Journal of Thyroid Cancer

Journal of Thyroid Cancer

Journal of Thyroid Cancer

Current Issue Volume No: 1 Issue No: 2

Editorial  Open Access Available online freely Peer Reviewed Citation

Image Guided Ablations for Thyroid Tumours

1Division of Breast Radiology, European Institute of Oncology IRCCS, Milan, Italy, European Institute of Oncology IEO, IRCCS, Via Giuseppe Ripamonti, 435 - 20141 Milano MI, Italy

2Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy, Università degli Studi di Milano, Via Festa del Perdono, 7 - 20122 Milano MI, Italy

3Division of Interventional Radiology, European Institute of Oncology IRCCS, Milan, Italy, European Institute of Oncology IEO, IRCCS, Via Giuseppe Ripamonti, 435 - 20141 Milano MI, Italy.


Image guided ablations might be regarded as a promising effective and safe alternative for treatment of recurrent thyroid cancer in particular in patients with high surgical risk or refusing surgery. Furthermore, image guided ablations seems to represent a promising alternative to surgery or observation for micropapillary thyroid carcinoma, with the aim of providing an effective treatment with minimal invasiveness. Further studies are necessary to confirm the role in this setting

Author Contributions
Received 11 Feb 2019; Accepted 12 Feb 2019; Published 16 Feb 2019;

Academic Editor: Manas Sahoo, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

Checked for plagiarism: Yes

Review by: Single-blind

Copyright ©  2019 Luca Nicosia, et al.

Creative Commons License     This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing interests

The authors have declared that no competing interests exist.


Luca Nicosia, Federica Ferrari, Giovanni Mauri, Franco Orsi (2019) Image Guided Ablations for Thyroid Tumours. Journal of Thyroid Cancer - 1(2):16-20.

Download as RIS, BibTeX, Text (Include abstract )

DOI 10.14302/issn.2574-4496.jtc-19-2657


Thyroid nodules are a very frequent condition in general population, with a prevalence ranging between 20% and 76% 1. The large majority of these nodules are benign and casually discovered. Thyroid cancer instead is relative infrequent, representing around 1–5% of all cancers in females and less than 2% in males 2. Benign thyroid nodules generally do not require medical or surgical treatments, unless they can cause symptoms, like discomfort, dyspnea, hoarseness or cosmetic concerns 3, 4, or if they produce active hormone 5. Until now, the standard treatment of benign nodules of thyroid is still represented by thyroidectomy (total or partial) 4, 5, 6 which, however, remain a major surgical procedure, with correlated morbidity and potential complications ranging between 2.5% and 8.1% 7.

In order to reduce the invasiveness of treatment, in the past years image guided ablations have been successfully applied in the treatment of benign thyroid nodules to obtain a meaningful reduction in nodule’s size and consequent improvement of related symptoms 8, 13. Image guided ablations have been reported to provide excellent results in benign nodules with minimal invasiveness, so that has been proposed as a potential first choice option for the treatment of benign thyroid nodules 14.

More recently, image guided ablations have also been applied in the treatment of thyroid malignancies, both for primary cancer and for recurrent or metastatic disease 15, 21. The role of image guided ablations in this setting is still limited and debated, but could be an interesting additional treatment in the multidisciplinary approach to thyroid cancer patients. The two most widely used techniques in the treatment of benign and malignant thyroid disease are radiofrequency ablation (RFA) and laser ablation (LA) 22, 23, 24, while microwave ablation (MWA) is emerging as a promising technique.

RFA still represent one of the most widely used ablative technique in the interventional field, being applied for the treatment of several kind of tumors in different organs 25, 26, 27, 28. RFA has been successfully applied in the treatment of recurrent thyroid cancers in patients considered at high surgical risk or refusing surgery. In this setting RFA has been reported to have an elevated technical success, with a significant reduction in serum thyroglobulin, as reported by a recent systematic-review and meta-analysis 29. In the treatment of small recurrences (< 2 cm) Kim et al 30 reported a similar 1- and 3- year recurrence free survival when comparing RFA (96.0% and 92.6%, respectively) and surgical reoperation (92.2% and 92.2%, respectively). Recently, the detection of small indolent papillary thyroid carcinoma has increased, without a consequent increase in thyroid cancer mortality, highlighting how those tumors might only have been overdiagnosed. Thus, some authors even proposed not to treat small micropapillary thyroid tumors, which have a very low risk, but only to follow them up, in order to avoid the invasiveness of a surgical treatment and to spare the thyroid function. A different approach would be to minimize the invasiveness of the treatment, thus providing a cure for the patient, but avoiding the drawbacks of surgery. In this scenario image-guided ablations seems to offer a promising therapeutic alternative. Thus, some ablative techniques, such as RFA, has also been applied in the treatment of papillary thyroid microcarcinomas 31. Zhang and colleagues reported on the application of RFA in 92 patients with micropapillary thyroid carcinomas, and found a significant volumetric reduction of the treated nodules over time, with no residual tumor at core-needle biopsy nor recurrences during follow-up 31. Also, no major complications occurred in their series.

Laser ablation uses the smallest applicators among various ablative techniques and represent a very interesting ablative method particularly in reason of its low invasiveness and high precision, which can provide some advantages in a highly complex anatomical region such the neck 32, 33, 34, 35. Laser ablation has also been one of the first techniques used for thyroid thermal ablation, and its use has been reported in the treatment of benign, hyperfunctioning, and malignant thyroid diseases 34, 36, 37, 38, 39, 40. Furthermore, safety of laser ablation has been described in several studies, with a low number of major complications. In a multicenter study performed by Pacella et al 41 on 1,837 treatments, an overall complication rate of 0.9% was reported. Our group applied laser ablation in the treatment of patients with metastatic nodes from papillary thyroid carcinoma, with promising results and a limited number of minor complications 34, 42.

In 2011 Papini 18 performed laser ablation on incidental papillary thyroid microcarcinoma diagnosed in a patient unsuitable for surgery; during follow-up by ultrasound-guided fine-needle aspiration biopsy and core-needle biopsy performed 12 months after treatment no neoplastic cells were discovered. Valcavi et al. 19 reported a series of three patients with a single papillary thyroid microcarcinomas: in all cases, there was no evidence of residual neoplastic tissue. Zhang et al reported 64 patients with papillary thyroid microcarcinoma treated with laser ablation, with a mean largest diameter reduction from 4.6 ± 1.5 to 0.6 ± 1.3 mm (p < 0.0.5), and the average volume reduction from 41.0 ± 40.4 mm3 to 1.8 ± 6.7 mm3 (p < 0.0.5). They also highlighted the potential role of contrast-enhanced ultrasound in the assessment of completeness of treatment, as two patients required treatment completion after CEUS was performed 43, 44. So, despite the actual evidences are limited, image-guided ablations seems to be a promising treatment strategy for small papillary thyroid cancers, holding the potential of compensating for image-guided deriving overdiagnosis 45.

In conclusion, image guided ablations might be regarded as a promising effective and safe alternative for treatment of recurrent thyroid cancer in particular in patients with high surgical risk or refusing surgery. Furthermore, image guided ablations seems to represent a promising alternative to surgery or observation for micropapillary thyroid carcinoma, with the aim of providing an effective treatment with minimal invasiveness. Further studies are necessary to confirm the role in this setting.


  1. 1.Kilfoy B A, Zheng T, Holford T R, Han X, Ward M H et al. (2009) . International atterns and Thrends in thyroid cancer incidence,1973-2002. Cancer Cuases Control 20, 525-531.
  1. 2.Li M H, Liu J T. (2018) Screening of benign and malignant thyroid nodules in 5 196 physical examination population. Zhonghua Zhong Liu Za Zhi. 40, 151-154.
  1. 3.Papini E, Gugliemi R, Pacella C M. (2016) Laser radiofrequency, and ethanol ablation for the management of thyroid nodules. , Curr Opin Endocrinol Diabetes Obes 23, 400-406.
  1. 5.Papini E, Guglielmi R, Bizzarri G, Pacella C M. (2004) Ultrasound-guided laser thermal ablation for treatment of benign thyroid nodules. , Endocr Pract 10, 276-283.
  1. 6.Tamhane S, Gharib H. (2016) Thyroid nodule update on diagnosis and management. Clin diabetes Endocrinol. 2-17.
  1. 7.Durante C, Grani G, Lamartina L, Filetti S, Mandel S J et al.. (2018).The Diagnosis and Management of Thyroid Nodules: A Review. JAMA 319: 914-924.
  1. 8.Spiezia S, Garberoglio R, Milone F, Ramundo V, Caiazzo C et al. (2009) Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. , Thyroid 19, 219-25.
  1. 9.Che Y, Jin S, Shi C, Wang L, Zhang X et al. (2015) Treatment of Benign Thyroid Nodules: Comparison of Surgery with Radiofrequency Ablation. , Am J Neuroradiol 36, 1321-1325.
  1. 10.Jeong W K, Baek J H, Rhim H, Kim Y S, Kwak M S et al. (2008) Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. , Eur Radiol 18, 1244-50.
  1. 11.Mainini A P, Monaco C, Pescatori L C, C De Angelis, Sardanelli F et al. (2017) Image-guided thermal ablation of benign thyroid nodules. , J Ultrasound 20, 11-22.
  1. 12.Pacella C M, Bizzarri G, Spiezia S, Bianchini A, Guglielmini R et al. (2004) Thyroid tissue: US-guided percutaneous laser thermal ablation. , Radiology 232, 272-80.
  1. 13.Achille G, Zizzi S, E Di Stasio, Grammatica A, Grammatica L. (2016) Ultrasound-guided percutaneous laser ablation in treating symptomatic solid benign thyroid nodules: Our experience in 45 patients. Head Neck. 38, 677-682.
  1. 14.Mauri G, Sconfienza L M. (2016) Percutaneous ablation holds the potential to substitute for surgery as first choice treatment for symptomatic benign thyroid nodules. , Int J Hyperth. Nov22 1-2.
  1. 15.Jeong S Y, Baek J H, Choi Y J, Lee J H. (2017) Ethanol and thermal ablation for malignant thyroid tumours. , Int J Hyperth 1-8.
  1. 16.Mauri G, Cova L, Tondolo T, Ierace T, Baroli A et al. (2013) Percutaneous laser ablation of metastatic lymph nodes in the neck from papillary thyroid carcinoma: preliminary results. , J Clin Endocrinol Metab 98, 1203-7.
  1. 17.Papini E, Bizzarri G, Bianchini A, Valle D, Misischi I et al. (2013) Percutaneous ultrasound-guided laser ablation is effective for treating selected nodal metastases in papillary thyroid cancer. , J Clin Endocrinol Metab 98, 92-7.
  1. 18.Papini E, Guglielmi R, Gharib H, Misischi I, Graziano F et al. (2011) Ultrasound-guided laser ablation of incidental papillary thyroid microcarcinoma: a potential therapeutic approach in patients at surgical risk. , Thyroid 21, 917-20.
  1. 19.Valcavi R, Piana S, Bortolan G S, Lai R, Barbieri V et al. (2013) Ultrasound-guided percutaneous laser ablation of papillary thyroid microcarcinoma: a feasibility study on three cases with pathological and immunohistochemical evaluation. Thyroid. 23, 1578-82.
  1. 20.Baek J H, Kim Y S, Sung J Y, Choi H, Lee J H. (2011) Locoregional control of metastatic well- differentiated thyroid cancer by ultrasound-guided radiofrequency ablation. , AJR Am J Roentgenol 197, 331-6.
  1. 21.Chung S R, Suh C H, Baek J H, Park H S, Choi Y J et al. (2017) Safety of Radiofrequency Ablation of Benign Thyroid Nodules and Recurrent Thyroid Cancers: A Systematic Review and Meta- Analysis. , Int J Hyperth 1-35.
  1. 22.Kim J-H, Baek J H, Lim H K, Hs Ahn, Baek S M et al. (2018) Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology. , Korean J Radiol 19, 632-655.
  1. 23.Mauri G, Pisani Mainini A, Monaco C, Pescatori L C, C De Angelis et al. (2018) Urgent need to apply a common language in image-guided thermal ablations. , J 21(1), 77-78.
  1. 24.Mauri G, Cova L, Monaco C G, Sconfienza L M, Corbetta S et al. (2017) Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA). , Int J Hyperth 33, 295-299.
  1. 25.Zampino M G, Magni E, Ravenda P S. (2016) Treatments for colorectal liver metastases: A new focus on a familiar concept. Crit Rev Oncol Hematol. 108, 154-163.
  1. 26.Mauri G, Sconfienza L M, Pescatori L C. (2017) Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis. , Eur Radiol 27(8).
  1. 27.Mauri G, Nicosia L, Varano G M. (2017) Tips and tricks for a safe and effective image-guided percutaneous renal tumour ablation. Insights Imaging.
  1. 28.Mauri G, Porazzi E, Cova L. (2014) Intraprocedural contrast-enhanced ultrasound (CEUS) in liver percutaneous radiofrequency ablation: clinical impact and health technology assessment. Insights Imaging. 5(2), 209-216.
  1. 29.Suh C H, Baek J H, Choi Y J, Lee J H. (2016) Efficacy and Safety of Radiofrequency and Ethanol Ablation for Treating Locally Recurrent Thyroid Cancer: A Systematic Review and Meta-Analysis. , Thyroid 26(3), 420-428.
  1. 30.Kim J, Yoo W S, Park Y J. (2015) Efficacy and Safety of Radiofrequency Ablation for Treatment of Locally Recurrent Thyroid Cancers Smaller than 2 cm. , Radiology 276(3), 909-918.
  1. 31.Zhang M, Luo Y, Zhang Y, Tang J. (2016) Efficacy and Safety of Ultrasound-Guided Radiofrequency Ablation for Treating Low-Risk Papillary Thyroid Microcarcinoma: A Prospective Study. , Thyroid 26(11), 1581-1587.
  1. 32.Pacella C M, Francica G, Di Lascio FML, Arienti V, Antico E et al. (2009) Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis. , J Clin Oncol 27, 2615-21.
  1. 33.Tombesi P, F Di Vece, Sartori S. (2015) Laser ablation for hepatic metastases from neuroendocrine tumors. , AJR Am J Roentgenol 204-732.
  1. 34.Mauri G, Cova L, Ierace T, Baroli A, E Di Mauro et al. (2016) Treatment of Metastatic Lymph Nodes in the Neck from Papillary Thyroid Carcinoma with Percutaneous Laser Ablation. Cardiovasc Intervent Radiol. 39(7), 1023-30.
  1. 35.Sartori S, Mauri G, Tombesi P, F Di Vece, Bianchi L et al. (2018) Ultrasound-guided percutaneous laser ablation is safe and effective in the treatment of small renal tumors in patients at increased bleeding risk. Int J Hyperth Off J Eur Soc Hyperthermic Oncol North Am Hyperth Gr,1–7 .
  1. 36.Pacella C M, Bizzarri G, Guglielmi R, Anelli V, Bianchini A et al. (2000) Thyroid Tissue: US-guided Percutaneous Interstitial Laser Ablation—A Feasibility Study. , Radiology 217, 673-677.
  1. 37.Chianelli M, Bizzarri G, Todino V, Minischi L, Bianchini A et al. (2014) Laser ablation and 131-iodine: a 24-month pilot study of combined treatment for large toxic nodular goiter. , J Clin Endocrinol Metab 99, 1283-6.
  1. 38.Gambelunghe G, Stefanetti E, Colella R, Monacelli M, Avenia N et al. (2018) A single session of laser ablation for toxic thyroid nodules: three-year follow-up results. , Int J Hyperth 1-5.
  1. 39.Amabile G, Rotondi M, Pirali B, Dionisio R, Agozzino L et al. (2011) Interstitial laser photocoagulation for benign thyroid nodules: Time to treat large nodules. Lasers Surg Med. 43, 797-803.
  1. 40.Papini E, Rago T, Gambelunghe G, Valcavi R, Bizzarri G et al. (2014) Long- term Efficacy of Ultrasound-Guided Laser Ablation for Benign Solid Thyroid Nodules. Results of a Three-Year Multicenter Prospective Randomized Trial. , J Clin Endocrinol Metab 99, 3653-3659.
  1. 41.Pacella C M, Mauri G, Achille G, Barbaro D, Bizzarri G et al. (2015) Outcomes and Risk Factors for Complications of Laser Ablation for Thyroid Nodules: A Multicenter Study on 1531 Patients. , J Clin Endocrinol Metab 100, 3903-3910.
  1. 42.Mauri G, Cova L, Tondolo T. (2013) Percutaneous laser ablation of metastatic lymph nodes in the neck from papillary thyroid carcinoma: preliminary results. J Clin Endocrinol Metab.
  1. 43.Zhang L, Zhou W, Zhan W, Peng Y, Jiang S et al. (2018) Percutaneous Laser Ablation of Unifocal Papillary Thyroid Microcarcinoma: Utility of Conventional Ultrasound and Contrast-Enhanced Ultrasound in Assessing Local Therapeutic Response. , World J Surg 42(8), 2476-2484.
  1. 44.Ma S, Zhou P, Wu X, Tian S, Zhao Y. (2016) Detection of the Single-Session Complete Ablation Rate by Contrast-Enhanced Ultrasound during Ultrasound-Guided Laser Ablation for Benign Thyroid Nodules: A Prospective Study. Biomed Res Int. 9565364.
  1. 45.Mauri G, Sconfienza L M. (2017) Image-guided thermal ablation might be a way to compensate for image deriving cancer overdiagnosis. , Int J Hyperth 33(4), 489-490.

Cited by (1)

  1. 1.Yang Huaxiang, Wu Yanjun, Luo Jie, Yang Xiaoliang, Yan Jing, 2019, Lever-elevating vs. liquid-isolating maneuvers during microwave ablation of high-risk benign thyroid nodules: a prospective single-center study, International Journal of Hyperthermia, 36(1), 1238, 10.1080/02656736.2019.1690711