AUTHOR=Yao Zhicheng , Wu Tao , Zheng Bowen , Tan Lei , Lian Yufan , Liu Bo , Ren Jie 

TITLE=A Novel Strategy for Single-Session Ultrasound-Guided Radiofrequency Ablation of Large Benign Thyroid Nodules: A Pilot Cohort Study

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 11 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.560508

DOI=10.3389/fendo.2020.560508

ISSN=1664-2392

ABSTRACT=Background: Ultrasound-guided radiofrequency ablation (RFA) of thyroid nodules (TNs) is a minimally invasive procedure that has been widely used to induce a volume reduction of symptomatic solid benign thyroid nodules (TNs). The goal of this study was to investigate a novel therapeutic approach of single-session ablation for large thyroid nodules (LTNs, Vol>20ml).
Methods: We performed a pilot cohort study of 21 patients with LTNs (Vol>20ml), who accept the ultrasound-guided RFA for symptomatic solid benign thyroid nodules during September 2018 to November 2019. RF ablation was performed by using an 18-gauge internally cooled electrode with ultrasonographic guidance in single-session combined with intraoperative hydro-dissection and immediately CEUS as strategy for safety and effect. Nodule volume was evaluated before ablation and at 1, 3, and 6 months after initial ablation, and all patients were asked to assess the cosmetic score (1-4 scores) and symptom score (0-10 scores) before ablation and every follow up after ablation.
Results: At 6-month follow-up, there was significant nodule volume reduction, from 27.49 mL ± 7.9 (standard deviation) to 3.82 mL ± 5.02 (P = 0.001), Cosmetic signs (P = 0.001) and pressure symptoms (P = 0.001) were significantly improved. All patients underwent RFA without any major complications, only very few patients got the voice change (2/21), however which resume within one month. Almost a half of patients received an additional RFA (11/21) to reach a totally ablation effect base on the intraoperative immediately CEUS evaluation.
Conclusion: RFA is effective for treating LTNs (Vol>20ml) and controlling clinical symptoms with a low complication rate. Patients were satisfied with cosmetic signs and pressure symptoms improvement. The intraoperative hydro-dissection and immediately CEUS can be a novel therapeutic approach of single-session ablation for LTNs.