Radiofrequency ablation for treatment of thyroid follicular neoplasm with low SUV in PET/CT study

Abstract

Objectives: To evaluate the feasibility of radiofrequency ablation (RFA) on follicular neoplasm with low standard uptake value (SUV) in a Positron emission tomography (PET/CT) study. Methods: From January 2018 to July 2019, 86 consecutive patients were diagnosed with follicular neoplasm. Of the patients, 28 with PET/CT scans were enrolled in this study. All patients received ultrasound, fine/core needle aspiration, and PET/CT scan prior to treatment. In accordance with previous studies, we recommended 6 patients who had follicular neoplasm with SUVmax !5 undergo surgical resection due to an elevated suspicion of malignancy. For 22 patients SUVmax <5, RFA was performed using the moving shot technique. Ultrasound was performed 6 to 12 months after each procedure. Results: Statistically significant volume reductions during follow-up between values prior to RFA and 12 months post RFA were demonstrated (12.6 ± 20.9 vs. 2.4 ± 3.0 cm 3 , p < 0.001). Volume reduction ratios at 6-12 months (mean: 10.1 months) after RFA were 73.3% ± 17.7%. One patient presented with vocal cord palsy and recovered within 3 months after RFA. No postprocedural hypothyroidism occurred in the RFA patients. Conclusions: By using PET/CT, we can select patients with low SUV follicular neoplasm. RFA offers a safe and feasible alternative treatment option for patients unsuitable or unwilling to undergo surgery. KEY POINTSBy using positron emission tomography-computed tomography, we can distinguish low SUV follicular neoplasm for radiofrequency ablation. For low SUV follicular neoplasm, RF ablation offers a safe and effective alternative treatment option for patients unsuitable or unwilling to undergo surgery.

Efficacy and safety of ultrasound-guided microwave ablation versus surgical resection for Bethesda category IV thyroid nodules: A retrospective comparative study

“…Of these patients, 23 who refused surgery or were at a high risk of surgery were actively followed up, with a median duration of 3.5 years during which no evidence of tumor progression was observed. However, active surveillance may cause anxiety in patients, which probably impairs patients' quality of life and compliance with follow-up (23). In the present study, 44/85 (51.76%) of Bethesda IV thyroid in the surgery group were diagnosed as benign lesions, involving 29 cases of FTA, nine nodular goiters, and six lymphocytic thyroiditis.…”

Radiofrequency Ablation of Indeterminate Thyroid Nodules: The First North American Comparative Analysis

“…Several works have reported an overall acceptable experience with indeterminate thyroid nodule RFA. Most recently, Lin et al treated 22 follicular neoplasms and reported a volume reduction of 73.3% at 6–12 months [ 24 ]. The authors reported only a single complication of temporary (3 months) vocal cord palsy [ 24 ].…”

“…Most recently, Lin et al treated 22 follicular neoplasms and reported a volume reduction of 73.3% at 6–12 months [ 24 ]. The authors reported only a single complication of temporary (3 months) vocal cord palsy [ 24 ]. A separate work of 10 small (<2 cm) follicular neoplasms were treated by RFA and achieved VRRs of 99.5%, with eight lesions disappearing completely.…”

2022 Taiwan clinical multicenter expert consensus and recommendations for thyroid radiofrequency ablation

“…The (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is non-invasive, and a nodule with an SUVmax ≥5 is highly indicative of malignancy, with a sensitivity of 76% and A c c e p t e d A r t i c l e specificity of 85% [118]. There is increasing evidence noting the differentiation between Hürthle cell carcinoma and follicular adenomas on PET [119,120]. In a study enrolling 46 patients with indeterminate results on FNA, which surveyed the efficacy of PET/CT for detection of malignant lesions, the values for the sensitivity and specificity, and the positive predictive and negative predictive values were 94%, 62%, 59%, and 95%, respectively [121].…”

“…In a study enrolling 46 patients with indeterminate results on FNA, which surveyed the efficacy of PET/CT for detection of malignant lesions, the values for the sensitivity and specificity, and the positive predictive and negative predictive values were 94%, 62%, 59%, and 95%, respectively [121]. Pre-ablative FDG-PET is helpful for further assessment of malignant FDG-avid LNs in patients with PTMC/PTC [117,120].…”