Clinical Study Summary

Techniques and Procedure Aspects of Radiofrequency Ablation of Thyroid Nodule

Thyroid nodules are a common medical problem in the USA. While most thyroid nodules (about 85%) are benign and need follow-up, some require treatment for associated symptoms and cosmetic issues.

With technology advancement, many minimally invasive treatments have been introduced to treat thyroid nodules non-surgically under ultrasound guidance:

  • Percutaneous Ethanol Injection (PEI): recommended for cystic (fluid-filled) thyroid nodules.
  • Hyperthermic treatment: Laser Ablation and Radiofrequency Ablation (RFA) recommended for solid (tissue-filled) benign thyroid nodules.
  • Others still under investigation: high-intensity focused ultrasound (HIFU), microwaves, cryotherapy, electroporation

This article focuses on detailing the basic principles, indications, and techniques designed to optimize the thyroid RFA procedure along with its clinical results and expected potential risks.

This summary aims to extract the most relevant information from the clinical study for patient education. If you are interested inreading the full clinical study, click here.

Principle of Radiofrequency ablation

RFA burns (ablates) the targeted nodular tissue with thermal (heat) energy produced from high-frequency electric waves ranging from 200 to 1200 kHz. During the procedure, a radiofrequency generator that creates high-frequency electric waves is connected to an electrode inserted directly into the thyroid tumor, delivering energy to the targeted area.

By disturbing the tissue located within a few millimeters around the electrode, heat energy is produced to ablate the tumor tissue immediately next to the electrode, causing destruction within the area. In addition to the direct heat effect, heat conduction from the ablated area can result in relatively slower damage to the tissue further away from the electrode tip. The extent of heat created is controlled by the specialist carrying out the procedure. The efficacy of this procedure depends on the temperature used and the composition of the tissue being treated.

Indications and Patient Selection

Generally, patient selection follows the criteria laid out in the Koran Society of Thyroid Radiology (KSThR) guideline, which was first established in 2009 then further revised in 2012 and 2017. Thyroid RFA is mostly recommended for patients with benign thyroid nodules who have cosmetic concerns or symptoms.

American Thyroid Association (ATA) guidelines also recognized Radiofrequency ablation(RFA) to be performed for certain recurrent thyroid cancers for patients at high surgical risks or who refuse surgery.

Pre-Procedure Assessment

Various precautions are taken both before and after thyroid Radiofrequency ablation(RFA) to ensure safety and efficacy.

Before thyroid RFA, several assessments are performed:

  • Fine needle aspirations to confirm benign thyroid nodules. Fine needle aspiration (FNA) biopsy is a process of simply removing some cells or fluid from the affected area using a fine needle for examination under a microscope.
  • Subjective assessment of symptoms of thyroid nodules and cosmetic issues
  • Ultrasound examinations to assess characteristics of thyroid nodules and to confirm benign features of cytologically proven thyroid nodules.
  • Blood tests and laboratory tests of serum hormone levels to evaluate the success of any ablation.

During The Procedure

Thyroid
RFA can be performed at the radiology unit or in the operating room.
It is performed
under continuous ultrasound (US) monitoring to provide a clear
visualization of the thyroid nodule.

The procedure should be performed by a surgeon or a radiologist experienced with thyroid US, Fine Needle Aspiration (FNA), and RFA. Before the procedure, patients will receive local anesthesia (1-2% lidocaine hydrochloride) at the puncture site. Some surgeons prefer to perform RFA without general anesthesia for the early detection of complications. Following the treatment, patients should be kept under observation for 1-2 hours.

Follow-up

Similarly,
after the procedure, several tests need to be performed to measure
the treatment efficacy. Evaluations include:

  • Clinical
    and cosmetic symptoms of thyroid nodules
  • Complications
  • Thyroid
    nodule volume
  • Follow-up
    clinical examinations at 1, 3, 6, and 12 months and each year for up
    to 5 years.

Therapeutic success has been defined as a 50% volume reduction at 12 months. Additional treatment will be recommended if follow-up ultrasound shows a remaining viable portion of the nodule and if the patient complains of ongoing clinical or cosmetic symptoms.

Risks And Adverse Events

According
to a recent meta-analysis with 728 nodules in 715 patients, overall
and major complication rates
were 3.2% and 0.7%, respectively.

Minor
Complication
Major
Complication
Pain Voice
Change
Hematoma Nodule
Rupture
Vomiting Permanent
hypothyroidism
Skin
burns
Brachial
plexus injury
Transient
Thyroiditis

The overall incidence for voice change (transient and permanent) is 1.44%.
Incidence of voice change was higher in a patient with recurrent thyroid cancer (7.95%) than in patients with benign thyroid nodule (0.94%)

Conclusion

The study shows favorable outcomes with RFA in thyroid nodule management regarding size reduction, toxic nodule cure, and compressive symptom resolution. Future studies are needed to guide the use of this novel technique as an alternative treatment option for thyroid diseases and thyroid cancer.

Technique and Procedural Aspects of Radiofrequency Ablation of
Current Otorhinolaryngology Reports. Retrieved January 27, 2021, from
https://link.springer.com/article/10.1007/s40136-020-00321-7

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Indication
The VIVA Combo RF Ablation System and star RF Electrode are intended for use in percutaneous and intraoperative coagulation and ablation of tissue.

Contraindications
There is a risk that error may result due to the radiofrequency current on patients who have pacemakers and other active implants. Do not use the radiofrequency lesion generator and electrode on these patients.
Complications:
The following types of complications may result due to the use of the radiofrequency lesion generator and electrode.
– Tumor recurrence
– Burn due to the over-heating of the the surgical equipment
– Dangerous situation due to the unskilled equipment control
– Cross-infection or complications due to the re-use of the inappropriate electrode
– Ascites/diarrhea
– Bleeding of the coagulated part
– Ventricular fibrillation
– Weakness of liver functions
– Symptoms after RFA treatment includes (abdominal) pain, fever, nausea, headache, right shoulder joint pain and chest discomfort might occur

Physician Finder

You are taking a big step by exploring your treatment options. You are not alone. Many other people were searching for the same answers too. Many of these individuals chose RFA.