Thyroid RF of Benign Nodules 101:Risk Assessment and Hydrodissection Technique for Radiofrequency Ablation of Thyroid Benign Nodules.
Example of a thyroid nodule too close to a danger structure that was separated from it by injecting dextrose between them (Arrows). Now the RF electrode can safely ablate the nodule with less chance of complications.
- Risk of complications and the use of dextrose to move danger structures away from the intended target nodule.
- Study listed looked at 382 patients, 188 patients underwent ablation with risk assessment and the corresponding preventive measures before ablation with dextrose. 194 without as control.
- Both group had equal risk scores .
- The complication in very high risk nodules was avoided in the group of patients with risk assessment and preventive measures before ablation.
- It is a very safe and effective way to carry out radiofrequency ablation after pre-treatment of thyroid nodules by dextrose hydrodissection technique according to risk assessment.
- It will provide clinicians with greater help in the ablation treatment of thyroid nodules, a and improve the safety of the thyroid ablation.
- I use this technique in my cases and in my Master’s class teaching on phantoms.
- In clinical practice, the difficulty and risk of the ablation were significantly different because of the location and the adjacent structures of the nodules, even if they owned the same size.
- RF ablation of thyroid nodules ignoring these differences, the risk of the ablation and the postoperative complication occurrence rate might be increased.
- The adjacent structures, such as recurrent laryngeal nerve, anterior cervical muscles, trachea, esophagus, common carotid artery, internal jugular vein, parathyroid glands, cervical sympathetic trunk and vagus nerve, might be thermally damaged during thermal ablation.
- Risk grades: 0. low risk: Nodules located in the thyroid and the distance between nodule edge and adjacent important structures was ≥ 2 mm.
- Grade 1 median risk :The distance between nodule edge and carotid sheath,anterior cervical muscles or cervical posterior muscles was less than 2 mm.
- .Grade 2, high risk: The distance between nodule edge and trachea, esophagus,or recurrent laryngeal nerve was less than 2 mm.
- Grade 3 very high risk: This type of nodules located within 2mm around the recurrent laryngeal nerve, trachea, or esophagus (<2mm), while the distance to carotid sheath, anterior cervical muscles or cervical posterior muscles was also less than 2mm.
- Using sterile syringe, sterile water was injected between the thyroid nodules and surrounding tissues, until the nodules and surrounding tissues were completely separated.
- In summary, it is a very safe and effective way to carry out radiofrequency ablation after targeted preconditioning of thyroid nodules by hydrodissection techniqueaccording to risk assessment based on zoning and risk grading of nodules.
- Complete ablation can be achieved and with low or no postoperative complications.
- Call me at 310-393-8860 or [email protected] for details of thyroid RF treatment.
Journal of Cancer 2018, Vol. 9 http://www.jcancer.org3058JJoouurrnnaallooffCCaanncceerr2018; 9(17): 3058-3066. doi: 10.7150/jca.26060Research
Tang Xiaoyin et al