2017: The Beginning of the “No Surgery” When Active Surveillance and Thyroid Ablation Can Treat Nodules Cysts and Even Some Small Cancers.
The series continues with the newest ablation method Microwave Ablation MWA.
- Water molecules are moved around billions of times causing heat (Dielectric hysteresis).
- Tissue destruction occurs with the proper amount of heat.
- Generator, power system,and an antenna. Medtronic MWA system.
- The antenna is positioned in the nodule.
- Up to 3 cm can be ablated with MWA compared to 1.5 cm with RFA.
microwaveablation of thyroid nodulesH. Korkusuz et al
Nuklearmedizin 2014; 0: ••–••DOI:10.3413/Nukmed-0631-13-10
Microwave ablation (MWA) is a new minimalinvasive method for thermal ablation of be-nign thyroid nodules. In contrast to well-es-tablished radiofrequency ablation (RFA),MWA offers several advantages with simi-larly successful results.11 patients (5 women, 6 men, averageage 62.3 years) with 18 benign thyroid nod-ules were treated. MWA was operated underlocal anesthesia with a system working in awavelength field of 902 to 928 MHz (AvecureMWG881, MedWaves, Inc. San Diego, CA).Pre- and postablative scans were controlledby two specialists in nuclear medicine withlongtime work experience.Conclusion:The preliminary data suggests that MWA is an effec-tive method to treat benign thyroid nodules.
Volume reductionUltrasound examination showed a signifi-cant decrease of nodule volume in allpatients. The mean volume reduction was6.8 ± 3.8 ml (range 2.4–11.6 ml) or 54.2 ±19.5% (range 19.9–77.3%) at the 3-monthfollow-up (p < 0.05
- Images of a thyroid nodule MWA ablation. Local on capsule Vegas nerve and Recurrent nerve located.
- Sizing the zone of destruction of the nodule and antenna in the nodule with formation of microbubbles.
- Cooling with iced saline is used.
- No grounding pads
- Ablation time is shorten with MWA over RFA.
- More difficult to deliver the heat to the nodule.
- Speed is up against safety from overheating the wrong tissue.
- The antenna size needs to be smaller to deliver heat to thyroid nodule in the small area of the neck.
- Advantages of MWA are efficient ablation, faster heating, higher temptures, and larger ablation zones.
- MWA is one of the future ways we still believe that there are more ways to reduce surgery on many more thyroid conditions that at present. MWA is being developed by Medtronic Corp.
- Microwave ablation is a relatively new technology under development and testing to treat the same types of cancer that can be treated with radiofrequency ablation. Microwave energy has several possible benefits over radiofrequency energy for tumor ablation but, because clinical microwave ablation systems are not widespread, the underlying principles and technologies may not be as familiar. The basic microwave ablation system contains many of the same components as a radiofrequency ablation system: a generator, a power distribution system, and an interstitial applicator.
Ultrasound guided MWA ablation of benign thyroid nodules: Safety and imaging follow-up in 222 patients
Microwave ablation is a minimally invasive technique that has been used to treat benign and malignant tumors of liver, lung and kidney. Towards thyroid nodules, only a few cases are reported so far. 477 benign thyroid nodules in 222 patients underwent microwave ablation in our department from July 2009 to March 2012. Microwave ablation was carried out using microwave antenna (16G) under local anesthesia.
All thyroid nodules significantly decreased in size after microwave ablation. A 6-month follow-up was achieved in 254 of 477 nodules, and the mean decrease in the volume of thyroid nodules was from 2.13 ± 4.42 ml to 0.45 ± 0.90 ml, with a mean percent decrease of 0.65 ± 0.65. A volume-reduction ratio greater than 50% was observed in 82.3% (209/254) of index nodules, and 30.7% (78/254) of index nodules disappeared 6-month after the ablation. The treatment was well tolerated and no major complications were observed except pain and transient voice changes.Microwave ablation seems to be a safe and effective technique for the treatment of benign thyroid nodules. Further prospective randomized studies are needed to define the role of the procedure in the treatment of thyroid nodules.
MWA of benign thyroid nodules: experimental and clinical studies
- Bing Feng,
- Made available online as an Accepted Preprint 23 March 2012
- © 2012 European Society of Endocrinology
MWA was performed in 11 patients (male to female ratio=1:10; mean age, 50±7 years) with 11 benign thyroid nodules.
Largest diameter decreased from 2.9±1.0 (range, 1.6–4.1) to 1.9±0.7 (range, 0.4–3.0) cm (P<0.01), and the volume decreased from 5.30±4.88 (range, 0.89–14.81) to 2.40±2.06 (range, 0.02–6.35) ml (P<0.01). The volume reduction ratio was 45.99±29.90 (range, 10.56–98.15) %. The cosmetic grading score was reduced from 3.20±0.79 to 2.30±0.95 (P<0.05). One patient experienced temporary nerve palsy and was recovered within 2 months after treatment.
Conclusion The internally cooled microwave antenna can yield ideal ablation lesions, and ultrasound-guided percutaneous MWA is a feasible technique for benign thyroid nodules.
The 14 century surgery methods have improve in 7 centuries but in the hands of a low volume surgeon complications still occur are an excessive rate compared to high volume surgeons.And if you could be treated with Ethanol, Radiofrequency, HIFU or MWA the chance of major complications approach ZERO.
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