Korean J Radiol.  2017 Jun;18(3):461-469. 10.3348/kjr.2017.18.3.461.

Innovative Techniques for Image-Guided Ablation of Benign Thyroid Nodules: Combined Ethanol and Radiofrequency Ablation

• Park HS
• Baek JH
• Choi YJ
• Lee JH

• KMID: 2427301
• DOI: http://doi.org/10.3348/kjr.2017.18.3.461

Abstract

In the treatment of benign thyroid nodules, ethanol ablation (EA), and radiofrequency ablation (RFA) have been suggested for cystic and solid thyroid nodules, respectively. Although combining these ablation techniques may be effective, no guidelines for or reviews of the combination have been published. Currently, there are three ways of combining EA and RFA: additional RFA is effective for treatment of incompletely resolved symptoms and solid residual portions of a thyroid nodule after EA. Additional EA can be performed for the residual unablated solid portion of a nodule after RFA if it is adjacent to critical structures (e.g., trachea, esophagus, and recurrent laryngeal nerve). In the concomitant procedure, ethanol is injected to control venous oozing after aspiration of cystic fluid prior to RFA of the remaining solid nodule.

Keyword

Benign thyroid nodule; Image-guided ablation; Radiofrequency; Ethanol

MeSH Terms

Catheter Ablation/adverse effects
Ethanol/*administration & dosage
Humans
Postoperative Complications
Thyroid Nodule/diagnostic imaging/*surgery
Treatment Outcome
Ultrasonography
Ethanol

Figure

• 

  Fig. 1 57-year-old man with right thyroid nodule.A. Ethanol ablation of 10.2-mL predominantly cystic nodule (white arrows) showing internal and peripheral vascularity. B. One month after ethanol ablation, volume of nodule (white arrows) was reduced by 88%, to 1.2 mL. C. Three years after ethanol ablation, volume of nodule (white arrows) had gradually increased to 4.9 mL. Recurrent nodule was managed by radiofrequency ablation. D. Three years after radiofrequency ablation, nodule volume (white arrows) was significantly reduced by 98%, and patient's residual symptoms had improved.

• 

  Fig. 2 65-year-old woman with right thyroid nodule.A. Ultrasound images showing predominantly cystic mass (white arrows) with increased vascularity, both in internal solid component and periphery. Initial nodule volume was 5.9 mL. B. Prior to radiofrequency ablation, internal fluid was aspirated, but nodule (white arrows) increased in size because of internal venous oozing. C. After bleeding was controlled by ethanol ablation, radiofrequency ablation was successfully performed using moving shot technique. Black arrows indicate electrode. D. Six months after radiofrequency ablation, nodule volume (white arrows) was significantly reduced by 98.5%, and patient's residual symptoms had improved.

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