Update techniques and tips of radiofrequency ablation for treating benign and malignant thyroid nodules

Update techniques and tips of

Radiofrequency ablation for treating

benign and malignant thyroid nodules

Dr. Le Thi My Thyroid center

Vinmee Times City Hopital

Thyroid center

Vinmec times city Hospital

"Established and operating fom 11/2020,

* Core teams:

«Endocrinologist

«Interventional radiologist
- surgeon (head and neck)

«Pathologist
I0ltgit.....


MIT for diagn& otrseaitmesnt

thyroid nodule

REA or thyroid lesions,

INA Biopsy, = PEL MA

egy PIMC MRecurences

CONTENTS

1, REAFOR BENIGN THYROLD NODULE: update

techniques and tip...

1, REAFOR PIMC

Indication RFA for

benign thyroid nodules

* Symptom benign thyroid nodules

neck pain, dysphasia, foreign

body sensation, discomfor,

cought.

* Cosmetic problem

* Tovic-hot nodules; Patients with Ae st FA MterdnAd 18 month after

autonomously functioning THOM! THIS fA

thyroid nodules (AFTN) causing III,IIM TIM TRỤ

Init II
TSH

II

Standard technique

* Local anesthesia

+ Ta isthmic approach

* Moving shot
* Complete US guidance

Periphery regrow or recurrence after RFA

Tee ide
tronand eon HEH),

Publi one. a

Long-Term Outcomes Following Thermal Ablation of Benign
Thyroid Noles san Alternatitvo Surgery. The Importance of
ontrol Regrowth

hg ng vn bat 98 fa9ng

pt of dit y Whi Chi erg, Kr, Au el ee Leo an fwNiHtIh lìWt n wnt

Syne fly nthe eed ttl ⁄ \\ \ À \Ị

Clie a (Wala

1Caren torn peta lt vated Rly, | \ \\ ị]
Adal rer ey oan Cig i Chap Sng, Sd tt, J | }}
lr \ J|
TE AIM a RH eo

Heed May 209 ed Ny 209A, 09 Welt — 0 N Wolk t Mobi Webi

‘Utrsonfanthgyroaidpy nal) pre rainy ablation (RF(8)A2)mon,ths pst RA, and (9
ols pos RFA. (DF) Diagrams inditchaetlel ome} ablated volume (Va) an vale volume (at
these mepoins, oh Vt decreases oer time, incrbye2aseeedn mont2hasnd 9, indicating that
pot ofthe residual vale ode tise had already begun In his cae, ationl RIA was performed month

afer aihegimage in The cnr oad bypechoariea of abate tise is indie,

ORIGINAL RESEARCH article This article is pat ofthe Research Topic
Aaoequency Aaton (FA) as. an Aermave t0 Convertor
Front, Endocrinol, Lt February
024 lwtw

See, Thyroid Endocrinology View a 14Arcs

‘naps or/10.S889/tendo 20205480

0

The Ablation of Thyroid Nodule's Afferent

Arteries Before Radiofrequency Ablation:

Preliminary Data

Chara Off’, Sara Garberoglo!, Giovanni Antone, Maria Graia

Esposito, Umberto Brancaccio’, Clavdla Miso, Edoardo D'Ambrosio,
Oona wf) Stelano Spleaa"

The Artery-Frst Ablation Technique

A patiotequency ataton © artery fstvR

Group A Group8

FA(Grou3p8)IM |W@UW }MMK Gino MN N.

followup (allow

Characteristics Population Group A Group B pale

{month volume +8 (ange) 14452 1167 (16045) 119841208104) 1800 086 (412-084) 09
{rmvoolumenvrtitonh+*SD s(ang) 47.20 1850-7425) 20670-0960) 963)26622) 0960
mnths vom +S ange 9262848 (095- 7B 0B(095-8
mons volume vration + SD (ange) (692008968) §6.H 1455 0004-7800, WUUMUỢN OBA
months von +S fang Bl 1688021 7682911 021-31) 07409474466) — 0W

mons volume varton + SD (ange) 7/04000(6/-03) JIML60/67-87) Đ:MĐWWHUM 6i
00400780) — 009

sual» Koen Ral» 19(4) ub 207 » PCSAAES?

Ñ N” Journal of Radlology

Kjonlingog

KoveanJ Raclol 2017 Jul-Aug; 184 618-623, PAVCID PMCS447037
Published oie 2017 May 19, do 10.53484.2017. 18.4615 PMID; 20670156

Thyroid Radiofrequency Ablation; Updates on Imovatve Devices and Techniques

t tyeSun Par, MD Jung Han Bak, MO, Po ut Whan Park, MO, Saw Rom Chung, MO,'Youra Jun hol MO,

© ht an un Hna, A!

3) Adhor information »Ariens» Copyigh and Lcanselnomaton scar

Advance techniques

to complete ablation zone

* Atery feeding RFA
* The marginal venous ablation technique
* Hydrodssection
* Control complication

The Artery-First Ablation Technique

‘Hypervascular nodules are resistant to heat because of

heat-sink effect > marginal recurrence is more common

‘Before RFA + evaluate feeding arteries using color
Doppler US
*Should not ablate arteries outsidthee thyroid gland fo

revent bleeding

The Artery-First Ablation Technique

The Artery-First Ablation Technique

Case 1:66 ¥0, male patiRTehont tnod,ule

ZW asculrrladye 4 =—_hotnodule F làng

Ni i of Volume ti The Artery-First Ablation Technique

Cas1:e 660, male patienRTth,ot nodule

PreeRPA PM PM Post 6M

Symptom sore } | | I

Cosmetics score 4 j 1 1

Nascularity grade 4 I Ị I

Diameter (au) 4) I 3 1

Volume (nl) lỊ IN 1 Ol

Volume reduction6 = Bi = BTh BL

ry lJ lJ It li

II lũ lÄ lũ

(Kb 185 Isl lhỊ

Case 2; 46 ¥0, Female patieRTnnotdu,le

em te
Sổ
ee ẤP
tì) //. 9 Hư ni

" Nh ata i
i ọ AY
ea

l

Ỉ v Hình. UẾU 5

1300/11/40)

The marginal venous ablation technique

«Venous staining achieved by perinodular vein ablation is also

effective in inducing venous infarction of thyroid nodules
> prevention of marginal recurrence,

- Evaluation of critical structures (the esophagus, RLN, medial

Variation of vagus nerve...) before ablation and monitoring
procedure are essential for complication-fee thyroid