How do you Treat Someone with a benign nodule with RFA?

How do you Treat Someone with a benign nodule with RFA?

How do you Treat Someone with a benign nodule with RFA?

Image of a benign symptomatic thyroid nodule for RFA treatemtn
RF ablation can be used to treat both benign thyroid nodules
and inoperable, recurrent thyroid cancers located in the
surgical bed as well as lymph nodes [14–28]. Indications
for RF ablation of benign thyroid nodules are nodulerelated
clinical problems such as symptoms, for example,
neck pain, dysphasia, foreign body sensation, discomfort,
and cough, cosmetic problems, or thyrotoxicosis in cases
of autonomously functioning thyroid nodules (AFTNs)
[29]. The Korean Society of Thyroid Radiology does not
recommend thyroid RF ablation for follicular neoplasms or
primary thyroid cancers because there is no evidence of
a treatment benefit by RF ablation in follicular neoplasms
or primary thyroid cancers [17, 29, 30]. Caution should
be taken with regard to the use of thyroid RF ablation in
pregnant women, patients with serious heart problems, and
those with contralateral vocal cord palsy [29].
According to the 2012 consensus statement and recommendations
of the Korean Society of Thyroid Radiology
[29], at least two separate US-guided fine needle aspirations
and/or core needle biopsies are necessary to confirm the
benign nature of a nodule [31, 32], and caution should
be taken when performing RF ablation of nodules with
malignant US features even when there are benign results
seen on fine needle aspiration or core needle biopsy [33–36].
US examination is important for characterizing a nodule and
to evaluate the surrounding anatomical structures [1]. The
size, shape, margin, proportion of solid/cystic components,
echogenicity, calcification, internal vascularity, and extracapsular
invasion of each nodule should be evaluated [1]. Three
orthogonal nodule diameters, including the largest diameter,
should be measured by US, and the nodule volume could
be calculated using the equation: V = πabc/6, where V is
the volume, a is the maximum diameter, and b and c are the
other two perpendicular diameters.
Laboratory tests usually include a complete blood
count, a blood coagulation battery, and measurements of
thyrotrophin, thyroid hormones, thyroid autoantibodies,
and calcitonin. If any serum concentrations are abnormal,
RF ablation should be performed only after performing
procedures to correct these abnormal test results [29].
99mTc pertechnetate scintigraphy can be used to differentiate
cold nodules from AFTNs, especially in patients showing
decreased serum thyrotrophin concentrations.
Prior to treatment of recurrent thyroid cancers, tumor
recurrence should be confirmed by positive US-guided fine
needle aspiration cytology and measurements of the washout
thyroglobulin (Tg) concentration [29]. US examination is
important in order to evaluate the size and characteristics of a
recurrent tumor as well as the critical surrounding anatomic
structures. A neck CT may be used when appropriate for the
evaluation of a recurrent tumor prior to RF ablation [29].

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