Radiol. 2012; 13:117–125.
14. Kohlhase KD, Korkusuz Y, Gröner D, Erbelding C, Happel C, Luboldt W, et al. Bipolar radiofrequency ablation of benign thyroid nodules using a multiple overlapping shot technique in a 3-month follow-up. Int J Hyperthermia. 2016; 32:511–516.
15. Korkusuz Y, Erbelding C, Kohlhase K, Luboldt W, Happel C, Grünwald F. Bipolar radiofrequency ablation of benign symptomatic thyroid nodules: initial experience. Rofo. 2016; 188:671–675.
16. Na DG, Lee JH, Kim SM, Lim HK, Baek JH. Unidirectional ablation electrode to minimize thermal injury during radiofrequency ablation: an experimental study in an ex vivo bovine liver model. J Vasc Interv Radiol. 2011; 22:935–940.
17. Turtulici G, Orlandi D, Corazza A, Sartoris R, Derchi LE, Silvestri E, et al. Percutaneous radiofrequency ablation of benign thyroid nodules assisted by a virtual needle tracking system. Ultrasound Med Biol. 2014; 40:1447–1452.
18. Laeseke PF, Sampson LA, Brace CL, Winter TC 3rd, Fine JP, Lee FT Jr. Unintended thermal injuries from radiofrequency ablation: protection with 5% dextrose in water. AJR Am J Roentgenol. 2006; 186:5 Suppl. S249–S254.
19. Lim HK, Lee JH, Ha EJ, Sung JY, Kim JK, Baek JH. Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients. Eur Radiol. 2013; 23:1044–1049.
20. Ahn HS, Kim SJ, Park SH, Seo M. Radiofrequency ablation of benign thyroid nodules: evaluation of the treatment efficacy using ultrasonography. Ultrasonography. 2016; 35:244–252.
21. Huh JY, Baek JH, Choi H, Kim JK, Lee JH. Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session--prospective randomized study. Radiology. 2012; 263:909–916.
22. Baek JH, Lee JH, Valcavi R, Pacella CM, Rhim H, Na DG. Thermal ablation for benign thyroid nodules: radiofrequency and laser. Korean J Radiol. 2011; 12:525–540.
23. Ikeda K, Osaki Y, Nakanishi H, Nasu A, Kawamura Y, Jyoko K. Recent progress in radiofrequency ablation therapy for hepatocellular carcinoma. Oncology. 2014; 87:Suppl 1. 73–77.
24. Ha EJ, Baek JH, Lee JH. Ultrasonography-based thyroidal and perithyroidal anatomy and its clinical significance. Korean J Radiol. 2015; 16:749–766.
25. Ha EJ, Baek JH, Lee JH. Moving-shot versus fixed electrode techniques for radiofrequency ablation: comparison in an ex-vivo bovine liver tissue model. Korean J Radiol. 2014; 15:836–843.
26. Baek JH, Ha EJ, Choi YJ, Sung JY, Kim JK, Shong YK. Radiofrequency versus ethanol ablation for treating predominantly cystic thyroid nodules: a randomized clinical trial. Korean J Radiol. 2015; 16:1332–1340.
27. Ha EJ, Baek JH, Lee JH, Kim JK, Shong YK. Clinical significance of vagus nerve variation in radiofrequency ablation of thyroid nodules. Eur Radiol. 2011; 21:2151–2157.
28. Sung JY, Baek JH, Kim KS, Lee D, Yoo H, Kim JK, et al. Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation: a prospective randomized study. Radiology. 2013; 269:293–300.
29. Gharib H, Hegedüs L, Pacella CM, Baek JH, Papini E. Clinical review: nonsurgical, image-guided, minimally invasive therapy for thyroid nodules. J Clin Endocrinol Metab. 2013; 98:3949–3957.
30. Baek JH, Moon WJ, Kim YS, Lee JH, Lee D. Radiofrequency ablation for the treatment of autonomously functioning thyroid nodules. World J Surg. 2009; 33:1971–1977.
31. Deandrea M, Sung JY, Limone P, Mormile A, Garino F, Ragazzoni F, et al. Efficacy and safety of radiofrequency ablation versus observation for nonfunctioning benign thyroid nodules: a randomized controlled international collaborative trial. Thyroid. 2015; 25:890–896.
32. Lee YH, Baek JH, Jung SL, Kwak JY, Kim JH, Shin JH, et al. Ultrasound-guided fine needle aspiration of thyroid nodules: a consensus statement by the Korean Society of Thyroid Radiology. Korean J Radiol. 2015; 16:391–401.
33. Lee SJ, Jung SL, Kim BS, Ahn KJ, Choi HS, Lim DJ, et al. Radiofrequency ablation to treat loco-regional recurrence of well-differentiated thyroid carcinoma. Korean J Radiol. 2014; 15:817–826.
34. Saaiq M, Zaib S, Ahmad S. Electrocautery burns: experience with three cases and review of literature. Ann Burns Fire Disasters. 2012; 25:203–206.
35. Baek JH, Lee JH, Sung JY, Bae JI, Kim KT, Sim J, et al. Complications encountered in the treatment of benign thyroid nodules with US-guided radiofrequency ablation: a multicenter study. Radiology. 2012; 262:335–342.
36. Lee MW. Fusion imaging of real-time ultrasonography with CT or MRI for hepatic intervention. Ultrasonography. 2014; 33:227–239.
37. Makino Y, Imai Y, Igura T, Ohama H, Kogita S, Sawai Y, et al. Usefulness of the multimodality fusion imaging for the diagnosis and treatment of hepatocellular carcinoma. Dig Dis. 2012; 30:580–587.
38. Toshikuni N, Tsutsumi M, Takuma Y, Arisawa T. Real-time image fusion for successful percutaneous radiofrequency ablation of hepatocellular carcinoma. J Ultrasound Med. 2014; 33:2005–2010.
39. Shin JH, Baek JH, Ha EJ, Lee JH. Radiofrequency ablation of thyroid nodules: basic principles and clinical application. Int J Endocrinol. 2012; 2012:919650.
40. Hong MJ, Baek JH, Choi YJ, Lee JH, Lim HK, Shong YK, et al. Radiofrequency ablation is a thyroid function-preserving treatment for patients with bilateral benign thyroid nodules. J Vasc Interv Radiol. 2015; 26:55–61.
41. Sung JY, Baek JH, Jung SL, Kim JH, Kim KS, Lee D, et al. Radiofrequency ablation for autonomously functioning thyroid nodules: a multicenter study. Thyroid. 2015; 25:112–117.
42. Bernardi S, Lanzilotti V, Papa G, Panizzo N, Dobrinja C, Fabris B, et al. Full-thickness skin burn caused by radiofrequency ablation of a benign thyroid nodule. Thyroid. 2016; 26:183–184.
43. Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology. 2008; 247:762–770.
44. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol. 2016; 17:370–395.
45. Russ G. Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS: description and reflections. Ultrasonography. 2016; 35:25–38.
46. Pillai K, Akhter J, Chua TC, Shehata M, Alzahrani N, Al-Alem I, et al. Heat sink effect on tumor ablation characteristics as observed in monopolar radiofrequency, bipolar radiofrequency, and microwave, using ex vivo calf liver model. Medicine (Baltimore). 2015; 94:e580.
47. Zhu AX, Salem R. Combining transarterial chemoembolization with radiofrequency ablation for hepatocellular carcinoma: one step forward? J Clin Oncol. 2013; 31:406–408.
48. Chok KS, Ng KC, Lam CM, Ng KK, Poon RT, Fan ST. Selective portal vein clamping for radiofrequency ablation of hepatocellular carcinoma with portal vein invasion. J Gastrointest Surg. 2005; 9:489–493.
49. Yoon HM, Baek JH, Lee JH, Ha EJ, Kim JK, Yoon JH, et al. Combination therapy consisting of ethanol and radiofrequency ablation for predominantly cystic thyroid nodules. AJNR Am J Neuroradiol. 2014; 35:582–586.
50. Deandrea M, Limone P, Basso E, Mormile A, Ragazzoni F, Gamarra E, et al. US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules. Ultrasound Med Biol. 2008; 34:784–791.
51. Park HS, Baek JH, Choi YJ, Lee JH. Innovative techniques for image-guided ablation of benign thyroid nodules: combined ethanol and radiofrequency ablation. Korean J Radiol. 2017; 18:461–469.
52. Valcavi R, Riganti F, Bertani A, Formisano D, Pacella CM. Percutaneous laser ablation of cold benign thyroid nodules: a 3-year follow-up study in 122 patients. Thyroid. 2010; 20:1253–1261.
53. Døssing H, Bennedbæk FN, Hegedüs L. Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules. Eur J Endocrinol. 2011; 165:123–128.
54. Zhao CK, Xu HX, Lu F, Sun LP, He YP, Guo LH, et al. Factors associated with initial incomplete ablation for benign thyroid nodules after radiofrequency ablation: first results of CEUS evaluation. Clin Hemorheol Microcirc. 2016; 11. 14. [Epub]. DOI: 10.3233/CH-16208.
55. Wang B, Han ZY, Yu J, Cheng Z, Liu F, Yu XL, et al. Factors related to recurrence of the benign non-functioning thyroid nodules after percutaneous microwave ablation. Int J Hyperthermia. 2017; 01. 12. [Epub]. DOI: 10.1080/02656736.2016.1274058.
56. Levit E, Bruners P, Günther RW, Mahnken AH. Bile aspiration and hydrodissection to prevent complications in hepatic RFA close to the gallbladder. Acta Radiol. 2012; 53:1045–1048.
57. Chen MH, Yang W, Yan K, Hou YB, Dai Y, Gao W, et al. Radiofrequency ablation of problematically located hepatocellular carcinoma: tailored approach. Abdom Imaging. 2008; 33:428–436.
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