Radiofrequency Ablation For Small Thyroid Cancer: Possible Alternative to Active Surveillance for Those Who Are Anxious about Leaving a Cancer Untreated

Radiofrequency Ablation For Small Thyroid Cancer: Possible Alternative to Active Surveillance for Those Who Are Anxious about Leaving a Cancer Untreated

Radiofrequency Ablation For Small Thyroid Cancer: Possible Alternative to Active Surveillance for Those Who Are Anxious about Leaving a Cancer Untreated

Radiofrequency Ablation For Small Thyroid Cancers: Possible Alternative to Active Surveillance for Those Who Are Anxious about Leaving a Cancer Untreated.

Radiofrequency ablation of small follicular neoplasms: initial clinical outcomes

International Journal of Hyperthermia

 Pages 1-7 | Received 09 Mar 2017, Accepted 12 May 2017, Published online: 25 May 2017

Background: In thyroid gland, radiofrequency ablation (RFA) has been applied to both recurrent cancers and benign nodules, although, according to the American Thyroid Association (ATA) and the Korean Society of Thyroid Radiology (KSThR) guidelines, surgery is the first-line treatment for follicular neoplasm. However, it has been argued that follicular neoplasm with lower risk of malignancy can be managed by close follow-up. In this study, we evaluated the effectiveness of RFA of small follicular neoplasms, examining reductions in volume and related clinical problems, and making observations over long-term follow-up.

Methods: We evaluated 10 follicular neoplasms in 10 patients who were treated with RF ablation between 2009 and 2011. A RF generator and the Korean ThyroidRF Mini-Probe 18-gauge internally cooled electrode were used to perform complete ablation of the whole nodules. Changes in nodules or ablated zones on follow-up ultrasound, and complications during and after RF ablation were evaluated.

 

Korean physician using the Thyroid RF Mini-Probe.

 

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The lower probe is the skinny ThyroidRF Mini-probe used  in this study from Korea.

 

The neck is a small confined space and a small bore and short probe length are ideal for thyroid work.

The probe is from StarMed Korea.

star-rf-electrode_1

Results: The mean follow-up period was 66.4 ± 5.1 months (range: 60–76 months). In eight patients, single session of RF ablation was sufficient, while two patients required two sessions. There was a significant reduction in the mean volume (99.5 ± 1.0%) of lesions, with eight ablated lesions (8/10, 80%) disappearing completely on follow-up. No recurrences were found in any ablated zones at last follow-up. Transient mild neck pain (n = 6) occurred during the procedure without requiring any medication.

8/10 the lesions were completely ablated as in this image above.

Conclusion: In addition to active surveillance, RF ablation may be an effective and safe alternative for the management of patients with small (<2 cm) follicular neoplasm suspected on thyroid biopsy and who strongly refuse surgery.

Comments:  8/10 follicular neoplasms disappeared completely. 10/10 No recurrences in the areas after 60-76 months. No complication in 10/10 .Mild neck pain only during the RFA session.Only 8/10 needed one session 2/10 needed 2. When patients refuse surgery for any reason or have other diseases making surgery risky, this may be used in place of active surveillance in small < 2 cm lesions.

Richard B. Guttler MD,FACE,ECNU

www.thyroid.com

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