Radiology: RF ablation safe treatment for benign thyroid nodules

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The complication rates in treating benign thyroid nodules with radiofrequency (RF) ablation are low, though various complications may still occur, warranting preventive measures, according to a study published in the October issue of Radiology.

Jung Hwan Baek, MD, from the University of Ulsan College of Medicine in Seoul, South Korea, and colleagues wanted to evaluate the clinical aspects and imaging features of complications encountered in RF ablation of thyroid nodules, and performed a retrospective study of patients who underwent the procedure. They looked at cases from June 2002 to September 2009, which totaled 1,459 patients who received RF ablation with an RF system with internally cooled electrodes at 13 thyroid centers in the Korean Society of Thyroid Radiology.

They observed a total of 48 complications, 20 major and 28 minor, for a complication rate of 3.3 percent. The most common major complication was voice change, which occurred in 15 patients. Other major complications were brachial plexus injury, tumor rupture and permanent hypothyroidism. The minor complications were led by hematoma in 15 patients, followed by vomiting in nine patients and skin burns in four. All patients were able to recover spontaneously from their complications, except for the one patient with permanent hypothyroidism and another who underwent surgery after a node rupture.

“Although image-guided interventional procedures have many advantages, their performance entails risks,” wrote the authors. “Comprehension of complications and methods to prevent complications are extremely important during the establishment of new interventional procedures.”

RF ablation has become a promising technique for treating various tumors, especially for focal liver cancers. It has also been shown to be effective at treating benign thyroid nodules, though there were fears about complications including voice changes, burns and hematoma formation. Previous studies of these complications were limited until this current research from the Korean Society of Thyroid Radiology.

Researchers noted several possible serious complications of RF ablation that had not previously been reported, perhaps the most serious being esophageal injury. To prevent this potentially life-threatening complication, the authors recommended operators maintain a safety margin between the esophagus and the tip of the RF electrode, consider the expected ablation zone and strictly trace the tip of the RF electrode during RF ablation of nodule near the esophagus. Patients should also be asked to swallow cold water during the ablation of units near the esophagus.

“Understanding the broad spectrum of complications, knowledge of techniques and management to prevent complications will minimize complications and sequelae in patients undergoing RF ablation of thyroid nodules,” wrote the authors. “These findings may help in the early detection, prevention and proper management of complications of thyroid RF ablation.”