Elsevier

Surgery

Volume 130, Issue 6, December 2001, Pages 971-977
Surgery

American Association of Endocrine Surgeons
Radiofrequency ablation of regional recurrence from well-differentiated thyroid malignancy*

Presented at the 22nd Annual Meeting of the American Association of Endocrine Surgeons, Atlanta, Ga, April 28-May 1, 2001.
https://doi.org/10.1067/msy.2001.118708Get rights and content

Abstract

Background. Regional recurrence of well-differentiated thyroid cancer (WTC) is primarily detected with ultrasonography (US), and current treatment is surgical. Radiofrequency ablation (RFA) has been used primarily for liver tumors as an alternative to a surgical procedure. We have applied RFA to a group of patients with locally recurrent WTC. Methods. Eight patients underwent percutaneous RFA for biopsy-proven recurrent WTC in the neck (mean size, 2.4 cm; range, 0.8-4.0 cm) while under intravenous conscious sedation and with US guidance. The RF electrode was inserted into the site of recurrence and treated with the maximum allowable current for between 2 and 12 minutes. Follow-up consisted of US in 8 patients, thyroglobulin levels in 6 patients, biopsy in 4 patients, and surgical treatment in 2 patients. Results. All 8 patients with no bleeding or infectious complications were treated as outpatients. A minor skin burn and 1 vocal cord paralysis occurred. No recurrent disease at the treatment site was detected, with a mean follow-up of 10.3 months. Histological examination showed no evidence of a tumor in the treated lymph nodes in 6 patients. Follow-up US examinations showed disappearance of previously detected color Doppler flow, as well as mass shrinkage and internal cystic change, or both. Conclusions. US-guided RFA is an exciting new treatment modality that appears to have a future role in treating locally recurrent WTC. (Surgery 2001;130:971-7.)

Section snippets

Patients and methods

Eight adult patients (age range, 43-86 years; mean, 59 years), 5 women and 3 men, underwent percutaneous RFA for biopsy-proven recurrent well-differentiated thyroid cancer in the neck. All patients signed an informed written consent and were determined to be without risk of bleeding, with a normal platelet count and normal coagulation parameters. The clinical information regarding the histological findings of tumor size and location is summarized in Table I.

. Clinical data of patients

PatientSexAge

Results

All 8 patients tolerated the RFA procedure to completion. One patient experienced hoarseness immediately after the RFA procedure. The RFA procedure in this patient was for recurrent papillary carcinoma in the central compartment after a previous total thyroidectomy. This RFA treatment most likely resulted in injury to the recurrent laryngeal nerve. The hoarseness improved after 2 months, but it did not completely resolve. A 5-mm skin burn developed in 1 patient at the RF electrode entry site as

Discussion

Percutaneous image-guided ablative therapies that use thermal energy sources, such as RF, have received much recent attention as minimally invasive strategies to treat neoplasms. Possible advantages of ablative therapies compared with surgical resection are their anticipated reduced morbidity and mortality, low cost, suitability for real-time image guidance, and ability to perform ablative procedures on outpatients. RF-induced tissue coagulation has been used in early clinical trials for the

Discussion

Dr Ian Hay (Rochester, Minn). As an endocrinologist dealing with papillary thyroid cancer patients with recurrent nodes daily, I am excited by this potential new application of RFA to selected patients who have this relatively frequent problem.

I wanted to let this Society know that this very afternoon in Seattle, my radiology colleagues are reporting to the annual American Radium Society meeting our experience over the past 8 years of treating 14 papillary thyroid cancer patients with another

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*

Reprint requests: Damian E. Dupuy, MD, Department of Diagnostic Imaging, Brown Medical School, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903.

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