Although ethanol ablation has been successfully used to treat cystic thyroid nodules, this procedure is less effective when the thyroid nodules are solid. Radiofrequency (RF) ablation, a newer procedure used to treat malignant liver tumors, has been valuable in the treatment of benign thyroid nodules regardless of the extent of the solid component. This article reviews the basic physics, techniques, applications, results, and complications of thyroid RF ablation, in comparison to laser ablation.
*Catheter Ablation/methods ; Humans ; *Laser Therapy/methods ; Thyroid Nodule/*surgery/ultrasonography

OBJECTIVETo evaluate the efficacy and the limitation of ultrasound-guided core-needle biopsy, ultrasound-guided core-needle aspiration and ultrasound-guided fine-needle aspiration in micro-nodules of thyroid.

METHODSA retrospective was performed in 92 patients with suspectable malignent micro-nodules in thyroid. Of them, 52 patients underwent US-CNB and US-FNA and 40 patients underwent US-CNA and US-FNA. The diagnoses for the micro-nodules were identified by histopathlogical examination after surgery.

RESULTAmong 52 cases with both US-CNB and US-FNA, 41 got nondiagnostic US-CNB and 11 cases successfully got the correct diagnoses of US-CNB; 6 cases got the incorrect diagnosis of US-FNA and 46 cases got the correct diagnosis of US-FNA. Of 40 cases with US-CNA and US-FNA, unsatisfactory specimen of US-CNA occurred in 14 cases and satisfactory specimen of US-CNA were got in 26 cases; unsatisfactory specimen of US-FNA occurred in 4 cases and satisfactory specimen of US-FNA. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US-FNA in 92 cases for the diagnosis of malignancy were 93.4%, 86.7%, 97.3%, 72.2% and 92.3%, respectively.

CONCLUSIONSUS-FNA is the most valuable method for the diagnosis of suspectable malignent micro-nodules in thyroid before operation.

Biopsy, Fine-Needle ; methods ; Biopsy, Needle ; Humans ; Needles ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Neoplasms ; Thyroid Nodule ; diagnostic imaging ; surgery ; Ultrasonography

OBJECTIVE: To seek for the ultrasound (US) findings of partially cystic thyroid nodules that are associated with malignancy. MATERIALS AND METHODS: We reviewed the US characteristics of 22 surgically confirmed partially cystic papillary carcinomas, and compared them with those of 80 benign partially cystic nodules. The review cases were selected in a random order from a total of 1029 partially cystic nodules that were diagnosed with an US-guided fine needle aspiration biopsy over a period of 8 years (June 2003 to October 2010) at our institution. RESULTS: In partially cystic thyroid nodules, a taller-than-wide shape (100%, p < 0.001) and spiculated or microlobulated margin (58.3%, p = 0.003) were significantly associated with malignancy. In terms of internal solid portion of the nodule, eccentric configuration (68.0%, p < 0.001), non-smooth margin (81.3%, p < 0.001), hypoechogenecity (30.0%, p < 0.042), and microcalcification (89.5%, p < 0.001) were more frequently demonstrated in malignant nodules than benign ones. CONCLUSION: In partially cystic thyroid nodules, understanding the characteristics of US findings is important to make a precise diagnosis of malignant nodules.
Adolescent ; Adult ; Aged ; Biopsy, Fine-Needle ; Carcinoma, Papillary/pathology/surgery/*ultrasonography ; Case-Control Studies ; Chi-Square Distribution ; Cysts/pathology/surgery/*ultrasonography ; Female ; Humans ; Male ; Middle Aged ; Statistics, Nonparametric ; Thyroid Neoplasms/pathology/surgery/*ultrasonography ; Thyroid Nodule/pathology/surgery/*ultrasonography

Objective: To evaluate the effect of ultrasound diagnosis of thyroid micro-malignant nodules and accumulate practical experience for the management of active surveillance for them, so as to avoid overtreatment. Methods: A total of 949 patients who were diagnosed with thyroid malignant nodules using ultrasonography, with the nodules being less than 1 cm in size and without regional lymph node metastasis or distant metastasis, were included. They were treated by the same surgeon of the Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from February 2014 to December 2020. 112 patients chose immediate surgery. The rest patients were asked to accept ultrasound examination every 6 months to 1 year. Follow-up endpoints: tumor size growth of 3 mm, tumor volume increase greater than 50%, lymph node metastasis or distant metastasis. Results: The median follow-up time was 19 months. 713 patients underwent surveillance for more than 6 months. Of the 713 patients, 570 (79.9%) were women, with mean age at 43.5 years old. Tumor progression was observed in 47 (6.6%) patients with a cumulative incidence of 2.7% (1 year), 7.2% (2 years) and 9.5% (3 years). In multivariate analysis, patient age [HR=0.508, 95%CI: 0.275-0.939, P=0.031], lesion number [HR=2.945, 95%CI: 1.593-5.444, P=0.001] and tumor size [HR=2.245, 95%CI: 1.202-4.192, P=0.011] at the beginning of observation were independent risk factors for tumor progression in patients with minimal thyroid malignant nodules during follow-up. During a median (range) active surveillance of 19 (6-80) months, 74 patients chose surgery during the surveillance. Among the 186 patients who underwent surgery, only 3 patients were diagnosed with fibrotic nodules in pathology, while the rest were papillary thyroid carcinoma. The ultrasound accuracy reached 98.4%(183/186). Conclusions: Ultrasonography is an effective method of diagnosing malignant thyroid nodules. Thyroid micro-malignant nodules progress slowly. As a result, it is safe to observe them instead of taking immediate surgery. Patient age, lesion number and tumor size at the beginning of observation are independent risk factors for the tumor progression of malignant nodules.
Humans ; Female ; Adult ; Male ; Thyroid Nodule/surgery* ; Carcinoma, Papillary/surgery* ; Lymphatic Metastasis ; Thyroid Neoplasms/surgery* ; Thyroidectomy/methods* ; Watchful Waiting ; Ultrasonography ; Retrospective Studies

The importance of routine neck ultrasonography for the detection of unsuspected local or nodal recurrence of thyroid cancer following thyroidectomy (with or without neck dissection) is well documented in many journal articles and international guidelines. Herein, we present a pictorial summary of the sonographic features of benign and malignant central neck compartment nodules and cervical lymph nodes via a series of high-quality ultrasonographic images, with a review of the literature.
Female ; Humans ; Male ; Neck ; diagnostic imaging ; surgery ; Neck Dissection ; Singapore ; Thyroid Neoplasms ; diagnostic imaging ; surgery ; Thyroid Nodule ; diagnostic imaging ; Thyroidectomy ; methods ; Ultrasonography

OBJECTIVETo evaluate the method, safety and short-term efficacy of ultrasound-guided percutaneous laser ablation (PLA) for benign solid thyroid nodule (BSTN).

METHODSThe treatment group consisting of 12 patients with single BSTN were treated with ultrasound-guided PLA. After treatment, the size and blood flow signals in conventional ultrasonography, the ablation extent of lesions in contrast-enhanced ultrasonography (CEUS), and the related complications and thyroid function were assessed in comparison with the the baseline. A control group including 12 untreated patients with single BSTN was followed-up in the same manner as in the treatment group.

RESULTSIn the treatment group, all the 12 patients completed the treatment successfully. During the follow-up, the volume of the nodules was reduced gradually (P<0.05), and blood flow signals in the nodules disappeared. Eleven nodules were non-enhanced in CEUS immediately after the treatment, and the complete ablation rate was 91.7%. During the operation, 3 patients complained of intolerable pain, which was ameliorated or totally relieved after appropriate treatment. The thyroid function showed no significant changes after the treatment (P>0.05). The control group followed up for 6 months showed no significant changes in the nodule volume or thyroid function in comparison with the baseline (P>0.05).

CONCLUSIONUltrasound-guided PLA is a safe and effective minimally invasive treatment of BSTN without obvious adverse effect on thyroid function.

Adult ; Female ; Follow-Up Studies ; Humans ; Laser Therapy ; adverse effects ; methods ; Male ; Middle Aged ; Neck Pain ; etiology ; Pilot Projects ; Thyroid Gland ; diagnostic imaging ; pathology ; surgery ; Thyroid Nodule ; diagnostic imaging ; pathology ; surgery ; Treatment Outcome ; Ultrasonography, Doppler, Color ; Ultrasonography, Interventional

Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology has developed recommendations for the optimal use of radiofrequency ablation for thyroid nodules. These recommendations are based on a comprehensive analysis of the current literature, the results of multicenter studies, and expert consensus.
Biopsy, Fine-Needle ; Catheter Ablation/*methods ; Consensus ; Humans ; Informed Consent ; Neoplasm Recurrence, Local/parasitology/surgery ; Patient Safety ; Radio Waves ; Republic of Korea ; Thyroid Neoplasms/pathology/*surgery ; Thyroid Nodule/pathology/*surgery ; Ultrasonography, Interventional

OBJECTIVETo study the diagnoses and treatments of small thyroid nodules (maximum diameter < 1 cm) with contralateral papillary thyroid microcarcinoma (PTMC).

METHODSA total of 253 patients with unilateral PTMC and contralateral thyroid benign nodules identified by ultrasound before thyroidectomy was retrospectively analysed. All patients underwent near-total or total thyroidectomy. Chi-square test was used for univariate analysis and logistic regression test for multivariate analysis.

RESULTSIn 53 (20.9%) of 253 patients with unilateral PTMC, the contralateral thyroid benign nodules identified by ultrasound were confirmed pathologically as PTMC. Univariate analysis showed multifocality of the primary tumor and Hashimoto's thyroiditis were correlated with contralateral PTMC (χ(2) = 24.834, χ(2) = 5.182, P < 0.05). However, there were no significant differences for the existence of contralateral PTMC in age, sex, tumor size, capsule invasion, lymph node metastasis, the number of nodules and Tg-level. Multivariate analysis showed only multifocal PTMC was an independent predictive factor for contralateral PTMC (OR = 5.352, P < 0.05).

CONCLUSIONSThe patients with unilateral multifocal PTMC have a high rate of PTMC in contralateral small thyroid nodules. However, it is very difficulty to define by ultrasonography preoperatively. The total thyroidectomy maybe serve as a useful treatment.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Papillary ; complications ; diagnostic imaging ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms ; complications ; diagnostic imaging ; surgery ; Thyroid Nodule ; complications ; diagnostic imaging ; surgery ; Ultrasonography ; Young Adult

OBJECTIVE: To compare single-session radiofrequency ablation (RFA) and ethanol ablation (EA) for treating predominantly cystic thyroid nodules (PCTNs). MATERIALS AND METHODS: This single-blind, randomized trial was approved by the Institutional Review Board of two centers and informed consent was obtained from all patients before enrollment. Fifty patients with a single PCTN (cystic portion less than 90% and greater than 50%) were randomly assigned to be treated by either RFA (25 patients) or EA (25 patients) at two hospitals. The primary outcome was the tumor volume reduction ratio (%) at the six-month follow-up and the superiority margin was set at 13% (RFA minus EA). Analysis was performed primarily in an intention-to-treat manner. The secondary outcomes were the therapeutic success rate, improvement of symptomatic and cosmetic problems, and the number of major complications. RESULTS: The mean volume reduction was 87.5 ± 11.5% for RFA (n = 22) and 82.4 ± 28.6% for EA (n = 24) (p = 0.710; mean difference [95% confidence interval], 5.1% [-8.0 to 18.2]), indicating no significant difference. Regarding the secondary outcomes, therapeutic success (p = 0.490), mean symptom (p = 0.205) and cosmetic scores (p = 0.710) showed no difference. There were no major complications in either group (p > 0.99). CONCLUSION: The therapeutic efficacy of RFA is not superior to that of EA; therefore, EA might be preferable as the first-line treatment for PCTNs.
Adult ; Aged ; Catheter Ablation ; Ethanol/*therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Single-Blind Method ; Thyroid Nodule/*drug therapy/*surgery/ultrasonography ; Treatment Outcome ; Tumor Burden