Minimally Invasive Ablation of a Toxic Thyroid Nodule by High-Intensity Focused Ultrasound

Esnault, Olivier; Rouxel, A.; Nestour, E. Le; Gheron, G.; Leenhardt, Laurence

doi:10.3174/ajnr.a1979

Cited by 41 publications

(17 citation statements)

References 16 publications

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“…Histological examination revealed that the damage was limited to the treated lesions with a nodule necrosis that ranged from 2 to 80 % [86]. A pilot study of a single hyperfunctioning nodule demonstrated that the nodule developed into a predominantly cystic lesion 2 weeks after treatment and that hyperthyroidism normalized after 3 months was maintained at 18 months [85]. The location of the nodule is important in determining the efficacy of HIFU.…”

Section: Clinical Resultsmentioning

confidence: 99%

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: Clinical Resultsmentioning

confidence: 99%

Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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“…9,23,27,32 A case report on a single hyperfunctioning nodule demonstrated that 2 weeks after HIFU treatment, the nodule appearance was cystic at US. 33 Thyroid function normalized after 3 months and was maintained during the follow-up to 18 months. At US examination, the treated nodule appeared as a thin hypoechoic lesion devoid of vascular signals, and thyroid scintiscan showed functional recovery of the surrounding thyroid tissue.…”

Section: Clinical Efficacymentioning

confidence: 97%

High-intensity focused ultrasound for thyroid nodule ablation: the evidence to date

Кovatcheva¹,

Zaletel²

2017

RMI

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Thyroid nodules are common in occurrence and most of them are benign in nature. Some of these nodules are to be treated as they continue to grow or cause undesirable symptoms. Recently, several minimally invasive thermal ablation techniques have been introduced to overcome the complications of traditional methods such as surgery. High-intensity focused ultrasound (HIFU) is the latest advance in treatment modalities, which is a noninvasive procedure that permits localized target destruction without affecting the surrounding tissues. HIFU is currently used in the treatment of various solid malignant and benign tumors. The purpose of this review is to provide an introduction to the literature, principles, and advances of HIFU therapy of benign thyroid nodules, as well as to provide a discussion on its efficacy, complications, and future.

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“…Additional, but still inadequately investigated nonsurgical treatment options such as High Intensity Focused Ultrasound (HIFU) (57,122) and microwaves (58,123) are currently under evaluation. Although results are promising, they are too preliminary and sparse to allow any recommendations.…”

Section: Translating All the Aforementioned Into Clinical Practicementioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications

Papini

Pacella

Hegedűs

2014

European Journal of Endocrinology

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In patients with thyroid nodules, ultrasound (US) imaging represents an indispensable tool for assessment of the risk of malignancy. Over approximately four decades, innovative technology and successive improvements have facilitated its entry into the routine management and greatly improved its predictive value. When US features cannot reliably rule out thyroid cancer, US guidance allows a correct and safe sampling also of small or deeply located thyroid lesions. Obtained in this way, cytological or microhistological specimens may reliably define the nature of most thyroid nodules, and the information from histochemical or molecular markers shows promise in the classification of the remaining indeterminate cases. While a prompt surgical treatment can be offered in the minority of suspicious or definitely malignant cases, most individuals warrant only a follow-up. However, at initial evaluation, or over the years, a fraction of these benign lesions may grow and/or become symptomatic. Such cases may benefit from US-guided minimally invasive procedures as an alternative to surgery. Image-guided percutaneous treatments most often achieve relief of neck complaints, are inexpensive, and can be performed on an outpatient basis. The risk of major complications, after adequate training, is very low. Importantly, thyroid function is preserved. Currently, percutaneous ethanol injection for cystic lesions and thermal ablation, with laser or radiofrequency, for solid nodules are increasingly used and disseminated beyond the initial core facilities. In centres with expertise and high patient volume, their use should be considered as first-line treatment alternatives to surgery for selected patients with benign enlarging or symptomatic thyroid lesions.

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Minimally Invasive Ablation of a Toxic Thyroid Nodule by High-Intensity Focused Ultrasound

Cited by 41 publications

References 16 publications

Image-guided thermal ablation of benign thyroid nodules

Image-guided thermal ablation of benign thyroid nodules

High-intensity focused ultrasound for thyroid nodule ablation: the evidence to date

DIAGNOSIS OF ENDOCRINE DISEASE: Thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications

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