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Thyroid Tissue: US-guided Percutaneous Interstitial Laser Ablation-A Feasibility Study¹

¹ From the Departments of Diagnostic Imaging (C.M.P., G.B., V.A., A.B., A.C., S.P.) and Endocrine, Metabolic, and Digestive Diseases (R.G., E.P.), Regina Apostolorum Hospital, Via San Francesco, 50, 00041 Albano Laziale, Rome, Italy. From the 1998 RSNA scientific assembly. Received August 3, 1999; revision requested September 20; final revision received March 2, 2000; accepted March 7. Address correspondence to C.M.P (e-mail: cmpac@tin.it).

PURPOSE: To evaluate percutaneous interstitial laser photocoagulation (ILP) as a palliative treatment of recurrent thyroid carcinoma untreatable with surgery or radioiodine administration.

MATERIALS AND METHODS: By using 18 resected thyroid glands, the volume and histologic pattern of ILP-induced thyroid damage were assessed. In vivo treatment feasibility was evaluated by using a low-energy laser in two volunteers before thyroidectomy for huge autonomously functioning nodules. With ultrasonographic (US) monitoring, a 21-gauge spinal needle was inserted into the thyroid nodules. A 300-µm quartz fiberoptic guide was inserted through the needle lumen, and the fiber tip was placed in direct contact with the tissue. Laser irradiation was performed with a 1.064-nm Nd:YAG laser in surgically resected glands, which were treated with 2, 3, 5, or 7 W.

RESULTS: Tissue ablation was well-defined histologically, and its area was related to laser irradiation parameters (range, 0–26 mm). No correlation was found between US images and the actual extent of laser-induced lesions. Large colloid or fluid collections did not permit regular heat diffusion within the tissue. In vivo low-energy ILP was performed without technical difficulties or complications.

CONCLUSION: ILP induces well-defined tissue ablation correlated with energy parameters in thyroid glands devoid of cystic areas. ILP could be a therapeutic tool for highly selected problems in thyroid tumor treatment.

Index terms: Interventional procedures, 273.1267, 273.12985 • Lasers, interstitial therapy, 273.1267 • Thyroid, neoplasms, 273.367 • Thyroid, therapeutic radiology, 273.1267, 273.12985 • Thyroid, US, 273.12985

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