Advances in ultrasound-guided thermal ablation for symptomatic benign thyroid nodules

Abstract

Benign thyroid nodules (BTNs), which account for 85-95% of all thyroid nodules (TNs), are a common clinical issue and have been increasingly detected over the last 2 decades due to the widespread use of ultrasound (US) imaging. The clinical treatment for BTNs is mainly focused on patients with nodular growth or clinical problems, either cosmetic or symptom-related. Percutaneous thermal ablation (TA) under US guidance has increasingly become a satisfactorily minimally invasive alternative to surgery for patients with symptomatic BTNs, especially for those in nonsurgical candidates, surgically high-risk individuals or patients refusing surgery. Based on the available English-language literature, the brief principles, procedures and clinical outcomes of 4 TA techniques, including laser ablation therapy (LAT), radiofrequency ablation (RFA), microwave ablation (MWA), and high-intensity focused ultrasound (HIFU) in the treatment of BTNs were retrospectively reviewed in this article. Good curative efficacy and clinical safety were noted in the published reports of the 4 TA techniques in the treatment of BTNs, with nodular volume reduction ratios of 46-93.5%, significant improvement in symptomatic and cosmetic problems, and euthyroid preservation for most patients. The conclusion is that all 4 TA techniques can be safe and effective treatment for patients with symptomatic BTNs; RFA seems to be the best because of the highest nodular volume reduction ratio (VRR) at follow-up. Furthermore, the image fusion navigation technique will play an important role through assisting in precise ablation for BTNs.

Keywords: ablation; thyroid nodule; ultrasonography.