Thyroid No Surgery 2107 Ethanol Ablation PEI and Radiofrequency Ablation RFA are Ready for Prime Time.
The advent of ultrasound-guided ablation techniques in nodular thyroid disease: towards a patient-tailored approach.
Best Pract Res Clin Endocrinol Metab. 2014 Aug;28(4):601-18.
Comments: Recent research from Mayo clinic and Asan Medical center in Korea have shown good results with both ethanol and RFA ablation of primary micro-papillary thyroid cancer as a third arm of treatment options with surgery, and Active surveillance
Richard Guttler MD,FACE,ECNU
My notes on this paper are below.
1. Surgery is the long-established therapeutic option for benign thyroid nodules, which steadily grow and become symptomatic.
2. The cost of thyroid surgery, the risk of temporary or permanent complications, and the effect on quality of life, however, remain relevant concerns.
3. Therefore, various minimally invasive treatments, directed towards office-based management of symptomatic nodules, without requiring general anaesthesia, and with negligible damage to the skin and cervical tissues, have been proposed during the past two decades.
4.Ultrasound-guided percutaneous ethanol injection PEI and thermal ablation radiofrequency RFA have been thoroughly evaluated, and are accessible procedures in specialized centres.
5. In clinical practice, relapsing thyroid cysts are effectively managed with percutaneous ethanol injection PEI treatment, which should be considered therapy of choice.
6.In solid non-functioning thyroid nodules that grow or become symptomatic, trained operators may safely induce, with a single session of treatment with radiofrequency ablation RFA, a 50% volume decrease and, in parallel, improve local symptoms.
7. Hyperfunctioning nodules remain best treated with radioactive iodine. The patients who refuse surgery or radioiodine can be treated with RFA but can expect it to not be a permanent solution but can give the patient time to think again about RAI or surgery.
8.Currently, minimally invasive treatment is also used for achieving local control of small size neck recurrences of papillary thyroid carcinoma, and saving the expense and pain and suffering of another neck dissection.