Complications Encountered in the Treatment of Benign Thyroid Nodules with US-guided Radiofrequency Ablation: A Multicenter Study

Baek, Jung Hwan; Lee, Jeong Hyun; Sung, Jin Yong; Bae, Jae-Ik; Kim, Young Ho; Sim, Jungsuk; Baek, Seung-Myeong; Kim, Youngsun; Shin, Jung Hee; Park, Jeong Seon; Kim, Dong Wook; Kim, Ji-Hoon; Kim, Min Jung; Jung, So Lyung; Na, Dong Gyu

doi:10.1148/radiol.11110416

Cited by 304 publications

(433 citation statements)

References 36 publications

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“…There was only one case of thyrotoxicosis, which spontaneously resolved within 30 days [46]. Major complications were, in the order of frequency, permanent voice change [33,34,44,46,47,52], rupture of the nodule [44,52], permanent hypothyroidism [41,52], and brachial plexus injury [47,52]. None of the patients experienced any lifethreatening complications related to RFA.…”

Section: Complicationsmentioning

confidence: 99%

“…In a multicentric study of 1459 patients, the overall complication rate was 3.3 %, with a major complication rate of 1.4 % [52]. The most common complication in all studies was pain [33,34,38,[45][46][47][48][49][50][51][52] (Table 1).…”

Section: Complicationsmentioning

confidence: 99%

“…The most common complication in all studies was pain [33,34,38,[45][46][47][48][49][50][51][52] (Table 1). In the order of frequency, authors also reported hematomas [33,47,52], vomiting [47,52], skin burn [33,52], fever [38], and thyrotoxicosis [46]. Hematomas can be controlled by neck compression and usually disappear within 2 weeks.…”

Section: Complicationsmentioning

confidence: 99%

“…None of the patients experienced any lifethreatening complications related to RFA. Baek et al showed that the major complication rate was lower for patients treated by experienced operators than for those treated by less-experienced operators, indicating that RFA is a safe procedure when performed by well-trained operators [52]. Voice change may be caused by the involvement of the recurrent laryngeal or vagus nerve [34,37].…”

Section: Complicationsmentioning

confidence: 99%

“…Voice change may be caused by the involvement of the recurrent laryngeal or vagus nerve [34,37]. Voice changes are usually transient, with most patients recovering within 3 months [34,44,46,47,52].…”

Section: Complicationsmentioning

confidence: 99%

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Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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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.Keywords Laser Á Radiofrequency Á Microwave Á Highintensity focused ultrasound Á Thyroid nodule 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

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Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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Thyroid Nodule Rupture Following Radiofrequency Ablation for Benign Thyroid Nodules

Austerlitz,

Mann,

Noel

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceNodule rupture is a rare but serious complication of thyroid radiofrequency ablation (RFA). With growing adoption of thyroid RFA across the US, an understanding of thyroid nodule rupture (TNR) is crucial for recognition, management, and, ultimately, prevention.ObjectiveTo determine procedural and patient factors that may contribute to TNR and describe experiences in managing TNR while synthesizing existing literature.Design, Setting, and ParticipantsThis retrospective case series examined all RFA procedures for benign thyroid nodules performed by 2 attending physicians at a single academic referral center between December 2019 and January 2024. A total of 298 consecutive patients underwent RFA for benign thyroid nodules. Criteria for offering RFA included nodules with 2 benign fine-needle aspirations, no suspicious ultrasonography features, a greatest dimension of 2 cm or greater, compressive or cosmetic concerns, and accessibility to a straight needle.ExposuresAll RFAs were performed using ultrasonography guidance using the moving-shot technique and a 7-mm or 10-mm active tip.Main Outcomes and MeasuresThe primary outcome was TNR, and measures were procedure, nodule, and patient characteristics that may have contributed to its pathogenesis. Secondary outcomes were nodule volume reduction, thyroid function, and management and sequelae of TNR. The hypothesis on the pathogenesis of TNR was formed before data collection.ResultsSix of 298 patients (2%; 4 women [67%]) with a mean age of 48.5 years (range, 34-65 years) experienced TNR for a mean of 36 days postprocedure (range, 19-54 days). The mean (SD) initial nodule volume among patients with TNR was 31.45 (16.52) mL, and 3 of 6 patients (50%) underwent prior lobectomy. All ruptures were anterior. All patients were treated conservatively, and none required surgery. Five patients recovered completely; the sixth and most recent patient was healing as of last follow-up.Conclusions and RelevanceThere are limited data on the etiology and optimal management of TNR. These 6 cases of anterior rupture suggest that a potential contributor to TNR is thermal and mechanical trauma exerted at the fulcrum point during the moving-shot technique. The use of a smaller active tip (eg, 7 mm) and cessation of energy delivery before this point may help avoid TNR. More robust reporting of this complication may clarify risk factors for and enhance prevention of TNR.

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Efficacy and safety of ultrasound‐guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease

et al. 2016

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Complications Encountered in the Treatment of Benign Thyroid Nodules with US-guided Radiofrequency Ablation: A Multicenter Study

Abstract: Although the complication rate of RF ablation is low, various complications may occur; comprehension of complications and suggested technical tips may prevent complications or properly manage those that occur.

Cited by 304 publications

References 36 publications

Image-guided thermal ablation of benign thyroid nodules

Image-guided thermal ablation of benign thyroid nodules

Thyroid Nodule Rupture Following Radiofrequency Ablation for Benign Thyroid Nodules

Efficacy and safety of ultrasound‐guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease

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