Endocrinol Metab.  2019 Jun;34(2):117-123. 10.3803/EnM.2019.34.2.117.

Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth

• Sim JS
• Baek JH

• KMID: 2450510
• DOI: http://doi.org/10.3803/EnM.2019.34.2.117

Abstract

Thermal ablation (TA) procedures, such as radiofrequency ablation and laser ablation, are used for the treatment of benign thyroid nodules. Short-term studies (<2 years) have demonstrated that TA is an effective and safe procedure to improve cosmetic or symptomatic problems. However, studies including a longer follow-up period show that treated thyroid nodules can increase in size after 2 to 3 years. Several studies suggest that this results from regrowth at the undertreated nodule margins. Here, we review current data on regrowth after TA and describe factors related to it and possible approaches to prevent it.

Keyword

Thyroid nodule; Ablation

MeSH Terms

Catheter Ablation
Follow-Up Studies
Laser Therapy
Thyroid Gland*
Thyroid Nodule*

Figure

• 

  Fig. 1 Ultrasonography of a thyroid nodule: (A) pre-radiofrequency ablation (RFA), (B) 2 months post-RFA, and (C) 9 months post-RFA. (D-F) Diagrams indicate the total volume (Vt), ablated volume (Va), and viable volume (Vv) at these timepoints. Although Vt decreases over time, Vv increased by 2 mL between months 2 and 9, indicating that growth of the residual viable nodule tissue had already begun. In this case, additional RFA was performed 1 month after obtaining the image in C. aThe centrally-located hypoechoic area of ablated tissue is indicated.

• 

  Fig. 2 (A) An electrode (short arrows) directly ablates the perinodular vein (arrow). Air bubbles are seen inside the venous lumen (arrowheads). (B) After completing venous ablation, compact filling of hot air bubbles is observed (arrowheads).

Reference

1. Kim JH, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, et al. 2017 Thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology. Korean J Radiol. 2018; 19:632–655. PMID: 29962870.

2. Cesareo R, Palermo A, Pasqualini V, Cianni R, Gaspa G, Manfrini S, et al. Radiofrequency ablation for the management of thyroid nodules: a critical appraisal of the literature. Clin Endocrinol (Oxf). 2017; 87:639–648. PMID: 28718950.

3. Papini E, Guglielmi R, Bizzarri G, Graziano F, Bianchini A, Brufani C, et al. Treatment of benign cold thyroid nodules: a randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up. Thyroid. 2007; 17:229–235. PMID: 17381356.

4. 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. PMID: 18207307.

5. Pacella CM, Bizzarri G, Guglielmi R, Anelli V, Bianchini A, Crescenzi A, et al. Thyroid tissue: US-guided percutaneous interstitial laser ablation-a feasibility study. Radiology. 2000; 217:673–677. PMID: 11110927.

6. 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. PMID: 18286289.

7. 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. PMID: 23096937.

8. 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. PMID: 21927553.

9. Sim JS, Baek JH, Lee J, Cho W, Jung SI. Radiofrequency ablation of benign thyroid nodules: depicting early sign of regrowth by calculating vital volume. Int J Hyperthermia. 2017; 33:905–910. PMID: 28540795.

10. Bernardi S, Dobrinja C, Fabris B, Bazzocchi G, Sabato N, Ulcigrai V, et al. Radiofrequency ablation compared to surgery for the treatment of benign thyroid nodules. Int J Endocrinol. 2014; 2014:934595. PMID: 25045352.

11. Radzina M, Cantisani V, Rauda M, Nielsen MB, Ewertsen C, D'Ambrosio F, et al. Update on the role of ultrasound guided radiofrequency ablation for thyroid nodule treatment. Int J Surg. 2017; 41(Suppl 1):S82–S93. PMID: 28506420.

12. Mauri G, Pacella CM, Papini E, Sconfienza LM, Solbiati L. Proceedings of the first Italian conference on thyroid minimally invasive treatments and foundation of the Italian research group for thyroid minimally invasive procedures. Int J Hyperthermia. 2018; 34:603–605. PMID: 29455559.

13. Ha EJ, Baek JH, Kim KW, Pyo J, Lee JH, Baek SH, et al. Comparative efficacy of radiofrequency and laser ablation for the treatment of benign thyroid nodules: systematic review including traditional pooling and bayesian network meta-analysis. J Clin Endocrinol Metab. 2015; 100:1903–1911. PMID: 25695887.

14. 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. PMID: 28458598.

15. Gambelunghe G, Stefanetti E, Colella R, Monacelli M, Avenia N, De Feo P. A single session of laser ablation for toxic thyroid nodules: three-year follow-up results. Int J Hyperthermia. 2018; 34:631–635. PMID: 29409365.

16. 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. PMID: 20929405.

17. Papini E, Rago T, Gambelunghe G, Valcavi R, Bizzarri G, Vitti P, et al. Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules. Results of a three-year multicenter prospective randomized trial. J Clin Endocrinol Metab. 2014; 99:3653–3659. PMID: 25050903.

18. Dossing H, Bennedbaek FN, Hegedus L. Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules. Eur J Endocrinol. 2011; 165:123–128. PMID: 21551168.

19. Gambelunghe G, Fede R, Bini V, Monacelli M, Avenia N, D'Ajello M, et al. Ultrasound-guided interstitial laser ablation for thyroid nodules is effective only at high total amounts of energy: results from a three-year pilot study. Surg Innov. 2013; 20:345–350. PMID: 22991383.

20. 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. PMID: 19265492.

21. 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. PMID: 25320840.

22. 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. PMID: 19575141.

23. Suh CH, Baek JH, Ha EJ, Choi YJ, Lee JH, Kim JK, et al. Ethanol ablation of predominantly cystic thyroid nodules: evaluation of recurrence rate and factors related to recurrence. Clin Radiol. 2015; 70:42–47. PMID: 25443776.

24. 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; 33:459–464. PMID: 28081645.

25. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016; 26:1–133. PMID: 26462967.

26. Piana S, Riganti F, Froio E, Andrioli M, Pacella CM, Valcavi R. Pathological findings of thyroid nodules after percutaneous laser ablation: a series of 22 cases with cyto-histological correlation. Endocr Pathol. 2012; 23:94–100. PMID: 22246921.

27. 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. 2017; 65:393–405. PMID: 27983547.

28. 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. PMID: 21998044.

29. Kim C, Lee JH, Choi YJ, Kim WB, Sung TY, Baek JH. Complications encountered in ultrasonography-guided radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers. Eur Radiol. 2017; 27:3128–3137. PMID: 27975148.

30. 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. PMID: 22438360.

31. Cervelli R, Mazzeo S, De Napoli L, Boccuzzi A, Pontillo-Contillo B, Materazzi G, et al. Radiofrequency ablation in the treatment of benign thyroid nodules: an efficient and safe alternative to surgery. J Vasc Interv Radiol. 2017; 28:1400–1408. PMID: 28844832.

32. Yue WW, Wang SR, Lu F, Sun LP, Guo LH, Zhang YL, et al. Radiofrequency ablation vs. microwave ablation for patients with benign thyroid nodules: a propensity score matching study. Endocrine. 2017; 55:485–495. PMID: 27905049.

33. Mauri G, Cova L, Monaco CG, Sconfienza LM, Corbetta S, Benedini S, et al. Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA). Int J Hyperthermia. 2017; 33:295–299. PMID: 27701923.

34. Li XL, Xu HX, Lu F, Yue WW, Sun LP, Bo XW, et al. Treatment efficacy and safety of ultrasound-guided percutaneous bipolar radiofrequency ablation for benign thyroid nodules. Br J Radiol. 2016; 89:20150858. PMID: 26800232.

35. Sim JS, Baek JH, Cho W. Initial ablation ratio: quantitative value predicting the therapeutic success of thyroid radiofrequency ablation. Thyroid. 2018; 28:1443–1449. PMID: 30226441.

36. Lang BH, Woo YC, Wong IY, Chiu KW. Single-session high-intensity focused ultrasound treatment for persistent or relapsed Graves disease: preliminary experience in a prospective study. Radiology. 2017; 285:1011–1022. PMID: 28727542.

37. Park HS, Baek JH, Park AW, Chung SR, Choi YJ, Lee JH. Thyroid radiofrequency ablation: updates on innovative devices and techniques. Korean J Radiol. 2017; 18:615–623. PMID: 28670156.