Keywords:
Interventional non-vascular, Thyroid / Parathyroids, Ultrasound, Ablation procedures, Neoplasia
Authors:
J. M. Escudero Fernandez, A. Antón Jiménez, E. A. Moraru, A. C. Montealegre Angarita, G. Aranda Velazquez, G. Cuatrecasas Cambra, A. Ortiz Zuñiga, G. Obiols Alfonso, X. Serres Creixams; Barcelona/ES
DOI:
10.26044/ecr2019/C-2666
Aims and objectives
Benign thyroid nodules are very common,
but their treatment is mainly justified if they become symptomatic or cause cosmetic alterations.
Until a few years ago,
surgery was the only treatment available,
but radiofrequency ablation (RFA) and ethanol ablation (EA) guided by ultrasonography appeared as safe and effective alternatives (1,
2).
These techniques increased the number of indications,
including significant growth during follow-up and patients that refuse surgical treatment or with surgical risk (2),
but also it can be used in patients with difficult management of post-surgical hypothyroidism,
because of decompensation of cardiac failure or malabsorption of levothyroxine.
RFA is contraindicated so far in malignant nodules although several articles favor its usefulness or in benign nodules with endothoracic growth (2)
RFA achieves volume reduction rates of approximately 50% at 6 months and 80% at 12 months,
although a non-negligible variability is observed between studies (51-92% at 12 months) (2).
Operator experience is one of the main causal factors for this variability.
RFA uses high-frequency alternating current produced by a radiofrequency generator oscillating in a closed loop circuit.
This current heats the tissue around the needle to over 60ºC,
which causes coagulative necrosis and irreversible damage into the surrounding tissue.
During the procedure the needle is internally cooled.
EA results are similar to RFA's in predominantly cystic nodules (solid part <10-20%) (3).
The procedure consists in the slow injection of absolute ethanol (99%) after aspiration of intracystic fluid.
The introduction of RFA entailed the re-emergence of EA since their combination allows the treatment of mixed solid-cystic nodules.
Objectives:
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To describe the technique of RFA under ultrasonographic guidance,
highlighting clues for better results.
-
To describe nodule and patient characteristics suitable to RFA and predictors of success.
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To analyze results and complications of RFA in a tertiary-level healthcare hospital.
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To enumerate other applications of this technique.