Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques

Park, Hye Sun; Baek, Jung Hwan; Park, Auh Whan; Chung, Sae Rom; Choi, Young Jun; Lee, Jeong Hyun

doi:10.3348/kjr.2017.18.4.615

Cited by 185 publications

(238 citation statements)

References 56 publications

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“…An electric field, produced by a radiofrequency generator connected to an internally cooled electrode needle, leads to frictional agitation at the ionic level and to heat generation (Joule effect). Monopolar electrodes, with collecting pads, and bipolar devices, without pads, are available [6,10,18]. Shorter (7-10 cm length) and thinner (17-19 G) devices, appropriate for use in the neck region, have substituted multi-hook expandable needles.…”

Section: Radiofrequencymentioning

confidence: 99%

“…The electrode is introduced under US guidance into the target nodule, and a continuous repositioning of the applicator ("moving shot" or "multiple overlapping shot" technique) results in an ellipsoidal necrotic area [19]. As with LTA, the appearance of hyperechoic signals close to the electrode tip indicates the development of tissue changes, while a steep rise in tissue impedance demonstrates the achievement of tissue necrosis [6,10,18].…”

Section: Radiofrequencymentioning

confidence: 99%

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2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

et al. 2020

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Standard therapeutic approaches for benign thyroid lesions that warrant intervention are surgery for cold and either surgery or radioiodine for autonomously functioning thyroid nodules (AFTN). Image-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for selected clinical conditions. Due to mounting scientific evidence and widening availability, ETA considered it appropriate to develop guidelines for the use of TA in adult patients. TA procedures are well tolerated, but a dedicated training of the operators is required and information on possible complications needs to be shared with the patients. The following factors should be considered when weighing between observation, surgery, and TA for benign thyroid nodules. In solid non-hyperfunctioning nodules, TA induces a decrease in thyroid nodule volume, paralleled by improvement in symptoms. Nodule re-growth is possible over time and may necessitate repeat treatment, or surgery, in a dialogue with the patient. In AFTN, radioactive iodine is the first-line treatment, but TA may be considered in young patients with small AFTN due to higher probability of restoring normal thyroid function and avoidance of irradiation. In cystic nodules, ethanol ablation (EA) is the most effective and least expensive treatment. TA may be considered for cystic lesions that relapse after EA or have a significant residual solid component following drainage and EA. TA should be restricted to benign lesions that cause symptoms or cosmetic concern. Presently, laser and radiofrequency ablation are the most thoroughly assessed techniques, with similar satisfactory clinical results. Microwaves and high-intensity focused ultrasound therapy options remain to be fully evaluated.© 2020 European Thyroid Association Published by S. Karger AG, Basel Recommendation 1. In adult patients with benign thyroid nodules that cause pressure symptoms and/or cosmetic concerns and decline surgery, image-guided TA should be considered as a costand risk-effective alternative option to surgical treatment or observation alone (1, ØØOO).Recommendation 2. We recommend against the use of TA for asymptomatic lesions (1, ØØØO).

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Section: Radiofrequencymentioning

confidence: 99%

Section: Radiofrequencymentioning

confidence: 99%

2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

et al. 2020

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“…All ablations were performed with an RF generator (VIVA RF generator, STARmed, Goyang, Korea, and M-2004, RF Medical, Seoul, Korea) and 18-gauge thyroid-dedicated straight-type internally cooled electrodes with a 0.4, 0.5, 0.7, or 1 cm active tip (VIVA, STARmed, and RFT-0710, RF Medical), depending on the size of the nodule. For local anesthesia, the patients were injected with 2% lidocaine at the skin puncture site and in the perithyroidal soft tissue [27]. The trans-isthmic approach with a moving shot technique was used under ultrasound guidance [3,7,28].…”

Section: Rfa Proceduresmentioning

confidence: 99%

“…To prevent complications during the procedure, careful observation of the adjacent structures was made, including nerves and blood vessels [29]. A hydrodissection technique was applied if the nodule was located in close proximity to critical structures [27]. Continuous injection of fluid and constant monitoring of the relationship between the nerves and tumor was required, as injected fluid gradually disappeared along the muscle plane.…”

Section: Rfa Proceduresmentioning

confidence: 99%

Management strategy for nerve damage during radiofrequency ablation of thyroid nodules

Chung

Baek

Choi

et al. 2019

International Journal of Hyperthermia

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Objective: The aim of this study was to introduce a management strategy for nerve damage occurring during radiofrequency ablation (RFA). Methods: From January 2016 to October 2017, 17 patients who experienced the symptoms of nerve damage during RFA were enrolled in this study. If damage to nerves was suspected during RFA, ablation was stopped immediately, and a cold solution of 5% dextrose was injected directly into the space where the nerves were located until symptoms improved. Patients were followed up after the procedure until symptoms had resolved. The clinical data of patients who received a cold dextrose solution injection for nerve damage were compared with those who did not receive such an injection. Results: Of 17 patients who experienced nerve damage, 12 received an injection of cold dextrose solution shortly after the emergence of symptoms. While resolution of symptoms was seen in all 17 patients, the mean time to recovery was significantly faster in the 12 patients who received treatment with an injection of cold dextrose solution than in those patients who did not receive such a treatment (p value ¼ .041). Conclusions: In the event of thermal damage to adjacent nerve structures during RFA, the direct injection of a cold dextrose solution is a simple and effective treatment that can result in rapid symptom resolution.

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“…A trans‐isthmic approach has been recommended to minimize this phenomenon . Tissue heating results in pain for patients who undergo thermal ablation, and the use of pericapsular lidocaine has been suggested to anesthetize surrounding sensory nerves . Rates of discomfort vary between studies with groups reporting rates between 2% and 60% .…”

Section: Malignant Thyroid Diseasementioning

confidence: 99%

Image‐guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications

et al. 2018

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Image-guided ablation of thyroid disease is increasingly being commonly reported. Techniques including ethanol injection and thermal ablation using radio-frequency, laser, and microwave devices have been described. Minimally invasive approaches to the management of benign cystic, solid, and functional thyroid nodules as well as both primary and recurrent thyroid malignancy have been reported. The purpose of this article is to review the current evidence relating to image-guided ablation of thyroid disease with a focus on clinical outcomes and complication rates for patients treated with this minimally invasive approach.

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Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques

Cited by 185 publications

References 56 publications

2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

Management strategy for nerve damage during radiofrequency ablation of thyroid nodules

Image‐guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications

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