2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology

Abstract

Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology (KSThR) developed recommendations for the optimal use of radiofrequency ablation for thyroid tumors in 2012. As new meaningful evidences have accumulated, KSThR decided to revise the guidelines. The revised guideline is based on a comprehensive analysis of the current literature and expert consensus.

Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid (MITT) group

“…Strong agreement was found among the participants about the need of two consistently benign cytological samples prior to undergo MIT, as a general rule. Similarly to what reported in the Korean guideline [38], we evaluated the opportunity of considering as sufficient a single benign cytological report. This issue was extensively discussed and the initial statement was modified, as most experts recommended a second cytological sampling regardless the US appearance of nodules.…”

“…In nodules that demonstrate both cytological and US low-risk features, the risk of a false negative result at cytology is definitely low, probably ranging from 1% to 3%. Similarly, the risk of malignancy in AFTNs is low in the adult population [38]. Therefore, in these low-risk nodules, a single negative cytological examination may be sufficient to candidate patients for thermal ablation [39][40][41][42].…”

Comparison of efficacy and complications between radiofrequency ablation and repeat surgery in the treatment of locally recurrent thyroid cancers: a single-center propensity score matching study

“…While the mortality rate in patients with differentiated thyroid cancer has consistently been very low over the past three decades [2], its recurrence rate has reportedly been highly variable, ranging from 20 to 59% [3,4]. Regarding the management of recurrent thyroid cancers, surgery followed by radioactive iodine therapy and thyroid hormone therapy is the mainstay of treatment [5], with reports of >97% of patients receiving surgery [6]. Nevertheless, repeat surgeries are often more challenging due to postoperative tissue adhesion and structural distortion, which increase the risk of complications [7][8][9].…”

Comparison between radioiodine therapy and single‐session radiofrequency ablation of autonomously functioning thyroid nodules: A retrospective study

“…During the last decade, Radiofrequency ablation was introduced as a reliable, minimally invasive procedure to treat symptomatic benign thyroid nodules in patients unwilling to or ineligible for surgery or RI therapy. Moreover, the Korean Society of Thyroid Radiology suggests using RFA in patients with nodule‐related symptoms, or with cosmetic problems, or in patients who are affected by AFTNs both in the toxic and pretoxic phases. In the Guidelines updated in 2017, the Korean Society stressed the risk of the worsening of pre‐existing chronic diseases after surgery or RI therapy, and pointed out the controversy, which remains around the RI effect on childbearing patients.…”