Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement
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Introduction
Nodular thyroid disease is a very common finding in clinical practice, discovered by ultrasound (US) in about 50 % of the general population, with higher prevalence in women and in the elderly [1, 2, 3, 4].
Whereas therapeutic flowchart is quite established and shared for malignant lesions, multiple options are now available for patients presenting with benign thyroid nodules, ranging from simple clinical and US follow-up to thyroid surgery. The majority of thyroid nodules, benign by fine-needle aspiration, are asymptomatic, stable, or slow-growing over time and require no treatment.
Nevertheless, large thyroid nodules may become responsible for pressure symptoms, resulting in neck discomfort, cosmetic complaints, and decreased quality of life. Partial/total thyroid surgery has so far constituted the only therapeutic approach for these. Although surgery is widely available, highly effective, and safe in skilled centers, complications (both temporary and permanent) still...
Keywords
Thyroid Nodule Percutaneous Ethanol Injection Radioiodine Therapy Benign Thyroid Nodule Nodular Thyroid DiseaseNotes
Conflict of interest
The authors (Roberto Garberoglio, Camillo Aliberti, Marialuisa Appetecchia, Marco Attard, Giuseppe Boccuzzi, Flavio Boraso, Giorgio Borretta, Giuseppe Caruso, Maurilio Deandrea, Milena Freddi, Gabriella Gallone, Giovanni Gandini, Guido Gasparri, Carlo Gazzera, Ezio Ghigo, Maurizio Grosso, Paolo Limone, Mauro Maccario, Luigi Mansi, Alberto Mormile, Pier Giorgio Nasi, Fabio Orlandi, Donatella Pacchioni, Claudio Maurizio Pacella, Nicola Palestini, Enrico Papini, Maria Rosa Pelizzo, Andrea Piotto, Teresa Rago, Fabrizio Riganti, Lodovico Rosato, Ruth Rossetto, Antonio Scarmozzino, Stefano Spiezia, Ornella Testori, Roberto Valcavi, Andrea Veltri, Paolo Vitti, Matteo Zingrillo) have no conflict of interest to disclose.
Ethical statement
The study described in this article does not contain studies with human or animal subjects performed by any of the authors.
Informed consent
For this type of study, formal consent is not required.
References
- 1.Ezzat S, Sarti DA, Cain DR, Braunstein GD (1994) Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med 154:1838–1840CrossRefPubMedGoogle Scholar
- 2.Gharib H, Papini E (2007) Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am 36:707–735CrossRefPubMedGoogle Scholar
- 3.Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214CrossRefPubMedGoogle Scholar
- 4.Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, Vitti P, AACE/AME/ETA Task Force on Thyroid Nodules (2010) American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract 16 (suppl 1):1–43Google Scholar
- 5.Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28:271–276CrossRefPubMedGoogle Scholar
- 6.Bergenfelz A, Jansson S, Kristoffersson A, Mårtensson H, Reihnér E, Wallin G, Lausen I (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg. 393:667–673CrossRefPubMedGoogle Scholar
- 7.Meier DA, Brill DR, Becker DV, Clarke SE, Silberstein EB, Royal HD, Balon HR, Society of Nuclear Medicine (2002) Procedure guideline for therapy of thyroid disease with (131)iodine. J Nucl Med 43:856–861PubMedGoogle Scholar
- 8.Reiners C, Schneider P (2002) Radioiodine therapy of thyroid autonomy. Eur J Nucl Med Mol Imag 29(Suppl 2):S471–S478CrossRefGoogle Scholar
- 9.Ceccarelli C, Bencivelli W, Vitti P, Grasso L, Pinchera A (2005) A outcome of radioiodine-131 therapy in hyperfunctioning thyroid nodules: a 20 years’ retrospective study. Clin Endocrinol (Oxf) 62:331–335CrossRefGoogle Scholar
- 10.Nieuwlaat WA, Hermus AR, Sivro-Prndelj F, Corstens FH, Huysmans DA (2001) Pretreatment with recombinant human TSH changes the regional distribution of radioiodine on thyroid scintigrams of nodular goiters. J Clin Endocrinol Metab 86:5330–5336CrossRefPubMedGoogle Scholar
- 11.Hegedüs L (2009) Therapy: a new nonsurgical therapy option for benign thyroid nodules? Nat Rev Endocrinol 5:476–478CrossRefPubMedGoogle Scholar
- 12.Gharib H, Hegedüs L, Pacella CM, Baek JH, Papini E (2013) Clinical review: nonsurgical, image-guided, minimally invasive therapy for thyroid nodules. J Clin Endocrinol Metab 98:3949–3957CrossRefPubMedGoogle Scholar
- 13.Bandeira-Echtler E, Bergerhoff K, Richter B (2014) Levothyroxine or minimally invasive therapies for benign thyroid nodules. Cochrane Database Syst RevGoogle Scholar
- 14.De Bernardi IC, Floridi C, Muollo A, Giacchero R, Dionigi GL, Reginelli A, Gatta G, Cantisani V, Grassi R, Brunese L, Carrafiello G (2014) Vascular and interventional radiology radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: literature review. Radiol Med 119:512–520CrossRefPubMedGoogle Scholar
- 15.Fuller CW, Nguyen SA, Lohia S, Gillespie MB (2014) Radiofrequency ablation for treatment of benign thyroid nodules: systematic review. Laryngoscope 124:346–353CrossRefPubMedGoogle Scholar
- 16.Papini E, Pacella CM, Hegedüs L (2014) Diagnosis of endocrine disease: thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications. Eur J Endocrinol 170:R133–R146CrossRefPubMedGoogle Scholar
- 17.Paschke R, Hegedüs L, Alexander E, Valcavi R, Papini E, Gharib H (2011) Thyroid nodule guidelines: agreement, disagreement and need for future research. Nat Rev Endocrinol 7:354–361CrossRefPubMedGoogle Scholar
- 18.Pacella CM, Bizzarri G, Guglielmi R, Anelli V, Bianchini A, Crescenzi A, Pacella S, Papini E (2000) Thyroid tissue: US-guided percutaneous interstitial laser ablation-a feasibility study. Radiology 217:673–677CrossRefPubMedGoogle Scholar
- 19.Kim YS, Rhim H, Tae K, Park DW, Kim ST (2006) Radiofrequency ablation of benign cold thyroid nodules: initial clinical experience. Thyroid 16:361–367CrossRefPubMedGoogle Scholar
- 20.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 18:1244–1250CrossRefPubMedGoogle Scholar
- 21.Baek JH, Jeong HJ, Kim YS, Kwak MS, Lee D (2008) Radiofrequency ablation for an autonomously functioning thyroid nodule. Thyroid 18:675–676CrossRefPubMedGoogle Scholar
- 22.Spiezia S, Garberoglio R, Di Somma C, Deandrea M, Basso E, Limone PP, Milone F, Ramundo V, Macchia PE, Biondi B, Lombardi G, Colao A, Faggiano A (2007) Efficacy and safety of radiofrequency thermal ablation in the treatment of thyroid nodules with pressure symptoms in elderly patients. J Am Geriatr Soc 55:1478–1479CrossRefPubMedGoogle Scholar
- 23.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 34:784–791CrossRefPubMedGoogle Scholar
- 24.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 2 years after radiofrequency thermal ablation. Thyroid 19:219–225CrossRefPubMedGoogle Scholar
- 25.Baek JH, Moon WJ, Kim YS, Lee JH, Lee D (2009) Radiofrequency ablation for the treatment of autonomously functioning thyroid nodules. World J Surg 33:1971–1977CrossRefPubMedGoogle Scholar
- 26.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. Am J Roentgenol 194:1137–1142CrossRefGoogle Scholar
- 27.Huh JY, Baek JH, Choi H, Kim JK, Lee JH (2012) Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session–prospective randomized study. Radiology 263:909–916CrossRefPubMedGoogle Scholar
- 28.Faggiano A, Ramundo V, Assanti AP, Fonderico F, Macchia PE, Misso C, Marciello F, Marotta V, Del Prete M, Papini E, Lombardi G, Colao A, Spiezia S (2012) Thyroid nodules treated with percutaneous radiofrequency thermal ablation: a comparative study. J Clin Endocrinol Metab 97:4439–4445CrossRefPubMedGoogle Scholar
- 29.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 23:1044–1049CrossRefPubMedGoogle Scholar
- 30.Bernardi S, Dobrinja C, Fabris B, Bazzocchi G, Sabato N, Ulcigrai V, Giacca M, Barro E, De Manzini N, Stacul F (2014) Radiofrequency ablation compared to surgery for the treatment of benign thyroid nodules. Int J Endocrinol, article ID 934595Google Scholar
- 31.Cesareo R, Pasqualini V, Simeoni C, Sacchi M, Saralli E, Campagna G, Cianni R (2015) Prospective study of effectiveness of ultrasound-guided radiofrequency ablation versus control group in patients affected by benign thyroid nodules. J Clin Endocrinol Metab 100:460–466CrossRefPubMedGoogle Scholar
- 32.Turtulici G, Orlandi D, Corazza A, Sartoris R, Derchi LE, Silvestri E, Baek JH (2014) Percutaneous radiofrequency ablation of benign thyroid nodules assisted by a virtual needle tracking system. Ultrasound Med Biol 40:1447–1452CrossRefPubMedGoogle Scholar
- 33.Sung JY, Kim YS, Choi H, Lee JH, Baek JH (2011) Optimum first-line treatment technique for benign cystic thyroid nodules: ethanol ablation or radiofrequency ablation? Am J Roentgenol 196:W210–W214CrossRefGoogle Scholar
- 34.Sung JY, Baek JH, Kim KS, Lee D, Yoo H, Kim JK, Park SH (2013) Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation: a prospective randomized study. Radiology 269:293–300CrossRefPubMedGoogle Scholar
- 35.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 34:1488–1493CrossRefPubMedGoogle Scholar
- 36.Jang SW, Baek JH, Kim JK, Sung JY, Choi H, Lim HK, Park JW, Lee HY, Park S, Lee JH (2012) How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: role of radiofrequency ablation. Eur J Radiol 81:905–910CrossRefPubMedGoogle Scholar
- 37.Sung JY, Baek JH, Jung SL, Kim JH, Kim KS, Lee D, Kim WB, Na DG (2015) Radiofrequency ablation for autonomously functioning thyroid nodules: a multicenter study. Thyroid 25:112–117CrossRefPubMedGoogle Scholar
- 38.Chianelli M, Bizzarri G, Todino V, Misischi I, Bianchini A, Graziano F, Guglielmi R, Pacella CM, Gharib H, Papini E (2014) Laser ablation and 131Iodine: a 24-month pilot study of combined treatment for large toxic nodular goitre. J Clin Endocrinol Metab 99:E1283–E1286CrossRefPubMedGoogle Scholar
- 39.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 244:296–304PubMedCentralCrossRefPubMedGoogle Scholar
- 40.Baek JH, Kim YS, Sung JY, Choi H, Lee JH (2011) Locoregional control of metastatic well-differentiated thyroid cancer by ultrasound-guided radiofrequency ablation. Am J Roentgenol 197:W331–W336CrossRefGoogle Scholar
- 41.Park KW, Shin JH, Han BK, Ko EY, Chung JH (2011) Inoperable symptomatic recurrent thyroid cancers: preliminary result of radiofrequency ablation. Ann Surg Oncol 18:2564–2568CrossRefPubMedGoogle Scholar
- 42.Lim HK, Baek JH, Lee JH, Kim WB, Kim TY, Shong YK, Hong SJ (2015) Efficacy and safety of radiofrequency ablation for treating locoregional recurrence from papillary thyroid cancer. Eur Radiol 25:163–170CrossRefPubMedGoogle Scholar
- 43.Baek JH, Lee JH, Sung JY, Bae JI, Kim KT, Sim J, Baek SM, Kim YS, Shin JH, Park JS, Kim DW, Kim JH, Kim EK, Jung SL, Na DG, Korean Society of Thyroid Radiology (2012) Complications encountered in the treatment of benign thyroid nodules with US-guided radiofrequency ablation: a multicenter study. Radiology 262:335–342CrossRefPubMedGoogle Scholar
- 44.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, Korean Society of Thyroid Radiology (KSThR), Korean Society of Radiologys (2012) Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations. Korean J Radiol 13:117–125PubMedCentralCrossRefPubMedGoogle Scholar
- 45.NIH National Institutes of Health. Consensus Development Program. http://consensus.nih.gov. Accessed 17 Feb 2012
- 46.ANAES Agence Nationale d’Accréditation et d’Évaluation en Santé (1999) Les Conférences de consensus. Base méthodologique pour leur réalisation en FranceGoogle Scholar
- 47.Candiani G, Colombo C, Daghini R, Magrini N, Mosconi P, Nonino F, Satolli R (2013) Manuale metodologico. Come organizzare una conferenza di consenso. http://www.snlg-iss.it/manuale_metodologico_consensus. Accessed 17 Feb 2012
- 48.Zingrillo M, Modoni S, Conte M, Frusciante V, Trischitta V (2003) Percutaneous ethanol injection plus radioiodine versus radioiodine alone in the treatment of large toxic thyroid nodules. J Nucl Med 44:207–210PubMedGoogle Scholar
- 49.Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, Tomoda C, Takamura Y, Kobayashi K, Miya A (2010) An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg 34:28–35CrossRefPubMedGoogle Scholar
- 50.Rogers H (2013) Do low grade thyroid cancers really require thyroidectomy? BMJ 347:f5734CrossRefPubMedGoogle Scholar
- 51.Brito JP, Hay ID, Morris JC (2014) Low risk papillary thyroid cancer. BMJ 348:g3045CrossRefPubMedGoogle Scholar
- 52.Papini E, Guglielmi R, Gharib H, Misischi I, Graziano F, Chianelli M, Crescenzi A, Bianchini A, Valle D, Bizzarri G (2011) Ultrasound-guided laser ablation of incidental papillary thyroid microcarcinoma: a potential therapeutic approach in patients at surgical risk. Thyroid 21:917–920PubMedCentralCrossRefPubMedGoogle Scholar
- 53.Valcavi R, Piana S, Bortolani GS, Lai R, Barbieri V, Negro R (2013) Ultrasound-guided percutaneous laser ablation of papillary thyroid microcarcinoma: a feasibility study on three cases with pathological and immunohistochemical evaluation. Thyroid 23:1578–1582CrossRefPubMedGoogle Scholar