A Medical Journal Summary
Radiofrequency Ablation for Thyroid Nodules & Cancer in teh United States: Balancing a Transformation of Thyroid Care With Risk for Misuse
An image-guided thermal ablation technique known as Thyroid radiofrequency ablation (RFA) is the most commonly used treatment option for thyroid nodules and cancers. It can drastically change the thyroid tumor management landscape. After Asia and Europe, the United States also utilizes the Thyroid RFA technique to non-invasively reduce the size of solid benign nodules when there’re cosmetic concerns and compressive symptoms. This innovative technique is cost-effective, eliminates the need for hospitalization surgical risks, and avoids scarring. Additionally, Thyroid RFA has proven to enhance the quality of life and patient satisfaction. Multiple studies have demonstrated that after 6 to 12 months of follow-up with the patients after Thyroid RFA therapy, their nodule volume decreased by around 80%. However, despite the significant benefits of Thyroid RFA over conventional surgery, there’s a significant risk of misuse.
When there is substantial data about a disease such as prostate cancer and a new treatment option is introduced without the guidelines for eligible patients, people start adopting it more than they need. For instance, when intensity-modulated radiotherapy started to treat prostate cancer, men with high-risk as well as low-risk diseases started adopting it rapidly. Therefore, for thyroid nodule and cancer management, policymakers and physicians must learn from experiences in several cancer types and provide clear guidelines and recommendations about eligible candidates to prevent the misuse of these therapies. Moreover, even though 2 fine-needle aspiration biopsies are conducted to confirm the benign cytology of the nodule, in rare cases, malignancy can be misused, and proper treatment may be delayed.
Thyroid RFA can be challenging, and the operator must have extensive experience to ensure safe implementation. To achieve maximum efficacy and mitigate unnecessary risk, selecting appropriate patients and providing multidisciplinary care such as surgeons’ involvement is essential to avoid selecting patients who need surgery. According to the Korean Society of Thyroid Radiology, it’s recommended to choose patients for Thyroid RFA therapy who have benign thyroid nodules having a diameter of more than 2cm and showing symptom and cosmetic concerns, papillary microcarcinomas, toxic autonomously functioning thyroid nodules, recurrent thyroid cancers, and patients having high surgical risks.
Furthermore, multidisciplinary care, such as the usage of tumor boards, is an effective way to optimize patient care. A similar model must be used for Thyroid RFA treatments and procedures. Since the nodule’s subsequent ultrasound evaluation will be abnormal in appearance, providers engaged in downstream care must be educated on post-treatment changes.
Finally, for low-risk cancers and small nodules, active surveillance is another effective management option. Small cancers and benign nodules should be monitored with serial ultrasound exams. According to a single institution’s retrospective study, 69% of patients who were treated with conventional thyroidectomy surgery for benign nodules may have been appropriate candidates for Thyroid RFA treatment instead.
Putting it all Together
Thyroid Radiofrequency ablation has the potential to alter the thyroid nodules and cancer patients’ care in the United States. However, the risk of misuse is significant. Therefore, there’s a crucial need for guidelines and consensus statements proposed by U.S. societies to guide judicious and appropriate use of non-invasive ablative treatment options for small cancers and thyroid nodules like Thyroid RFA treatments. In addition, to avoid patient harm and optimize the use of Thyroid RFA, dissemination and implementation must be evidence-based and involve well-trained experts.
You can read the full medical journal here
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Citation:
Radiofrequency Ablation for Thyroid Nodules and Cancer in the United States: Balancing a Transformation of Thyroid Care With Risk for Misuse, Megan R. Haymart, MD, Maria Papaleontiou, MD Published: December 14, 2021DOI:https://doi.org/10.1016/j.eprac.2021.12.006
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