title: The advent of ultrasound-guided ablation techniques in nodular thyroid disease: towards a patient-tailored approach.
abstract: Surgery is the long-established therapeutic option for benign thyroid nodules, which steadily grow and become symptomatic. The cost of thyroid surgery, the risk of temporary or permanent complications, and the effect on quality of life, however, remain relevant concerns. 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. Today, ultrasound-guided percutaneous ethanol injection and thermal ablation with laser or radiofrequency have been thoroughly evaluated, and are accessible procedures in specialized centres. In clinical practice, relapsing thyroid cysts are effectively managed with percutaneous ethanol injection treatment, which should be considered therapy of choice. In solid non-functioning thyroid nodules that grow or become symptomatic, trained operators may safely induce, with a single session of laser ablation treatment or radiofrequency ablation, a 50% volume decrease and, in parallel, improve local symptoms. In contrast, hyperfunctioning nodules remain best treated with radioactive iodine, which results in a better control of hyperthyroidism, also in the long-term, and fewer side-effects. Currently, minimally invasive treatment is also investigated for achieving local control of small size neck recurrences of papillary thyroid carcinoma in patients who are poor candidates for repeat cervical lymph node dissection. This particular use should still be considered experimental.
authors.affiliation: Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy. Electronic address: papinie@gmail.com.
authors.forename: Enrico
authors.initials: E
authors.lastname: Papini
authors.affiliation: Department of Diagnostic Imaging, Ospedale Regina Apostolorum, Albano, Rome, Italy.
authors.forename: Claudio M
authors.initials: CM
authors.lastname: Pacella
authors.affiliation: Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Misischi
authors.affiliation: Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Guglielmi
authors.affiliation: Department of Diagnostic Imaging, Ospedale Regina Apostolorum, Albano, Rome, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Bizzarri
authors.affiliation: Department of ENT Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Døssing
authors.affiliation: Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Hegedus
mesh_terms: D006301:Health Services Needs and Demand; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D018802:Patient-Centered Care; D057285:Precision Medicine / Q000295:instrumentation / Q000379:methods / Q000639:trends*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods / Q000639:trends; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000601:surgery*; D013965:Thyroidectomy / Q000295:instrumentation / Q000379:methods / Q000639:trends*; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods* / Q000639:trends
keywords: laser ablation; lymph node metastases; minimally-invasive procedures; percutaneous ethanol injection; radiofrequency ablation; thyroid nodule