In the last years,
the experiences gained in the treatment of benign thyroid nodules through image-guided percutaneous thermal ablation have been reported with encouraging results,
so that currently,
these treatments (such as microwave ablation,
laser ablation or radiofrequency ablation),
are often proposed as first-choice for patients with symptomatic benign thyroid nodules.
Good results have been obtained with radiofrequency (RFA) and laser ablation (LA).
Volumetric reduction is obteined both after ablative procedure,
with similar results:
- RFA (47-84% at 3-6 months / 93% at 1 year),
- LA (37-81% at 3-6 months / 82% at 1 year).
In particular,
LA shows a slightly higher efficacy in the treatment of big solid nodules (volume greater than 30 ml),
while RFA appears more effective in the treatment of small and medium-sized benign thyroid nodules,
in a smaller number of treatment sessions,
by using an energy about ten times greater,
without major side effects (Fig.1).
Both had been demonstrating having similarly reproducibility,
safety and equally effectiveness in the treatment of benign thyroid nodules,
if performed by operators with the same experience.
Moreover,
in the last years,
the use of CEUS (contrast harmonic imaging technique) had improved the efficacy of minimally invasive percutaneous tumor ablation treatments,
since it allows to detect and characterize focal lesions by assessing their microvascularization with a second generation contrast material,
thus improving a better definition of the nodule’s volume,
in different phases of the ablation treatment:
from planning (to a better identification and definition of the target lesion)to follow-up (above all in defining the volume of the ablated area).
In particular it is helpfull immediately after ablation,
to better depict the effectivness and completeness of the treatment (Fig.2).
Its intraoperative use,
shows an immediate visualization of the results,
allowing residual vital tissue ablation in real time.