Percutaneous laser ablation for benign and malignant thyroid diseases

Giovanni Mauri, Luca Nicosia, Paolo Della Vigna, Gianluca Maria Varano, Daniele Maiettini, Guido Bonomo, Gioacchino Giuliano, Franco Orsi, Luigi Solbiati, Elvio De Fiori, Enrico Papini, Claudio Maurizio Pacella, Luca Maria Sconfienza, Giovanni Mauri, Luca Nicosia, Paolo Della Vigna, Gianluca Maria Varano, Daniele Maiettini, Guido Bonomo, Gioacchino Giuliano, Franco Orsi, Luigi Solbiati, Elvio De Fiori, Enrico Papini, Claudio Maurizio Pacella, Luca Maria Sconfienza

Abstract

Minimally invasive image-guided thermal ablation is becoming increasingly common as an alternative to surgery for the treatment of benign thyroid nodules. Among the various techniques for thermal ablation, laser ablation (LA) is the least invasive, using the smallest applicators available on the market and enabling extremely precise energy deposition. However, in some cases, multiple laser fibers must be used simultaneously for the treatment of large nodules. In this review, the LA technique is described, and its main clinical applications and results are discussed and illustrated.

Keywords: Laser therapy; Thyroid gland; Thyroid nodule; Ultrasonography.

Conflict of interest statement

C.M.P. and G.M. are consultants for Elesta s.r.l. All other authors have no conflict of interest.

Figures

Fig. 1.. Ultrasonography showing laser treatment of…
Fig. 1.. Ultrasonography showing laser treatment of a 62-year-old patient with a benign thyroid nodule.
A. Ultrasonography scan before treatment demonstrates a large, isoechoic, non-homogeneous thyroid nodule. B. Contrast-enhanced ultrasonography of the same nodule before treatment shows intense enhancement of the nodule. C. Ultrasonography during treatment shows the insertion of two laser fibers with the use of dedicated planning software. Hyperechoic areas due to gas formation are seen around the needle tips (green and yellow lines, yellow markers, and blue circle line indicate expected fiber path, expected position of needle tip, and expected area of ablation with 1 pull-back, respectively). D. Contrast-enhanced ultrasonography performed after treatment demonstrates lack of enhancement in the treated area (markers).
Fig. 2.. Ultrasonography of a 62-year-old patient…
Fig. 2.. Ultrasonography of a 62-year-old patient with a benign thyroid nodule treated with laser ablation.
A. Ultrasonography shows a large, isoechoic, non-homogeneous, predominantly solid thyroid nodule (arrowheads). B. Ultrasonography during treatment shows two parallel laser fibers that are clearly visible as hyperechoic lines (arrows), and hyperechoic areas due to gas formation during ablation around the tip of the laser fibers. C. Ultrasonography after one pull-back of the two laser (arrows) fibers shows the two laser fibers visible as hyperechoic lines, while an area of non-homogeneous hyperechogenicity is seen in the previously ablated area, corresponding to residual gas after treatment. D. Ultrasonography taken 2 months after treatment demonstrates a 58% volumetric reduction of the treated nodules, which appear as isoechoic and non-homogeneous (arrowheads).
Fig. 3.. 18-Fludeoxyglucose positron emission tomography (…
Fig. 3.. 18-Fludeoxyglucose positron emission tomography (18FDG-PET) and ultrasonography in a 73-year-old patient with previous papillary thyroid carcinoma and a cytologically proven metastatic lymph node treated with laser ablation.
A. 18FDG-PET scan shows a left cervical area of focal intense uptake (arrows) representing a metastatic lymph node. B. Ultrasonography performed at the same level shows a hypoechoic oval-shaped lymph node, with loss of normal nodal appearance (arrow; c, carotid artery). C. Contrast-enhanced ultrasonography demonstrates intense enhancement of the lymph node (asterisk). D. Ultrasonography during the treatment shows two laser fibers, visible as hyperechoic lines (arrows), extending into the lymph node. E. Ultrasonography during ablation shows two hyperechoic areas around the tip of the two laser fibers (arrows), reflecting gas formation during ablation. F. Post-treatment contrast-enhanced ultrasonography demonstrates the lack of enhancement in the treated lymph node (asterisk). G. 18FDG-PET after treatment shows no uptake at the level of the previously treated lymph node (arrows).

References

    1. Kilfoy BA, Zheng T, Holford TR, Han X, Ward MH, Sjodin A, et al. International patterns and trends in thyroid cancer incidence, 1973-2002. Cancer Causes Control. 2009;20:525–531.
    1. Li MH, Liu JT. Screening of benign and malignant thyroid nodules in 5 196 physical examination population. Zhonghua Zhong Liu Za Zhi. 2018;40:151–154.
    1. Papini E, Gugliemi R, Pacella CM. Laser, radiofrequency, and ethanol ablation for the management of thyroid nodules. Curr Opin Endocrinol Diabetes Obes. 2016;23:400–406.
    1. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules, 2016 Update. Endocr Pract. 2016;22:622–639.
    1. Papini E, Guglielmi R, Bizzarri G, Pacella CM. Ultrasound-guided laser thermal ablation for treatment of benign thyroid nodules. Endocr Pract. 2004;10:276–283.
    1. Tamhane S, Gharib H. Thyroid nodule update on diagnosis and management. Clin Diabetes Endocrinol. 2016;2:17.
    1. Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The diagnosis and management of thyroid nodules: a review. JAMA. 2018;319:914–924.
    1. Spiezia S, Garberoglio R, Milone F, Ramundo V, Caiazzo C, Assanti AP, et al. Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid. 2009;19:219–225.
    1. Che Y, Jin S, Shi C, Wang L, Zhang X, Li Y, et al. Treatment of benign thyroid nodules: comparison of surgery with radiofrequency ablation. AJNR Am J Neuroradiol. 2015;36:1321–1325.
    1. Jeong WK, Baek JH, Rhim H, Kim YS, Kwak MS, Jeong HJ, et al. Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. Eur Radiol. 2008;18:1244–1250.
    1. Mainini AP, Monaco C, Pescatori LC, De Angelis C, Sardanelli F, Sconfienza LM, et al. Image-guided thermal ablation of benign thyroid nodules. J Ultrasound. 2017;20:11–22.
    1. Mauri G, Sconfienza LM. Percutaneous ablation holds the potential to substitute for surgery as first choice treatment for symptomatic benign thyroid nodules. Int J Hyperthermia. 2017;33:301–302.
    1. Jeong SY, Baek JH, Choi YJ, Lee JH. Ethanol and thermal ablation for malignant thyroid tumours. Int J Hyperthermia. 2017;33:938–945.
    1. Mauri G, Cova L, Tondolo T, Ierace T, Baroli A, Di Mauro E, et al. Percutaneous laser ablation of metastatic lymph nodes in the neck from papillary thyroid carcinoma: preliminary results. J Clin Endocrinol Metab. 2013;98:E1203–E1207.
    1. Papini E, Bizzarri G, Bianchini A, Valle D, Misischi I, Guglielmi R, et al. Percutaneous ultrasound-guided laser ablation is effective for treating selected nodal metastases in papillary thyroid cancer. J Clin Endocrinol Metab. 2013;98:E92–E97.
    1. Papini E, Guglielmi R, Gharib H, Misischi I, Graziano F, Chianelli M, et al. Ultrasound-guided laser ablation of incidental papillary thyroid microcarcinoma: a potential therapeutic approach in patients at surgical risk. Thyroid. 2011;21:917–920.
    1. Valcavi R, Piana S, Bortolan GS, Lai R, Barbieri V, Negro R. Ultrasound-guided percutaneous laser ablation of papillary thyroid microcarcinoma: a feasibility study on three cases with pathological and immunohistochemical evaluation. Thyroid. 2013;23:1578–1582.
    1. Baek JH, Kim YS, Sung JY, Choi H, Lee JH. Locoregional control of metastatic well-differentiated thyroid cancer by ultrasoundguided radiofrequency ablation. AJR Am J Roentgenol. 2011;197:W331–W336.
    1. Chung SR, Suh CH, Baek JH, Park HS, Choi YJ, Lee JH. Safety of radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: a systematic review and meta-analysis. Int J Hyperthermia. 2017;33:920–930.
    1. Kim JH, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, et al. 2017 Thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology. Korean J Radiol. 2018;19:632–655.
    1. Mauri G, Pisani Mainini A, Monaco C, Pescatori LC, De Angelis C, Sconfienza LM. Urgent need to apply a common language in image-guided thermal ablations. J Ultrasound. 2018;21:77–78.
    1. Pacella CM, Francica G, Di Lascio FM, Arienti V, Antico E, Caspani B, et al. Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis. J Clin Oncol. 2009;27:2615–2621.
    1. Tombesi P, Di Vece F, Sartori S. Laser ablation for hepatic metastases from neuroendocrine tumors. AJR Am J Roentgenol. 2015;204:W732.
    1. Mauri G, Cova L, Ierace T, Baroli A, Di Mauro E, Pacella CM, et al. Treatment of metastatic lymph nodes in the neck from papillary thyroid carcinoma with percutaneous laser ablation. Cardiovasc Intervent Radiol. 2016;39:1023–1030.
    1. Sartori S, Mauri G, Tombesi P, Di Vece F, Bianchi L, Pacella CM. Ultrasound-guided percutaneous laser ablation is safe and effective in the treatment of small renal tumors in patients at increased bleeding risk. Int J Hyperthermia. 2018;35:19–25.
    1. Pacella CM, Bizzarri G, Guglielmi R, Anelli V, Bianchini A, Crescenzi A, et al. Thyroid tissue: US-guided percutaneous interstitial laser ablation: a feasibility study. Radiology. 2000;217:673–677.
    1. Chianelli M, Bizzarri G, Todino V, Misischi I, Bianchini A, Graziano F, et al. Laser ablation and 131-iodine: a 24-month pilot study of combined treatment for large toxic nodular goiter. J Clin Endocrinol Metab. 2014;99:E1283–E1286.
    1. Gambelunghe G, Stefanetti E, Colella R, Monacelli M, Avenia N, De Feo P. A single session of laser ablation for toxic thyroid nodules: three-year follow-up results. Int J Hyperthermia. 2018;34:631–635.
    1. Amabile G, Rotondi M, Pirali B, Dionisio R, Agozzino L, Lanza M, et al. Interstitial laser photocoagulation for benign thyroid nodules: time to treat large nodules. Lasers Surg Med. 2011;43:797–803.
    1. Papini E, Rago T, Gambelunghe G, Valcavi R, Bizzarri G, Vitti P, et al. 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. 2014;99:3653–3659.
    1. Stafford RJ, Fuentes D, Elliott AA, Weinberg JS, Ahrar K. Laserinduced thermal therapy for tumor ablation. Crit Rev Biomed Eng. 2010;38:79–100.
    1. Schena E, Saccomandi P, Fong Y. Laser ablation for cancer: past, present and future. J Funct Biomater. 2017;8:E19.
    1. Saccomandi P, Schena E, Giurazza F, Del Vescovo R, Caponero MA, Mortato L, et al. Temperature monitoring and lesion volume estimation during double-applicator laser-induced thermotherapy in ex vivo swine pancreas: a preliminary study. Lasers Med Sci. 2014;29:607–614.
    1. Fuentes D, Feng Y, Elliott A, Shetty A, McNichols RJ, Oden JT, et al. Adaptive real-time bioheat transfer models for computer-driven MR-guided laser induced thermal therapy. IEEE Trans Biomed Eng. 2010;57:1024–1030.
    1. Jacques SL. Laser-tissue interactions. Photochemical, photothermal, and photomechanical. Surg Clin North Am. 1992;72:531–558.
    1. Goldberg SN, Gazelle GS, Halpern EF, Rittman WJ, Mueller PR, Rosenthal DI. Radiofrequency tissue ablation: importance of local temperature along the electrode tip exposure in determining lesion shape and size. Acad Radiol. 1996;3:212–218.
    1. Thomsen S. Pathologic analysis of photothermal and photomechanical effects of laser-tissue interactions. Photochem Photobiol. 1991;53:825–835.
    1. Larson TR, Bostwick DG, Corica A. Temperature-correlated histopathologic changes following microwave thermoablation of obstructive tissue in patients with benign prostatic hyperplasia. Urology. 1996;47:463–469.
    1. Nixon IJ, Angelos P, Shaha AR, Rinaldo A, Williams MD, Ferlito A. Image-guided chemical and thermal ablations for thyroid disease: review of efficacy and complications. Head Neck. 2018;40:2103–2115.
    1. Mauri G, Cova L, Monaco CG, Sconfienza LM, Corbetta S, Benedini S, et al. Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA) Int J Hyperthermia. 2017;33:295–299.
    1. Pacella CM, Bizzarri G, Spiezia S, Bianchini A, Guglielmi R, Crescenzi A, et al. Thyroid tissue: US-guided percutaneous laser thermal ablation. Radiology. 2004;232:272–280.
    1. Ma S, Zhou P, Wu X, Tian S, Zhao Y. 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. 2016;2016:9565364.
    1. Achille G, Zizzi S, Di Stasio E, Grammatica A, Grammatica L. Ultrasound-guided percutaneous laser ablation in treating symptomatic solid benign thyroid nodules: our experience in 45 patients. Head Neck. 2016;38:677–682.
    1. Prada F, Bene MD, Fornaro R, Vetrano IG, Martegani A, Aiani L, et al. Identification of residual tumor with intraoperative contrastenhanced ultrasound during glioblastoma resection. Neurosurg Focus. 2016;40:E7.
    1. Zhang L, Zhou W, Zhan W, Peng Y, Jiang S, Xu S. Percutaneous laser ablation of unifocal papillary thyroid microcarcinoma: utility of conventional ultrasound and contrast-enhanced ultrasound in assessing local therapeutic response. World J Surg. 2018;42:2476–2484.
    1. Mauri G, Porazzi E, Cova L, Restelli U, Tondolo T, Bonfanti M, et al. Intraprocedural contrast-enhanced ultrasound (CEUS) in liver percutaneous radiofrequency ablation: clinical impact and health technology assessment. Insights Imaging. 2014;5:209–216.
    1. Mauri G, Nicosia L, Varano GM, Bonomo G, Della Vigna P, Monfardini L, et al. Tips and tricks for a safe and effective imageguided percutaneous renal tumour ablation. Insights Imaging. 2017;8:357–363.
    1. Ginat DT, Saad WE. Bowel displacement and protection techniques during percutaneous renal tumor thermal ablation. Tech Vasc Interv Radiol. 2010;13:66–74.
    1. Orlandi D, Sconfienza LM, Lacelli F, Bertolotto M, Sola S, Mauri G, et al. Ultrasound-guided core-needle biopsy of extra-ocular orbital lesions. Eur Radiol. 2013;23:1919–1924.
    1. Mauri G, Solbiati L. Virtual navigation and fusion imaging in percutaneous ablations in the neck. Ultrasound Med Biol. 2015;41:898.
    1. Mauri G, De Beni S, Forzoni L, D'Onofrio S, Kolev V, Lagana MM, et al. Virtual navigator automatic registration technology in abdominal application. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:5570–5574.
    1. Papini E, Guglielmi R, Bizzarri G, Graziano F, Bianchini A, Brufani C, et al. Treatment of benign cold thyroid nodules: a randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up. Thyroid. 2007;17:229–235.
    1. Dossing H, Bennedbaek FN, Hegedus L. Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules. Eur J Endocrinol. 2011;165:123–128.
    1. Oddo S, Felix E, Mussap M, Giusti M. Quality of life in patients treated with percutaneous laser ablation for non-functioning benign thyroid nodules: a prospective single-center study. Korean J Radiol. 2018;19:175–184.
    1. Pacella CM, Mauri G, Achille G, Barbaro D, Bizzarri G, De Feo P, et al. Outcomes and risk factors for complications of laser ablation for thyroid nodules: a multicenter study on 1531 patients. J Clin Endocrinol Metab. 2015;100:3903–3910.
    1. Ha EJ, Baek JH, Kim KW, Pyo J, Lee JH, Baek SH, et al. Comparative efficacy of radiofrequency and laser ablation for the treatment of benign thyroid nodules: systematic review including traditional pooling and bayesian network meta-analysis. J Clin Endocrinol Metab. 2015;100:1903–1911.
    1. Pacella CM. Image-guided thermal ablation of benign thyroid nodules. J Ultrasound. 2017;20:347–349.
    1. Pacella CM, Mauri G. Is there a role for minimally invasive thermal ablations in the treatment of autonomously functioning thyroid nodules? Int J Hyperthermia. 2018;34:636–638.
    1. Jegerlehner S, Bulliard JL, Aujesky D, Rodondi N, Germann S, Konzelmann I, et al. Overdiagnosis and overtreatment of thyroid cancer: A population-based temporal trend study. PLoS One. 2017;12:e0179387.
    1. O'Grady TJ, Gates MA, Boscoe FP. Thyroid cancer incidence attributable to overdiagnosis in the United States 1981-2011. Int J Cancer. 2015;137:2664–2673.
    1. Muntean V, Domsa I, Zolog A, Piciu D, Fabian O, Bosu R, et al. Incidental papillary thyroid microcarcinoma: is completion surgery required? Chirurgia (Bucur) 2013;108:490–497.
    1. Burman KD. Treatment of recurrent or persistent cervical node metastases in differentiated thyroid cancer: deceptively simple options. J Clin Endocrinol Metab. 2012;97:2623–2625.
    1. Griffin A, Brito JP, Bahl M, Hoang JK. Applying criteria of active surveillance to low-risk papillary thyroid cancer over a decade: how many surgeries and complications can be avoided? Thyroid. 2017;27:518–523.
    1. Brito JP, Ito Y, Miyauchi A, Tuttle RM. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid. 2016;26:144–149.
    1. Haser GC, Tuttle RM, Su HK, Alon EE, Bergman D, Bernet V, et al. Active surveillance for papillary thyroid microcarcinoma: new challenges and opportunities for the health care system. Endocr Pract. 2016;22:602–611.
    1. Kim JH, Baek JH, Sung JY, Min HS, Kim KW, Hah JH, et al. Radiofrequency ablation of low-risk small papillary thyroidcarcinoma: preliminary results for patients ineligible for surgery. Int J Hyperthermia. 2017;33:212–219.
    1. Mauri G, Sconfienza LM. Image-guided thermal ablation might be a way to compensate for image deriving cancer overdiagnosis. Int J Hyperthermia. 2016;33:489–490.
    1. Lee J, Jung JH, Kim WW, Hwang SO, Park JY, Jeong JY, et al. Ultrasound-guided laser ablation using multidirectional-firing fiber for papillary thyroid carcinoma: an ex vivo study with evaluation of tumor cell viability. Photomed Laser Surg. 2016;34:300–304.
    1. Zhang L, Zhou W, Zhan W. Role of ultrasound in the assessment of percutaneous laser ablation of cervical metastatic lymph nodes from thyroid carcinoma. Acta Radiol. 2018;59:434–440.
    1. Zhou W, Zhang L, Zhan W, Jiang S, Zhu Y, Xu S. Percutaneous laser ablation for treatment of locally recurrent papillary thyroid carcinoma <15 mm. Clin Radiol. 2016;71:1233–1239.

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