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Image-guided thermal ablation of benign thyroid nodules

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Abstract

Benign thyroid nodules are a common disease in the general population. Most often, they are completely asymptomatic and discovered occasionally during routine ultrasound examinations, and do not require any treatment. When thyroid nodules become symptomatic, surgical excision is still considered standard treatment. In the last few years, several experiences in the treatment of benign thyroid nodules through image-guided percutaneous thermal ablation have been reported with encouraging results, so that currently, these treatments are often proposed as first-choice options for patients with symptomatic benign thyroid nodules. In this paper, we discuss the present literature on the topic, focusing on different techniques available for image-guided percutaneous ablation, particularly radiofrequency (RFA), laser (LA), microwave (MWA), and high-intensity-focus ultrasound (HIFU). Little evidence about the efficacy of MWA and HIFU is now available. According to the literature, good results have been obtained with RFA and LA. Regarding RFA, volume reduction after ablative treatment has been found to range from 47 to 84 % at 3–6 months, and from 62 to 93 % at 1 year; LA also seems to be effective in achieving shrinkage of thyroid nodules, with volume reduction from 37 to 81 % at 3–6 months, and from 13 to 82 % at 1-year follow-up. Moreover, applications of advanced image-guidance modality, such as contrast-enhanced ultrasound and virtual navigation with fusion imaging, are discussed.

SOMMARIO

I noduli benigni della tiroide sono una evenienza comune nella popolazione generale. Più spesso vengono scoperti occasionalmente durante un esame ecografico fatto per altri motivi, sono asintomatici e non richiedono alcun trattamento. Qualora i noduli diventino sintomatici, l’escissione chirurgica è ancora considerato il trattamento standard. Tuttavia, negli ultimi anni, è cresciuta l’esperienza circa il trattamento di tali noduli tramite ablazione percutanea sotto guida ecografica tanto che, attualmente, questo viene spesso proposto come trattamento di scelta. Lo scopo del nostro lavoro è fare una revisione della letteratura riguardante l’argomento, con un particolare focus sulle differenti tecniche attualmente a disposizione, in particolare radiofrequenza (RFA), laser (LA), microonde (MWA) e high-intensity-focus ultrasound (HIFU). Al momento ci sono ancora poche evidenze sull’efficacia di MWA e HIFU. Secondo quanto riportato in letteratura, buoni risultati sono stati ottenuti con RFA e LA. Riguardo la radiofrequenza, la riduzione volumetrica dopo la procedura ablativa va da 47 a 84 % a 3–6 mesi e da 62 a 93 % a 1 anno; anche il laser sembra essere efficace nel causare la riduzione del nodulo, con percentuali che vanno da 37 a 81 % a 3–6-mesi a da 13 a 82 % a 1 anno di follow-up Abbiamo poi discusso brevemente le applicazioni di tecniche di imaging più avanzate, come l’ecografia con mezzo di contrasto e la navigazione virtuale.

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Authors and Affiliations

  1. Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy

    Anna Pisani Mainini, Cristian Monaco, Lorenzo Carlo Pescatori & Chiara De Angelis

  2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milan, Italy

    Francesco Sardanelli & Luca Maria Sconfienza

  3. Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy

    Francesco Sardanelli

  4. Radiologia/Diagnostica per immagini con servizio di radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy

    Luca Maria Sconfienza

  5. Dipartimento di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20100, Milan, Italy

    Giovanni Mauri

Authors
  1. Anna Pisani Mainini
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  2. Cristian Monaco
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  3. Lorenzo Carlo Pescatori
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  4. Chiara De Angelis
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  5. Francesco Sardanelli
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  6. Luca Maria Sconfienza
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  7. Giovanni Mauri
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Corresponding author

Correspondence to Giovanni Mauri.

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Conflict of interest

Dr. Anna Pisani Mainini has nothing to disclose; Dr. Cristina Monaco has nothing to disclose; Dr. Lorenzo Carlo Pescatori has nothing to disclose; Dr. Chiara De Angelis has nothing to disclose; Prof. Francesco Sardanelli has nothing to disclose; Prof. Luca Maria Sconfienza has nothing to disclose; and Dr. Giovanni Mauri has nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Mainini, A.P., Monaco, C., Pescatori, L.C. et al. Image-guided thermal ablation of benign thyroid nodules. J Ultrasound 20, 11–22 (2017). https://doi.org/10.1007/s40477-016-0221-6

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  • DOI: https://doi.org/10.1007/s40477-016-0221-6

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