Detailed RFA Ablation Procedure for Benign Thyroid Nodules and Recurrent Thyroid Cancers:
Consensus Statement and Recommendations from Korean Society of Thyroid Radiology
1.We recommend that RF ablation be performed using a ‘trans-isthmic approach’ and a ‘moving shot technique’ under local anesthesia because these techniques are useful for the safe and effective RF ablation procedure
Local injection of the thyroid gland capsule
. A modified, straight, internally cooled electrode is suitable for use in the moving shot technique.
2. Physicians should monitor blood pressure, pulse rate and the voice of each patient by regular conversations during the procedure.
3.If a voice change is suspected, the physician should stop the procedure immediately.
4. Although pain was found to be the most common complaints during RF ablation, it was relieved rapidly when the generator output was reduced or turned off.
5. Painkillers and sedatives can relieve pain during the ablation, but we do not recommend the painkillers or sedatives during the ablation because the early detection of complications is impossible in patients under deep sedation, which disturbs communication.
6. Ultrasound monitoring is important for detecting hemorrhage. If a hematoma is too large or pain is too severe due to hemorrhage, manual compression may be helpful, allowing the procedure to continue.
7. Hematomas usually disappear completely within 2 weeks. When a large hematoma develops, the RF procedure should be delayed for 1-2 weeks .
8. Patient condition should be monitored after the procedure. Patients with severe pain, edema, skin burn, vomiting, dyspnea, or voice change should be continuously monitored. The decision to admit a patient should be at the discretion of each physician.
9.During the follow-up periods, painkillers and steroids can be used to relieve symptoms.
10. Color-Doppler US is a primary imaging modality during follow-up.
11. In addition, patients can be monitored by CT, MRI, thyroid scans, and thyroid function tests.
12. Color-Doppler US is useful for detecting any undertreated or regrowing portion of the ablated nodules.
13. We recommend that patients be followed-up at 1-2, 6 and 12 months after RF ablation, as well as every 6-12 months thereafter, depending on the status of the treated nodules.
14. Additional treatments may be indicated in patients with incompletely resolved clinical concerns or if a viable growing portion of the nodule is detected on US.