Journal of Diagnostics Concepts & Practice >

2024 , Vol. 23 >Issue 04: 424 - 429

DOI: https://doi.org/10.16150/j.1671-2870.2024.04.011

Review article

Advances in the study of indications for thermal ablation therapy of thyroid nodules

  • YANG Yixuan ,
  • ZHOU Jianqiao
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  • Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2024-01-13

  Accepted date: 2024-07-04

  Online published: 2024-08-25

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Abstract

Thyroid nodules, a common endocrine tumor, have shown a significant increase in incidence globally. The total incidence rate of thyroid nodules worldwide is about 25% from 2000 to 2022, of which the incidence of malignant thyroid nodules is 4.0% to 6.5%. In recent years, the application of thermal ablation technology in the treatment of thyroid nodules has been steadily increasing, with broader indications and fewer contraindications. Thermal ablation techniques have been widely applied in the treatment of benign thyroid nodules. Studies have demonstrated that radiofrequency ablation (RFA) and microwave ablation (MWA) significantly reduce nodule volume and alleviate symptoms. For retrosternal thyroid nodules, the post-treatment volume reduction rate exceeds 90%. For calcified benign nodules, a five-year follow-up showed an average volume reduction rate of 92.95%. Studies on follicular tumors indicated that more than half of the nodules achieved a 90%-volume reduction one year after thermal ablation, with a low incidence of complications in the treatment group. In the treatment of malignant thyroid tumors, thermal ablation has shown promising results in T1aN0M0 solitary low-risk papillary thyroid microcarcinoma (PTMC), with a disease progression rate as low as 3.6%. For T1bN0M0-T2N0M0 primary solitary papillary thyroid carcinoma (PTC), the prognosis following thermal ablation is comparable to surgery, with a lower incidence of complications. In patients with multifocal PTC, the success rate of thermal ablation was 100%, with a low rate of local tumor progression during follow-up. For PTMC located in the isthmus, adjacent to the trachea, or close to the thyroid capsule, thermal ablation demonstrated similar efficacy to surgery, with lower rates of complications and recurrence. This review summarizes the current indications of thermal ablation technology in the treatment of thyroid nodules and provides a reference for clinical applications.

Key words： Thyroid nodules; Thermal ablation; Ultrasound intervention; Indications

Cite this article

YANG Yixuan , ZHOU Jianqiao . Advances in the study of indications for thermal ablation therapy of thyroid nodules[J]. Journal of Diagnostics Concepts & Practice, 2024 , 23(04) : 424 -429 . DOI: 10.16150/j.1671-2870.2024.04.011

References

[1] MU C, MING X, TIAN Y, et al. Mapping global epidemio-logy of thyroid nodules among general population: A systematic review and meta-analysis[J]. Front Oncol, 2022, 12:1029926.
[2] TAMHANE S, GHARIB H. Thyroid nodule update on diagnosis and management[J]. Clin Diabetes Endocrinol, 2016, 2:17.
[3] CABANILLAS M E, MCFADDEN D G, DURANTE C. Thyroid cancer[J]. Lancet, 2016, 388(10061):2783-2795.
[4] GOLDBERG S N. Radiofrequency tumor ablation: principles and techniques[J]. Eur J Ultrasound, 2001, 13(2):129-147.
[5] DONG B, LIANG P, YU X, et al. Percutaneous sonographically guided microwave coagulation therapy for hepatocellular carcinoma: results in 234 patients[J]. AJR Am J Roentgenol, 2003, 180(6):1547-1555.
[6] GOLDBERG S N, MALLERY S, GAZELLE G S, et al. EUS-guided radiofrequency ablation in the pancreas: results in a porcine model[J]. Gastrointest Endosc, 1999, 50(3):392-401.
[7] YU J, LIANG P, YU X L, et al. US-guided percutaneous microwave ablation versus open radical nephrectomy for small renal cell carcinoma: intermediate-term results[J]. Radiology, 2014, 270(3):880-887.
[8] YANG Y, ZHANG J, HAN Z Y, et al. Ultrasound-guided percutaneous microwave ablation for submucosal uterine fibroids[J]. J Minim Invasive Gynecol, 2014, 21(3):436-441.
[9] YANG X, YE X, ZHENG A, et al. Percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: clinical evaluation of 47 cases[J]. J Surg Oncol, 2014, 110(6):758-763.
[10] NA D G, LEE J H, JUNG S L, et al. Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations[J]. Korean J Radiol, 2012, 13(2):117-125.
[11] GARBEROGLIO R, ALIBERTI C, APPETECCHIA M, et al. Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement[J]. J Ultrasound, 2015, 18(4):423-430.
[12] KIM J H, BAEK J H, LIM H K, et al. 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology[J]. Korean J Radiol, 2018, 19(4):632-655.
[13] 中国医师协会甲状腺肿瘤消融治疗技术专家组, 中国抗癌协会甲状腺癌专业委员会, 中国医师协会介入医师分会超声介入专业委员会, 等. 甲状腺良性结节、微小癌及颈部转移性淋巴结热消融治疗专家共识(2018版)[J]. 中国肿瘤, 2018, 27(10):768-773.
  Thyroid Tumor Ablation Experts Group of Chinese Medical Doctor Association, Chinese Association of Thyroid Oncology, Interventional Ultrasound Committee of Chinese College of Interventionalists, et al. Expert consensus on thermal ablation for thyroid benign nodes, microcarcinoma and metastatic cervical lymph nodes(2018 edition)[J]. Chin Cancer, 2018, 27(10):768-773.
[14] ZHOU J, YIN L, WEI X, et al. 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS[J]. Endocrine. 2020; 70(2):256-279.
[15] ORLOFF L A, NOEL J E, STACK B C JR, et al. Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association[J]. Head Neck, 2022, 44(3):633-660.
[16] ZHANG L, ZHOU W, ZHOU J Q, et al. 2022 Expert consensus on the use of laser ablation for papillary thyroid microcarcinoma[J]. Int J Hyperthermia, 2022, 39(1):1254-1263.
[17] JUNG S L, BAEK J H, LEE J H, et al. Efficacy and safety of radiofrequency ablation for benign thyroid nodules: a prospective multicenter study[J]. Korean J Radiol, 2018, 19(1):167-174.
[18] ORLANDI D, VIGLINO U, DEDONE G, et al. US-CT fusion-guided percutaneous radiofrequency ablation of large substernal benign thyroid nodules[J]. Int J Hyperthermia, 2022, 39(1):847-854.
[19] LI Y, HE H, LI W, et al. Efficacy and safety of radiofrequency ablation for calcified benign thyroid nodules: results of over 5 years' follow-up[J]. BMC Med Imaging, 2022, 22(1):75.
[20] GRANI G, LAMARTINA L, DURANTE C, et al. Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management[J]. Lancet Diabetes Endocrinol, 2018, 6(6):500-514.
[21] DANIELS G H. Follicular Thyroid Carcinoma: A Perspective. Thyroid. 2018; 28(10):1229-1242.
[22] LIN W C, TUNG Y C, CHANG Y H, et al. Radiofrequency ablation for treatment of thyroid follicular neoplasm with low SUV in PET/CT study[J]. Int J Hyperthermia, 2021, 38(1):963-969.
[23] HA S M, SUNG J Y, BAEK J H, et al. Radiofrequency ablation of small follicular neoplasms: initial clinical outcomes[J]. Int J Hyperthermia, 2017, 33(8):931-937.
[24] DONG Y, ZHAN W, ZHOU J, et al. Volume reduction rate of radiofrequency ablation in ≤ 2 cm Bethesda IV thyroid nodules[J]. Eur Radiol, 2024, 34(3):1597-1604.
[25] LI X, LAN Y, LI N, et al. Ultrasound-guided thermal ablation of bethesda Ⅳ thyroid nodules: a pilot study[J]. Front Endocrinol (Lausanne), 2021, 12:674970.
[26] YAN L, LIU Y, LI W, et al. Long-term outcomes of ultrasound-guided thermal ablation for the treatment of solitary low-risk papillary thyroid microcarcinoma: a multicenter retrospective study[J]. Ann Surg, 2023, 277(5):846-853.
[27] KIM H J, CHO S J, BAEK J H. Comparison of thermal ablation and surgery for low-risk papillary thyroid microcarcinoma: a systematic review and meta-analysis[J]. Korean J Radiol, 2021, 22(10):1730-1741.
[28] LAN Y, LUO Y, ZHANG M, et al. Quality of life in papillary thyroid microcarcinoma patients undergoing radiofrequency ablation or surgery: a comparative study[J]. Front Endocrinol (Lausanne), 2020, 11:249.
[29] TONG M, WANG L, GAI Z, et al. Clinical outcomes of radiofrequency ablation for solitary T1aN0M0 versus T1bN0M0 papillary thyroid carcinoma: a propensity-matched cohort study[J]. Int J Hyperthermia, 2023, 40(1):2257908.
[30] XIAO J, ZHANG M, ZHANG Y, et al. Efficacy and safety of ultrasonography-guided radiofrequency ablation for the treatment of T1bN0M0 papillary thyroid carcinoma: a retrospective study[J]. Int J Hyperthermia, 2020, 37(1):392-398.
[31] XIAO J, ZHANG Y, ZHANG M, et al. Ultrasonography-guided radiofrequency ablation for the treatment of T2N0M0 papillary thyroid carcinoma: a preliminary study[J]. Int J Hyperthermia, 2021, 38(1):402-408.
[32] YAN L, ZHANG M, SONG Q, et al. The efficacy and safety of radiofrequency ablation for bilateral papillary thyroid microcarcinoma[J]. Front Endocrinol (Lausanne), 2021, 12:663636.
[33] ZHOU H D, YU X Y, WEI Y, et al. A clinical study on microwave ablation of multifocal (≤ 3) T1N0M0 papillary thyroid carcinoma[J]. Eur Radiol, 2023, 33(6):4034-4041.
[34] SONG Q, GAO H, REN L, et al. Radiofrequency ablation versus total thyroidectomy in patients with papillary thyroid microcarcinoma located in the isthmus: a retrospective cohort study[J]. Int J Hyperthermia, 2021, 38(1):708-714.
[35] ZHENG L, LIU F Y, YU J, et al. Thermal ablation for papillary thyroid microcarcinoma located in the isthmus: a study with 3 years of follow-up[J]. Future Oncol, 2022, 18(4):471-480.
[36] JING H, YAN L, XIAO J, et al. Radiofrequency ablation for papillary thyroid microcarcinoma with a trachea-adjacent versus trachea-distant location[J]. Int J Hyperthermia, 2024, 41(1):2270671.
[37] JING H, YAN L, XIAO J, et al. Radiofrequency ablation for capsular-located versus noncapsular-located papillary thyroid microcarcinoma: a propensity score matching study of 1095 patients[J]. Eur Radiol, 2024, 34(7):4716-4726.
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