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Thyroid Tissue: US-guided Percutaneous Laser Thermal Ablation¹

¹ From the Departments of Radiology and Diagnostic Imaging (C.M.P., G.B., A.B., A.C., S.P.) and Endocrine, Metabolic, and Digestive Diseases (R.G., E.P.), Ospedale Regina Apostolorum, Via San Francesco 50, 00041 Albano Laziale, Rome, Italy; Department of Physiopathology, La Sapienza University 2nd Campus, Rome, Italy (V.T.); and Surgery Unit of Neck Pathologies, Ospedale Santa Maria del Popolo degli Incurabili, Naples, Italy (S.S.). Received October 21, 2002; revision requested January 7, 2003; final revision received October 23; accepted November 17. Address correspondence to C.M.P. (e-mail: cmpacel@katamail.com).

PURPOSE: To evaluate in vivo the safety and effectiveness of percutaneous laser thermal ablation (LTA) in the debulking of thyroid lesions.

MATERIALS AND METHODS: Twenty-five adult patients at poor surgical risk with cold nodules (n = 8), autonomously hyperfunctioning thyroid nodules (n = 16), or anaplastic carcinoma (n = 1) underwent LTA. One to four 21-gauge spinal needles were inserted with ultrasonographic (US) guidance into the thyroid lesions. A 300-µm-diameter quartz optical fiber was advanced through the sheath of the needle. Nd:YAG laser was used with output power of 3–5 W. Side effects, complications, and clinical and hormonal changes were evaluated at the end of LTA and during follow-up. Linear regression analysis was used to investigate the correlation between energy delivered and reduction in nodule volume. Volume of induced necrosis and reduction in nodule volume were assessed with US or computed tomography.

RESULTS: LTA was performed without difficulties in 76 LTA sessions. After treatment with 5 W, two patients experienced mild dysphonia, which resolved after 48 hours and 2 months. Improvement of local compression symptoms was experienced by 12 of 14 (86%) patients. Thyroid-stimulating hormone (TSH) was detectable in five of 16 (31%) patients with hyperfunctioning nodules at 6 months after LTA. Volume of induced necrosis ranged from 0.8 to 3.9 mL per session. Anaplastic carcinoma treated with four fibers yielded 32.0 mL of necrosis. Echo structure and baseline volume did not influence response. Energy load and reduction in nodule volume were significantly correlated (r² = .75, P < .001). Mean nodule volume reduction at 6 months in hyperfunctioning nodules was 3.3 mL ± 2.8 (62% ± 21.4 [SD]) and in cold nodules was 7.7 mL ± 7.5 (63% ± 13.8).

CONCLUSION: LTA may be a therapeutic tool for highly selected problems in the treatment of thyroid lesions.

© RSNA, 2004

Index terms: Interventional procedures, technology, 273.1269 • Lasers, interstitial therapy, 273.1269 • Thyroid, neoplasms, 273.36, 273.37 • Thyroid, US, 273.12986

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