To condemn RFA for primary thyroid papillary thyroid cancer based on one case is self serving to promote their agenda with robotic surgery. The error was in not doing the FNA first. The use of RFA and Ethanol for small micro-papillary thyroid cancer as a third arm along with surgery, Active surveillance and now Tumor ablation methods PEI, and RFA.
Mayo Clinic’s Ian Hay has shown ethanol ablation can ablate small micro-papillary cancers at the World Thyroid Cancer congress this year in Boston. DR.JH Baek has done similar studies with radiofrequency ablation.
Richard Guttler MD,FACE, ECNU
J.Cancer Research and Therapeutics
Primary papillary thyroid carcinoma previously treated incompletely with radiofrequency ablation
Hoon Yub Kim,et al
|Date of Web Publication||29-Nov-2010|
|Figure 1: The preoperative US shows a 1.6-cm-sized, taller than wide, hypoechoic nodule with multiple echogenic spots, suggesting microcalcifications, in the mid-lateral aspect of right lobe of thyroid gland (arrow)|
|Figure 2: In the operation, mild adhesion of sternothyroid muscle with antero-lateral surface of mid-portion of the right lobe, which turned out to be the surface of the radiofrequency-ablated nodule (white arrow), was observed|
|Figure 3: Scan power view (original magnification ×12.5) of pathological thyroid specimen (a) exhibits partial effect of ablation therapy on papillary carcinoma (black arrow heads). Low-power view (b, original magnification ×40) and high-power view (c, original magnification ×400) of the portion of the tumor under the radiofrequency ablation effect show dense infiltration of macrophages and multinucleated giant cells after the destruction of cancer cells, which was not observed in the low-power view (d, original magnification ×40) and high-power view (e, original magnification ×400) of the portion of the tumor out of the ablation effect, thus with the viable cancer cells|
Recently RFA has been applied to benign thyroid nodules because it can reduce the volume of the nodules by inducing focal coagulative necrosis. Kim et al.  reported their initial experience of RFA for benign thyroid nodules, and showed that the residual volume after thyroid RFA was approximately 11.8% at the 9- to 18.5-month follow-up. Jeong et al.  reported that volume reduction ratio after the RFA greater than 50% was observed in 91.06% of nodules, and 27.81% of index nodules were disappeared at the 1- to 41-month follow-up.
Nowadays, RFA therapies for this cosmetic purpose are widely performed in local outpatient clinics in Korea. The Korea Thyroid Association recommends doctors to confirm the diagnosis of benign at least twice by FNAC before performing the RFA for thyroid nodules.
But in this case, RFA was mal-performed with the FNAC at the same time, in other words, without confirmation of the diagnosis. But fortunately histological examination revealed papillary carcinoma later, and the patient could undergo radical thyroid surgery using the da Vinci; surgical system with acceptable cosmetic results.
So in conclusion, RFA for the operable primary thyroid malignancy should be avoided, because of the possibility of the remnant viable cancer portion and the undetectable nodal metastasis.
In addition, robotic or endoscopic thyroid surgery may be a feasible operative method for benign or malignant thyroid nodules previously treated with RFA.
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