THYROID THERMAL ABLATION TECHNIQUES - PRINCIPLES
Thermal energy sources such as laser ablation (LA) or radiofrequency ablation (RFA) make the destruction of benign thyroid nodules possible without surgical removal. The potential advantages of in situ tumor ablation include decreased costs, reduced morbidity, the possibility of performing procedures on outpatients, and the possibility of treating patients who are poor candidates for surgery because of age, comorbidity, or extent of disease. The main disadvantages of in situ ablation procedures, instead, concern the difficulty of evaluating the extent of disease and, rarely, of the irreversible tissue damage induced by image-guided thermal ablation.
Indications and Limitations
Currently available ultrasound-guided minimally invasive procedures can induce a rapid, clinically significant long-term size reduction of benign thyroid nodules with minimal risks. Ethanol injection should preferentially be considered as the first-line treatment for relapsing thyroid cysts. The thermo-ablative techniques, instead, may be used as an alternative to surgery in patients with solid or partially cystic benign thyroid nodules causing aesthetic problems or compressive symptoms, achieving a significant volume reduction. Less appropriate indications are large nodular goiters, multinodular thyroid disease, or deeply positioned lesions.