J Surg Ultrasound.  2023 May;10(1):14-23. 10.46268/jsu.2023.10.1.14.

Ultrasound (US)-Guided Ablation of Thyroid Nodules

• Kim BS

• KMID: 2552569
• DOI: http://doi.org/10.46268/jsu.2023.10.1.14

Abstract

The conventional treatment of symptomatic benign thyroid nodules is surgical excision under general anesthesia. Ultrasound-guided ablation of thyroid nodules has emerged as an alternative to surgery for symptomatic benign thyroid nodules. The procedure can be performed on an outpatient basis and has a low complication rate. Cystic thyroid nodules can be effectively managed with percutaneous ethanol injections and solid thyroid nodules can be treated using thermal ablation, such as radiofrequency ablation (RFA), laser ablation (LA), high intensity focus ultrasound (HIFU), and microwave ablation. Ethanol injections use a chemical reaction and thermal ablation uses heat injury to cause the cells to break down and the nodule to shrink. In recent years, RFA is available for achieving local control of recurrences of papillary thyroid carcinoma in patients who are poor candidates for general anesthesia. RFA and LA are the most commonly used techniques. HIFU and microwave ablation are newer techniques and should be considered experimental due to insufficient evidence regarding their utility.

Keyword

Thyroid nodule; Ablation; Ethanol; Radiofrequency; Laser

Figure

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  Fig. 1 Ethanol injection is effective against cyst. (A) A complex nodule (arrow) was observed in the right thyroid prior to ethanol injection. (B) Cystic content was aspirated using a 24 G needle. (C) Ethanol was injected into the nodule using the same needle. (D) Three months after the ethanol injection, the cystic content disa-ppear-ed, leaving only the solid portion (arrow).

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  Fig. 2 Tumescent injection through a needle (arrow) can create a safe distance between major organs and thyroid nodules.

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  Fig. 3 Radiofrequency ablation (RFA) is effective against solid no-dules. (A) A heterogeneous nodule was observed in the right thyroid before the RFA procedure (arrow). (B) During RFA, hyperechoic lesions were shown around the tip of the needle due to air bubbles. (C) Imme-diately after the RFA, the nodule changed to a heterogeneous lesion. (D) One year after the RFA, the nodule (arrow) had shrunk.

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  Fig. 4 Laser ablation is similar to radiofrequency ablation in that both use heat. (A) A nodule was observed in the left thyroid before laser ablation (arrow). (B) After the ablation, the nodule changed to a heterogeneous lesion. (C) Three months after the ablation, the nodule had shrunk. (D) One year after the ablation, the nodule (arrow) had shrunk even more.

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  Fig. 5 High-intensity focused ultrasound (HIFU) is a non-invasive ablation method that uses a skin contact method instead of a needle puncture, unlike other methods such as ethanol, radiofrequency, laser, and microwave ablation.

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  Fig. 6 There are differences in the heating generation mechanism between radiofrequency and microwave ablation. (A) Radiofrequency causes ionic agitation through alternating current. (B) Microwave causes oscillation and friction of water molecules.

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  Fig. 7 (A) Radiofrequency ablation uses a circuit system. (B) Microwave ablation uses an antenna system without a grounding pad.

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