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11:30
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Jung Hwan BaekSouth Korea
Speaker
Standard and Advanced Techniques for Thyroid RFAThermal ablation, especially radiofrequency ablation (RFA), is promising technique not only for benign thyroid nodules but also for thyroid cancers. In various thyroid tumors, RFA effectively improves tumor-related symptoms and cosmetic problems by reducing tumor volume. RFA is recently adopted to recurrent and primary thyroid cancers. In terms of complication, major complication rate was reported as 1.4% - 8% according to the types, locations and size of the thyroid tumors.
Therefore, proper techniques and experience of operators are key factors to achieve effective and safe RFA. To maximize efficacy and to minimize complications, the Korean Society of Thyroid Radiology Guidelines (KSThR Guidelines 2012, 2017, and 2025) recommend the use of standard techniques; the perithyroidal lidocaine injection to control pain, trans-isthmic approach, moving-shot technique and hydrodissection (HD) technique. Furthermore, KSThR Guidelines recommend advanced techniques, such as vascular ablation, bolus injection of cold water (to manage nerve damage problems) or tracheal stent assisted RFA.
In this lecture, therefore I will introduce various standard and advanced techniques to maximize the ablation zone and to minimize injury of surrounding critical structures. Furthermore, I will briefly touch “how to combine proper device and techniques” for thyroid RFA.The Efficacy and Safety of RFA for PTMC in Long-Term Cohort Study: Do Above and BeyondThe incidence of thyroid cancer has increased not only in Korea, but in worldwide. This situation is mainly due to an increase in the over detection of small papillary thyroid carcinomas (PTCs) using high-resolution ultrasonography (US). Almost all newly detected thyroid cancers are small papillary thyroid cancers (PTCs), while the incidence of large PTCs and aggressive histological types has remained stable. In addition, mortality of thyroid cancer has remained stable in Korea. Therefore, several studies have suggested over-diagnosis of small thyroid cancers, especially papillary thyroid microcarcinomas (PTMC). Since the majority of PTMCs progress slowly and show excellent outcome and considering the drawbacks of surgery including voice change or hypoparathyroidism, it is time to re-evaluate the role of surgery (especially immediate surgery) for all biopsy proven PTMCs.
According to publications from South Korea and other countries, the incidence of thyroid carcinoma had increased 15-fold between 1993 and 2011; however, its mortality rate did not decrease. Moreover, the number of patients who suffered from surgical complications increased significantly. Considering the exceedingly low disease-specific mortality rate of PTMCs and the potential complications of thyroidectomy, it is imperative to consider alternative management strategies for PTMC management. Therefore, this lecture will review the current oncologic outcome (in both short and long-term follow-up studies) of thermal ablation in PTMC and compare it with the results of active surveillance and surgery.
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Hendra ZufryIndonesia
Speaker
The Efficacy and Safety of Thyroid RFA: The Latest UpdatesRadiofrequency ablation (RFA) of the thyroid has emerged as a minimally invasive alternative to surgery for benign cystic and solid nodules, low risk papillary thyroid microcarcinoma (PTMC), and recurrent thyroid cancer. Standardized training and international guidelines have facilitated its global adoption. Long term efficacy and safety data position thyroid RFA as a primary treatment compared with other thermal techniques.
In recurrent thyroid cysts, RFA achieves a mean volume reduction ratio (VRR) of 87 ± 11.6 % after one session, outperforming ethanol ablation. For benign solid nodules, a single treatment yields 98.8 % VRR at ten year follow up. Larger nodules (> 20 mL) or multinodular goiters often require multiple sessions to optimize shrinkage, cosmesis, and symptom relief.
Autonomous thyroid nodules (ATNs) under 30 mL demonstrate rapid VRR and early TSH normalization, while larger ATNs reach approximately 70 % VRR by six months, correlating with euthyroidism. In indeterminate Bethesda III nodules with low suspicion ultrasound features, RFA delivers 87.4 % VRR at one year in surgery averse patients; Bethesda IV lesions achieve 94.9 ± 6.1 % VRR.
In low risk PTMC, RFA produces 100 % VRR without disrupting thyroid function over two years, offering an alternative to active surveillance. Early stage papillary thyroid cancers (T1a/T1b) show 99.31 % VRR at 48 months, with higher disappearance rates in T1a. In recurrent papillary carcinoma, RFA attains 100 % VRR and comparable disease free survival to reoperation, with fewer complications. A case of recurrent cervical medullary carcinoma reported 68.6 % VRR at six months.
Complication rates are low. Pre procedural risks include lidocaine toxicity; intra procedural events comprise pain, hematoma, burns, and transient voice changes; post procedural issues may involve mild thyroid dysfunction, discomfort, or rare nodule rupture. These events are generally mild and non–life threatening. Optimal outcomes depend on meticulous patient preparation, advanced electrode design, precise anatomic knowledge, judicious anesthesia, and high operator proficiency in basic and advanced RFA techniques. Patient satisfaction scores are consistently high, reflecting improved quality of life and favorable aesthetic outcomes.
Key Word : Thyroid RFA, Efficacy, Safety Profile, Long term Data.
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