Radiofrequency (RF) ablation
In radiofrequency (RF) ablation, an alternate current is given to the target tissue via a needle. This electricity current moves the ions to and fro and causes friction that produces heat and destroys the cells. RF is one of the oldest ablation techniques in medicine. In the past, it has been extensively used for the treatment of liver, lung, kidney and bone tumors in cancer patients. It can thus be used for the ablation of thyroid cancer metastases to the liver and lung.
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In the benign thyroid nodules, RF ablation was first reported by Dr Kim in 2006, and since then, it has been successfully used by many other investigators especially in Asia. Many studies performed in thousands of patients report that RF ablation is very successful in the treatment of benign thyroid nodules. After RF ablation, like laser, the nodules become smaller, cosmesis is improved and the complaints such as hoarseness, shortness of breath and swallowing difficulty improve or disappear completely.
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How to perform RF ablation?
First, an ultrasound examination is done and the nodule(s) to be ablated are visualized. Then, local anesthetic is injected into the skin and the RF needle is placed into the nodule under ultrasound guidance. After the RF machine is activated, heat is produced at the tip of the needle. By moving the RF needle continuously in different directions (moving shot technique), the whole nodule is destroyed completely with RF energy. After the procedure, the RF needle is removed and the patient may be discharged one hour later.
Which thyroid nodules are suitable for RF ablation?
Like laser, RF ablation destroys the tumor by heating. Although it is a well-known ablation technique in other organs, it has been used in the thyroid only in the last decade. In the thyroid, RF ablation is indicated for the treatment of solid or predominantly solid benign nodules. Like laser and alcohol, it has also been successful in the ablation of recurrent lymph node metastases of papillary carcinoma, and in one study, it was found to be equally successful but also safer than surgery.
What are the advantages of RF ablation?
In RF, the needle is slightly thicker than those used in alcohol and laser ablations. It can be done under local anesthesia and conscious sedation. Like other ablations, it creates no scar on the skin. After the procedure, the patients may go home following one hour observation. Complication rates are very low as in laser and alcohol ablations.
In our patient with a 57x50x49 mm solid nodule in the right lobe, the nodule was treated with percutaneous radiofrequency ablation under ultrasound guidance. The 6 months and 1 year ultrasound examinations demonstrated 60% and 90% volumetric reduction respectively.
In our patient with a single, large (53x45x47 mm) solid nodule in the istmus, percutaneous radiofrequency ablation was done to treat the nodule. The six months control ultrasound examination showed over 80% volume reduction of the treated thyroid nodule.
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