Minimally Invasive Techniques for the Management of Thyroid Nodules

Baldwin, Chelsey K.; Natter, Michael; Patel, Kepal N.; Hodak, Steven P.

doi:10.1016/j.ecl.2022.01.001

Cited by 9 publications

(8 citation statements)

References 106 publications

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“…In addition to the thermal ablation technologies, ultrasound-guided intratumoral administration of ethanol has been used as a chemical ablation method to destroy low-risk papillary thyroid cancer (Baldwin et al 2022). The alcohol injection promotes cellular dehydration leading to protein denaturation, damage to the vascular endothelial and platelet aggregation with fibrin clot formation leading to vascular thrombosis, tissue ischemia, and coagulation necrosis.…”

Section: Percutaneous Ablation Technologies Currently Under Evaluationmentioning

confidence: 99%

“…Most of the data available examining thermal ablation approaches in the management of low-risk thyroid cancer come from single-institution retrospective case series describing carefully selected patients with papillary microcarcinomas (≤1 cm in maximal diameter) who were not interested in active surveillance and declined surgical intervention or who were conisdered high risk for surgical intervention (Cho et al 2019, Choi & Jung 2020, Min et al 2020, Cho et al 2021, Tufano et al 2021, Baldwin et al 2022, Chung et al 2022. Limited data are available for papillary thyroid cancer nodules 1-2 cm (Cao et al 2021, Xiao et al 2021a or 2-4 cm (Xiao et al 2021b) in maximal diameter.…”

Section: Overview Of Published Case Series Examining Thermal Ablation...mentioning

confidence: 99%

“…Effective pain control can be accomplished using either local anesthesia or light conscious sedation depending on the preference of the patient and the operating clinician. Serious complications such as thermal injury to surrounding structures (trachea, esophagus, major vessels, brachial plexus, or sympathetic chain), significant hematoma formation, hemorrhage, or thyroid nodule rupture are exceptionally uncommon and rarely encountered (Baldwin et al 2022).…”

Section: Safety Of Percutaneous Thermal Ablationmentioning

confidence: 99%

“…In Ou et al's review of 40 retrospective case series (Ou et al 2022), transient hoarseness was described in 1.4% (71 of 5074 patients ablated) which resolved within 1-6 months (Table 1). However, most studies assessed potential injury to the recurrent laryngeal nerve through voice exam and not direct documentation of vocal cord function pre-and postprocedure (Cho et al 2019, Choi & Jung 2020, Baldwin et al 2022. Permanent vocal cord dysfunction is exceptionally uncommon, but it may take weeks to months for the voice to return to normal (Ou et al 2022).…”

Section: Safety Of Percutaneous Thermal Ablationmentioning

confidence: 99%

“…Even though thyroid lobectomy and active surveillance has been shown to be safe and effective management options for low-risk thyroid cancer (Chou et al 2022), many patients who are not interested in active surveillance are seeking an even more minimalistic therapeutic option to destroy the small focus of papillary thyroid cancer without having to undergo thyroid surgery. To meet this unmet need, ultrasound-guided percutaneous ablation technologies, developed as a nonsurgical therapeutic option to decrease the volume of benign thyroid nodules, are now being used to destroy small intrathyroidal papillary thyroid cancer nodules (Hegedus et al 2020, Min et al 2020, Tufano et al 2021, Baldwin et al 2022, Pace-Asciak et al 2022. These percutaneous ablation technologies utilize real-time ultrasound guidance to insert a needle probe that delivers thermal energy into a small thyroid cancer nodule under either local anesthesia or mild conscious sedation in the outpatient setting.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous ablation of low-risk papillary thyroid cancer

Tuttle

Ridouani

2023

Endocrine-Related Cancer

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Minimalistic management options such as active surveillance and thyroid lobectomy are increasingly being accepted as reasonable management options for properly selected patient with low-risk papillary thyroid cancer. Leveraging technologies developed for the treatment of benign thyroid nodules, ultrasound guided percutaneous thermal ablation is now being evaluated as a potential additional minimalistic management option for small, intrathyroidal, low-risk papillary thyroid cancer. Published retrospective data on more than 5,000 low risk papillary thyroid cancer patients treated with thermal ablation indicate that with appropriate training and proper patient selection these technologies can be safely and effectively applied to papillary microcarcinomas. When compared to immediate surgery, thermal ablation appears to have lower complication rates with similar short-term rates of recurrence. Proper patient selection is facilitated by use of a clinical framework which integrates imaging characteristics, patient characteristics, and medical team characteristics to classify a patient as ideal, appropriate, or inappropriate for minimalistic management options (active surveillance, thyroid lobectomy, or thermal ablation). While retrospective in nature and lacking randomized prospective clinical trial data, currently available data does support the proposition that thermal ablation technologies reliably destroy papillary thyroid microcarcinoma lesions and are associated with clinically acceptable oncologic outcomes when done by experienced teams in properly selected patients.

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Section: Percutaneous Ablation Technologies Currently Under Evaluationmentioning

confidence: 99%