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Mini-Invasive Techniques for the Treatment of Thyroid Nodules: Critical Issues

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Minimally Invasive Therapies for Endocrine Neck Diseases

Abstract

In the last few decades, US-guided mini-invasive techniques such as percutaneous ethanol injection (PEI), laser thermal ablation (LTA), and radiofrequency thermal ablation (RFA) (and more recently high-focused ultrasound – HIFU) have been introduced for the treatment of thyroid nodules. The advantages of mini-invasive techniques are that they are less expensive and have fewer complications than surgery, they do not require a general anesthesia, they are fast, and the patients can generally be discharged soon after the procedure. Another important advantage is that they do not affect thyroid function and do not leave skin scars. Despite these evident advantages, and the increasing diffusion of mini-invasive techniques, some critical issues still remain, regarding both technical and clinical aspects. Here we review these issues, with the aim of focusing on the implications for clinical practice.

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References

  1. Gharib H, Hegedüs L, Pacella CM et al (2013) Clinical review: nonsurgical, image-guided, minimally invasive therapy for thyroid nodules. J Clin Endocrinol Metab 98:3949–3957

    Article  PubMed  CAS  Google Scholar 

  2. Papini E, Pacella CM, Hegedus L (2014) Thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications. Eur J Endocrinol 170:R133–R146

    Article  PubMed  CAS  Google Scholar 

  3. Esnault O, Franc B, Menegaux F et al (2011) High-intensity focused ultrasound ablation of thyroid nodules: first human feasibility study. Thyroid 21:965–973

    Article  PubMed  Google Scholar 

  4. Feng B, Liang P, Cheng Z et al (2012) Ultrasound-guided percutaneous microwave ablation of benign thyroid nodules: experimental and clinical studies. Eur J Endocrinol 166:1031–1037

    Article  PubMed  CAS  Google Scholar 

  5. Baek JH, Lee JH, Sung JY et al (2012) Korean society of thyroid radiology complications encountered in the treatment of benign thyroid nodules with US-guided radiofrequency ablation: a multicenter study. Radiology 262:335–342

    Article  PubMed  Google Scholar 

  6. Ha EJ, Baek JH, Lee JH et al (2013) Radiofrequency ablation of benign thyroid nodules does not affect thyroid function in patients with previous lobectomy. Thyroid 23:289–293

    Article  PubMed  CAS  Google Scholar 

  7. Bennedbaek FN, Nielsen LK, Hegedüs L (1998) Effect of percutaneous ethanol injection versus suppressive doses of L-thyroxine on benign solitary solid cold thyroid nodules: a randomized trial. J Clin Endocrinol Metab 83:830–835

    Article  PubMed  CAS  Google Scholar 

  8. Bennedbaek FN, Hegedüs L (1999) Percutaneous ethanol injection therapy in benign solitary solid cold thyroid nodules: a randomized trial comparing one with three injections”. Thyroid 9:225–233

    Article  PubMed  CAS  Google Scholar 

  9. Monzani F, Caraccio N, Basolo F et al (2000) Surgical and pathological changes after percutaneous ethanol injection therapy of thyroid nodules. Thyroid 10:1087–1092

    Article  PubMed  CAS  Google Scholar 

  10. Kim DW, Rho MH, Park HJ et al (2012) Ultrasonography-guided ethanol ablation of predominantly solid thyroid nodules: a preliminary study for factors that predict the outcome. Br J Radiol 85:930–936

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  11. Livraghi T, Paracchi A, Ferrari C et al (1990) Treatment of autonomous thyroid nodules with percutaneous ethanol injection: preliminary results. Work in progress. Radiology 175:827–829

    Article  PubMed  CAS  Google Scholar 

  12. Lippi F, Ferrari C, Manetti L et al (1996) Treatment of solitary autonomous thyroid nodules by percutaneous ethanol injection: results of an Italian multicenter study. The Multicenter Study Group. J Clin Endocrinol Metab 81:3261–3264

    PubMed  CAS  Google Scholar 

  13. Tarantino L, Francica G, Sordelli I et al (2008) Percutaneous ethanol injection of hyperfunctioning thyroid nodules: long-term follow-up in 125 patients. Am J Roentgenol 190:800–808

    Article  Google Scholar 

  14. Yano Y, Sugino K, Akaishi J et al (2011) Treatment of autonomously functioning thyroid nodules at a single institution: radioiodine therapy, surgery and ethanol injection therapy. Ann Nucl Med 25:749–754

    Article  PubMed  CAS  Google Scholar 

  15. Verde G, Papini E, Pacella CM (1994) Ultrasound guided percutaneous ethanol injection in the treatment of cystic thyroid nodules. Clin Endocrinol 41:719–724

    Article  CAS  Google Scholar 

  16. Zingrillo M, Torlontano M, Chiarella R et al (1999) Percutaneous ethanol injection may be a definitive treatment for symptomatic thyroid cystic nodules not treatable by surgery: five-year follow-up study. Thyroid 9:763–767

    Article  PubMed  CAS  Google Scholar 

  17. Bennedbaek FN, Hegedüs L (2003) Treatment of recurrent thyroid cysts with ethanol: a randomized double-blind controlled trial. J Clin Endocrinol Metab 88:5773–5777

    Article  PubMed  CAS  Google Scholar 

  18. Kim YJ, Baek JH, Ha EJ et al (2012) Cystic versus predominantly cystic thyroid nodules: efficacy of ethanol ablation and analysis of related factors. Eur Radiol 22:1573–1578

    Article  PubMed  Google Scholar 

  19. Heilo A, Sigstad E, Fagerlid KH et al (2011) Efficacy of ultrasound-guided percutaneous ethanol injection treatment in patients with a limited number of metastatic cervical lymph nodes from papillary thyroid carcinoma. J Clin Endocrinol Metab 96:2750–2755

    Article  PubMed  CAS  Google Scholar 

  20. Hay ID, Lee RA, Davidge-Pitts C, Reading CC et al (2013) Long-term outcome of ultrasound-guided percutaneous ethanol ablation of selected “recurrent” neck nodal metastases in 25 patients with TNM stages III or IVA papillary thyroid carcinoma previously treated by surgery and 131I therapy. Surgery 154:1448–1454

    Article  PubMed  Google Scholar 

  21. Gharib H, Papini E, Pashke R et al (2010) American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 16(suppl 1):1–43

    Article  PubMed  Google Scholar 

  22. Cooper DS, Doherty GM, Haugen BE et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  PubMed  Google Scholar 

  23. Shin JE, Baek JH, Lee JH (2013) Radiofrequency and ethanol ablation for the treatment of recurrent thyroid cancers: current status and challenges. Curr Opin Oncol 25:14–19

    Article  PubMed  CAS  Google Scholar 

  24. Pacella CM, Bizzarri G, Guglielmi R et al (2000) Thyroid tissue: US-guided percutaneous interstitial laser ablation-a feasibility study. Radiology 217:673–677

    Google Scholar 

  25. Deandrea M, Limone P, Basso E et al (2008) US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules. Ultrasound Med Biol 34:784–791

    Article  PubMed  Google Scholar 

  26. Spiezia S, Garberoglio R, Milone F et al (2009) Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid 19:219–225

    Google Scholar 

  27. Baek JH, Kim YS, Lee D et al (2010) Benign predominantly solid thyroid nodules: prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition. Am J Roentgenol 194:1137–1142

    Article  Google Scholar 

  28. Holmer C, Lehmann KS, Knappe V et al (2011) Bipolar radiofrequency ablation for nodular thyroid disease–ex vivo and in vivo evaluation of a dose–response relationship. J Surg Res 169:234–240

    Article  PubMed  Google Scholar 

  29. Lim HK, Lee JH, Ha EJ et al (2013) Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients. Eur Radiol 23:1044–1049

    Article  PubMed  Google Scholar 

  30. Kim YS, Rhim H, Tae K et al (2006) Radiofrequency ablation of benign cold thyroid nodules: initial clinical experience. Thyroid 16:361–367

    Article  PubMed  Google Scholar 

  31. Jeong WK, Baek JH, Rhim H et al (2008) Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. Eur Radiol 18:1244–1250

    Article  PubMed  Google Scholar 

  32. Deandrea M, Kee Shong Y, Sung JY et al (2013) Radiofrequency ablation using moving-shot technique is a reproducible, effective technique for treating benign thyroid nodules. Preliminary results of an international randomized controlled study. 37th annual meeting of the European thyroid association, Leiden, 7–11 Sept

    Google Scholar 

  33. Pacella CM, Bizzarri G, Spiezia S et al (2004) Thyroid tissue: US-guided percutaneous laser thermal ablation. Radiology 232:272–280

    Article  PubMed  Google Scholar 

  34. Døssing H, Bennedbaek FN, Karstrup S et al (2002) Benign solitary solid cold thyroid nodules: US-guided interstitial laser photocoagulation–initial experience. Radiology 225:53–57

    Article  PubMed  Google Scholar 

  35. Døssing H, Bennedbaek FN, Hegedüs L (2005) Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules – a randomised study. Eur J Endocrinol 152:341–345

    Article  PubMed  Google Scholar 

  36. Amabile G, Rotondi M, De Chiara G et al (2006) Low-energy interstitial laser photocoagulation for treatment of nonfunctioning thyroid nodules: therapeutic outcome in relation to pretreatment and treatment parameters. Thyroid 16:749–755

    Article  PubMed  Google Scholar 

  37. Papini E, Rago T, Gambelunghe G et al (2014) Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules. Results of a three-year multicenter prospective randomized trial. J Clin Endocrinol Metab 99:3653–3659

    Article  PubMed  CAS  Google Scholar 

  38. Valcavi R, Riganti F, Bertani A et al (2010) Percutaneous laser ablation of cold benign thyroid nodules: a 3-year follow-up study in 122 patients. Thyroid 20:1253–1261

    Article  PubMed  CAS  Google Scholar 

  39. Baek JH, Lee JH, Valcavi R et al (2011) Thermal ablation for benign thyroid nodules: radiofrequency and laser. Korean J Radiol 12:525–540

    Article  PubMed  PubMed Central  Google Scholar 

  40. Faggiano A, Ramundo V, Assanti AP et al (2012) Thyroid nodules treated with percutaneous radiofrequency thermal ablation: a comparative study. J Clin Endocrinol Metab 97:4439–4445

    Article  PubMed  CAS  Google Scholar 

  41. Sung JY, Kim YS, Choi H et al (2011) Optimum first-line treatment technique for benign cystic thyroid nodules: ethanol ablation or radiofrequency ablation? Am J Roentgenol 196:210–214

    Article  Google Scholar 

  42. Sung JY, Baek JH, Kim KS et al (2013) Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation: a prospective randomized study. Radiology 269:293–300

    Article  PubMed  Google Scholar 

  43. Jang SW, Baek JH, Kim JK et al (2012) How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: role of radiofrequency ablation. Eur J Radiol 81:905–910

    Article  PubMed  Google Scholar 

  44. Lee JH, Kim YS, Lee D et al (2010) Radiofrequency ablation (RFA) of benign thyroid nodules in patients with incompletely resolved clinical problems after ethanol ablation (EA). World J Surg 34:1488–1493

    Article  PubMed  Google Scholar 

  45. Døssing H, Bennedbæk FN, Hegedüs L (2013) Interstitial laser photocoagulation (ILP) of benign cystic thyroid nodules–a prospective randomized trial. J Clin Endocrinol Metab 98:1213–1217

    Article  Google Scholar 

  46. Huh JY, Baek JH, Choi H et al (2012) Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session–prospective randomized study. Radiology 263:909–916

    Article  PubMed  Google Scholar 

  47. Døssing H, Bennedbaek FN, Hegedüs L (2006) Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules: one versus three treatments. Thyroid 16:763–768

    Article  PubMed  Google Scholar 

  48. Amabile G, Rotondi M, Pirali B et al (2011) Interstitial laser photocoagulation for benign thyroid nodules: time to treat large nodules. Lasers Surg Med 43:797–803

    Article  PubMed  Google Scholar 

  49. Spiezia S, Vitale G, Di Somma C et al (2003) Ultrasound-guided laser thermal ablation in the treatment of autonomous hyperfunctioning thyroid nodules and compressive nontoxic nodular goiter. Thyroid 13:941–947

    Article  PubMed  Google Scholar 

  50. Døssing H, Bennedbaek FN, Bonnema SJ et al (2007) Randomized prospective study comparing a single radioiodine dose and a single laser therapy session in autonomously functioning thyroid nodules. Eur J Endocrinol 157:95–100

    Article  PubMed  Google Scholar 

  51. Chianelli M, Bizzarri G, Todino V et al (2014) Laser ablation and 131-iodine: a 24-month pilot study of combined treatment for large toxic nodular goiter. J Clin Endocrinol Metab 99:1283–1286

    Article  Google Scholar 

  52. Baek JH, Moon WJ, Kim YS et al (2009) Radiofrequency ablation for the treatment of autonomously functioning thyroid nodules. World J Surg 33:1971–1977

    Article  PubMed  Google Scholar 

  53. Shin JH, Baek JH, Ha EJ et al (2012) Radiofrequency ablation of thyroid nodules: basic principles and clinical application. Int J Endocrinol 2012:919650

    Article  PubMed  PubMed Central  Google Scholar 

  54. Døssing H, Bennedbæk FN, Hegedüs L (2011) Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules. Eur J Endocrinol 165:123–128

    Article  PubMed  Google Scholar 

  55. Bernardi S, Dobrinja C, Fabris B et al (2014) Radiofrequency ablation compared to surgery for the treatment of benign thyroid nodules. Int J Endocrinol 2014:934595

    Article  PubMed  PubMed Central  Google Scholar 

  56. Dupuy DE, Monchik JM, Decrea C et al (2001) Radiofrequency ablation of regional recurrence from well-differentiated thyroid malignancy. Surgery 130:971–977

    Article  PubMed  CAS  Google Scholar 

  57. Monchik JM, Donatini G, Iannuccilli J et al (2006) Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma. Ann Surg 244:296–304

    Article  PubMed  PubMed Central  Google Scholar 

  58. Park KW, Shin JH, Han BK et al (2011) Inoperable symptomatic recurrent thyroid cancers: preliminary results of radiofrequency ablation. Ann Surg Oncol 18:2564–2568

    Article  PubMed  Google Scholar 

  59. Baek JH, Kim YS, Sung JY et al (2011) Locoregional control of metastatic well-differentiated thyroid cancer by ultrasound-guided radiofrequency ablation. Am J Roentgenol 197:331–336

    Article  Google Scholar 

  60. Papini E, Bizzarri G, Bianchini A et al (2013) Percutaneous ultrasound-guided laser ablation is effective for treating selected nodal metastases in papillary thyroid cancer. J Clin Endocrinol Metab 98:92–97

    Article  Google Scholar 

  61. Solbiati L, Cova L, Ierace T et al (2011) Percutaneous US-guided interstitial laser ablation of new metastatic lymph nodes in the neck from papillary thyroid carcinoma following thyroidectomy and lymphadenectomy (abstract) In: Radiological Society of North America scientific assembly and annual meeting. Radiological Society of North America, Oak Brook

    Google Scholar 

  62. Pacella CM, Papini E (2013) Image-guided percutaneous therapies for local recurrences of thyroid tumors. J Endocrinol Invest 36:61–70

    Article  PubMed  CAS  Google Scholar 

  63. Papini E, Guglielmi R, Gharib H et al (2011) Ultrasound-guided laser ablation of incidentally papillary thyroid carcinoma: a potential therapeutic approach in patients at high surgical risk. Thyroid 21:917–920

    Article  PubMed  PubMed Central  Google Scholar 

  64. Valcavi R, Piana S, Bortolan GS et al (2013) Ultrasound-guided percutaneous laser ablation of papillary thyroid microcarcinoma: a feasibility study on three cases with pathological and immunohistochemical evaluation. Thyroid 23:1578–1582

    Google Scholar 

  65. Papini E, Guglielmi R, Bizzarri G et al (2007) Treatment of benign cold thyroid nodules: a randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up. Thyroid 17:229–235

    Article  PubMed  CAS  Google Scholar 

  66. Ritz JP, Lehmann KS, Schumann T et al (2011) Effectiveness of various thermal ablation techniques for the treatment of nodular thyroid disease: comparison of laser-induced thermotherapy and bipolar radiofrequency ablation. Lasers Med Sci 26:545–552

    Article  PubMed  Google Scholar 

  67. Kovatcheva R, Vlahov JD, Stoinov J et al (2014) US-guided High-intensity focused ultrasound as a promising non-invasive method for treatment of primary hyperparathyroidism. Eur Radiol 24:2052–2058

    Article  PubMed  Google Scholar 

  68. Yue W, Wang S, Yu S et al (2014) Ultrasound-guided percutaneous microwave ablation of solitary T1N0M0 papillary thyroid microcarcinoma: initial experience. Int J Hyperthermia 30:150–157

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, “Centre for Thyroid Diseases”, A.O. Ordine Mauriziano di Torino, Via Magellano 1, Torino, 10128, Italy

    Paolo Piero Limone, Alberto Mormile, Maurilio Deandrea, Francesca Garino, Elena Gamarra & Federico Ragazzoni

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  1. Paolo Piero Limone
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  2. Alberto Mormile
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  3. Maurilio Deandrea
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  4. Francesca Garino
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  5. Elena Gamarra
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  6. Federico Ragazzoni
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Correspondence to Paolo Piero Limone .

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Editors and Affiliations

  1. Chief of Endocrine Surgery Unit, Policlinico Gemelli – CIC, Università Cattolica del Sacro Cuore, Rome, Milano, Italy

    Celestino Pio Lombardi

  2. Chief of Istituto Semeiotica Chirurgica, Chief of Endocrine and Metabolic Surgery Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy

    Rocco Bellantone

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Limone, P.P., Mormile, A., Deandrea, M., Garino, F., Gamarra, E., Ragazzoni, F. (2016). Mini-Invasive Techniques for the Treatment of Thyroid Nodules: Critical Issues. In: Lombardi, C., Bellantone, R. (eds) Minimally Invasive Therapies for Endocrine Neck Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-20065-1_9

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  • DOI: https://doi.org/10.1007/978-3-319-20065-1_9

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