European Radiology

, Volume 25, Issue 1, pp 163–170 | Cite as

Efficacy and safety of radiofrequency ablation for treating locoregional recurrence from papillary thyroid cancer

  • Hyun Kyung Lim
  • Jung Hwan BaekEmail author
  • Jeong Hyun Lee
  • Won Bae Kim
  • Tae Yong Kim
  • Young Kee Shong
  • Suck Joon Hong



To assess the efficacy and safety of ultrasound- (US) guided radiofrequency ablation (RFA) for controlling locoregional recurrent papillary thyroid cancer (PTC) in a large patient population.


We included patients who had undergone RFA for locoregional recurrent PTC between September 2008 and April 2012 who fulfilled the following criteria: no metastasis beyond the neck; not more than four tumours; confirmed recurrence by US-guided fine needle aspiration biopsy or thyroglobulin measurement of needle washouts; more than a six-month follow-up period; and surgery not feasible or was refused by the patient.


Sixty-one recurrent tumours in 39 patients were included. The mean follow-up duration was 26.4 ± 13.7 months. Tumour volume decreased significantly from 0.20 ± 0.35 ml before ablation to 0.02 ± 0.11 ml (P < .001), with a mean volume reduction ratio of 95.1 ± 12.3 %. Fifty tumours (82.0 %) completely disappeared. Eleven tumours were visible at last follow-up US. The mean serum thyroglobulin level decreased from 1.21 ± 1.91 to 0.50 ± 0.80 ng/ml (P = .001). The overall complication rate was 7.7 % (3/39).


RFA can effectively control locoregional recurrent PTC without life-threatening complications; therefore, RFA may replace “berry picking surgery” in selected patients.

Key Points

RFA for recurrent PTC achieved a volume reduction ratio of 95.1 ± 12.3 %

Eighty-two percent (50/61) of recurrent PTC completely disappeared after RFA

The mean serum thyroglobulin level decreased significantly (P = .001) after RFA

RFA may replace “berry picking surgery” for recurrent PTC


Radiofrequency ablation Recurrent thyroid cancer Ultrasound Thyroid Ethanol ablation 



Papillary thyroid carcinoma


Radioactive iodine




Radiofrequency ablation


Ethanol ablation


Fine needle aspiration biopsy


thyroglobulin measurement of needle washout


Volume reduction ratio



The scientific guarantor of this publication is Hyun Kwon Ha, head of the department of Radiology and Research institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, observational, performed at one institution.

Supplementary material


(WMV 18666 kb)


  1. 1.
    Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29PubMedCrossRefGoogle Scholar
  2. 2.
    Shah JP, Loree TR, Dharker D, Strong EW, Begg C, Vlamis V (1992) Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg 164:658–661PubMedCrossRefGoogle Scholar
  3. 3.
    Cady B, Rossi R (1988) An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 104:947–953PubMedGoogle Scholar
  4. 4.
    Kim BM, Kim MJ, Kim EK, Park SI, Park CS, Chung WY (2008) Controlling recurrent papillary thyroid carcinoma in the neck by ultrasonography-guided percutaneous ethanol injection. Eur Radiol 18:835–842PubMedCrossRefGoogle Scholar
  5. 5.
    Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS (1993) Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 114:1050–1057, discussion 1057–1058PubMedGoogle Scholar
  6. 6.
    Samaan NA, Schultz PN, Hickey RC, Goepfert H, Haynie TP, Johnston DA, Ordonez NG (1992) The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab 75:714–720PubMedGoogle Scholar
  7. 7.
    Baek JH, Kim YS, Sung JY, Choi H, Lee JH (2011) Locoregional control of metastatic well-differentiated thyroid cancer by ultrasound-guided radiofrequency ablation. AJR Am J Roentgenol 197:W331–W336PubMedCrossRefGoogle Scholar
  8. 8.
    Dupuy DE, Monchik JM, Decrea C, Pisharodi L (2001) Radiofrequency ablation of regional recurrence from well-differentiated thyroid malignancy. Surgery 130:971–977PubMedCrossRefGoogle Scholar
  9. 9.
    Heilo A, Sigstad E, Fagerlid KH, Haskjold OI, Grøholt KK, Berner A, Bjøro T, Jørgensen LH (2011) Efficacy of ultrasound-guided percutaneous ethanol injection treatment in patients with a limited number of metastatic cervical lymph nodes from papillary thyroid carcinoma. J Clin Endocrinol Metab 96:2750–2755PubMedCrossRefGoogle Scholar
  10. 10.
    Lewis BD, Hay ID, Charboneau JW, McIver B, Reading CC, Goellner JR (2002) Percutaneous ethanol injection for treatment of cervical lymph node metastases in patients with papillary thyroid carcinoma. AJR Am J Roentgenol 178:699–704PubMedCrossRefGoogle Scholar
  11. 11.
    Lim CY, Yun JS, Lee J, Nam KH, Chung WY, Park CS (2007) Percutaneous ethanol injection therapy for locally recurrent papillary thyroid carcinoma. Thyroid 17:347–350PubMedCrossRefGoogle Scholar
  12. 12.
    Monchik JM, Donatini G, Iannuccilli J, Dupuy DE (2006) Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma. Ann Surg 244:296–304PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Papini E, Bizzarri G, Bianchini A, Valle D, Misischi I, Guglielmi R, Salvatori M, Solbiati L, Crescenzi A, Pacella CM, Gharib H (2013) Percutaneous ultrasound-guided laser ablation is effective for treating selected nodal metastases in papillary thyroid cancer. J Clin Endocrinol Metab 98:E92–E97PubMedCrossRefGoogle Scholar
  14. 14.
    Park KW, Shin JH, Han BK, Ko EY, Chung JH (2011) Inoperable symptomatic recurrent thyroid cancers: preliminary result of radiofrequency ablation. Ann Surg Oncol 18:2564–2568PubMedCrossRefGoogle Scholar
  15. 15.
    Shin JE, Baek JH, Lee JH (2013) Radiofrequency and ethanol ablation for the treatment of recurrent thyroid cancers: current status and challenges. Curr Opin Oncol 25:14–19PubMedCrossRefGoogle Scholar
  16. 16.
    Lim HK, Lee JH, Ha EJ, Sung JY, Kim JK, Baek JH (2013) Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients. Eur Radiol 23:1044–1049PubMedCrossRefGoogle Scholar
  17. 17.
    Baek JH, Kim YS, Lee D, Huh JY, Lee JH (2010) Benign predominantly solid thyroid nodules: prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition. AJR Am J Roentgenol 194:1137–1142PubMedCrossRefGoogle Scholar
  18. 18.
    Jeong WK, Baek JH, Rhim H, Kim YS, Kwak MS, Jeong HJ, Lee D (2008) Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. Eur Radiol 18:1244–1250PubMedCrossRefGoogle Scholar
  19. 19.
    Kim YS, Rhim H, Tae K, Park DW, Kim ST (2006) Radiofrequency ablation of benign cold thyroid nodules: initial clinical experience. Thyroid 16:361–367PubMedCrossRefGoogle Scholar
  20. 20.
    Deandrea M, Limone P, Basso E, Mormile A, Ragazzoni F, Gamarra E, Spiezia S, Faggiano A, Colao A, Molinari F, Garberoglio R (2008) US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules. Ultrasound Med Biol 34:784–791PubMedCrossRefGoogle Scholar
  21. 21.
    Spiezia S, Garberoglio R, Milone F, Ramundo V, Caiazzo C, Assanti AP, Deandrea M, Limone PP, Macchia PE, Lombardi G, Colao A, Faggiano A (2009) Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid 19:219–225PubMedCrossRefGoogle Scholar
  22. 22.
    Lee JH, Kim YS, Lee D, Choi H, Yoo H, Baek JH (2010) Radiofrequency ablation (RFA) of benign thyroid nodules in patients with incompletely resolved clinical problems after ethanol ablation (EA). World J Surg 34:1488–1493PubMedCrossRefGoogle Scholar
  23. 23.
    Baek JH, Moon WJ, Kim YS, Lee JH, Lee D (2009) Radiofrequency ablation for the treatment of autonomously functioning thyroid nodules. World J Surg 33:1971–1977PubMedCrossRefGoogle Scholar
  24. 24.
    Baek JH, Jeong HJ, Kim YS, Kwak MS, Lee D (2008) Radiofrequency ablation for an autonomously functioning thyroid nodule. Thyroid 18:675–676PubMedCrossRefGoogle Scholar
  25. 25.
    Jeon SJ, Kim E, Park JS, Son KR, Baek JH, Kim YS, do Park J, Cho BY, Na DG (2009) Diagnostic benefit of thyroglobulin measurement in fine-needle aspiration for diagnosing metastatic cervical lymph nodes from papillary thyroid cancer: correlations with US features. Korean J Radiol 10:106–111PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Baek JH, Lee JH, Valcavi R, Pacella CM, Rhim H, Na DG (2011) Thermal ablation for benign thyroid nodules: radiofrequency and laser. Korean J Radiol 12:525–540PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Goldberg SN, Charboneau JW, Dodd GD, Dupuy DE, Gervais DA, Gillams AR, Kane RA, Lee FT, Livraghi T, McGahan JP, Rhim H, Silverman SG, Solbiati L, Vogl TJ, Wood BJ (2003) Image-guided tumor ablation: proposal for standardization of terms and reporting criteria. Radiology 228:335–345PubMedCrossRefGoogle Scholar
  28. 28.
    Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of Interventional Radiology clinicalpractice guidelines. J Vasc Interv Radiol 14:S199–S202PubMedCrossRefGoogle Scholar
  29. 29.
    Hay ID, Lee RA, Davidge-Pitts C, Reading CC, Charboneau JW (2013) Long-term outcome of ultrasound-guided percutaneous ethanol ablation of selected “recurrent” neck nodal metastases in 25 patients with TNM stages III or IVA papillary thyroid carcinoma previously treated by surgery and 131I therapy. Surgery 154:1448–1454PubMedCrossRefGoogle Scholar
  30. 30.
    Mauri G, Cova L, Tondolo T, Larace T, Baroli A, Di Mauro E, Pacella CM, Goldberg SN, Solbiati L (2013) Percutaneous laser ablation of metastatic lymph nodes in the neck from papillary thyroid carcinoma: preliminary results. J Clin Endocrinol Metab 98:E2013–E2017CrossRefGoogle Scholar
  31. 31.
    Pacella CM, Papini E (2013) Image-guided percutaneous ablation theparies for local recurrences of thyroid tumors. J endocrinol Invest 36:61–70PubMedCrossRefGoogle Scholar
  32. 32.
    Na DG, Lee JH, Jung SL, Kim JH, Sung JY, Shin JH, Kim EK, Lee JH, Kim DW, Park JS, Kim KS, Baek SM, Lee Y, Chong S, Sim JS, Huh JY, Bae JI, Kim KT, Han SY, Bae MY, Kim YS, Baek JH (2012) Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers:consensus statement and recommendations. Korean J Radiol 13:117–125PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Hyun Kyung Lim
    • 1
    • 2
  • Jung Hwan Baek
    • 1
    Email author
  • Jeong Hyun Lee
    • 1
  • Won Bae Kim
    • 3
  • Tae Yong Kim
    • 3
  • Young Kee Shong
    • 3
  • Suck Joon Hong
    • 4
  1. 1.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea
  2. 2.Department of RadiologySeoul Soonchunhyang University HospitalSeoulKorea
  3. 3.Department of Internal MedicineUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea
  4. 4.Department of SurgeryUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea

Personalised recommendations