Percutaneous microwave ablation of benign thyroid nodules

Summary

Aim: Thyroid nodules represent a common clinical issue. Amongst other minimally invasive procedures, percutaneous microwave ablation (MWA) poses a promising new approach. The goal of this retrospective study is to find out if there is a correlation between volume reduction after 3 months and ^99mTcuptake reduction of treated thyroid nodules. Patients, methods: 14 patients with 18 nodules were treated with MWA. Pre-ablative assessment included sonographical and functional imaging of the thyroid with ^99mTcpertechnetate and ^99mTc-MIBI. Additionally, patients underwent thyroid scintigraphy 24 hours after ablation in order to evaluate the impact of the treatment on a functional level and to ensure sufficient ablation of the targeted area. At a 3-month follow-up, ultrasound examination was performed to assess nodular volume reduction. Results: Mean relative nodular volume reduction after three months was 55.4 ± 17.9% (p < 0.05). ^99mTcuptake 24 hours after treatment was 45.2 ± 31.9% (^99mTc-MIBI) and 35.7 ± 20.3% (^99mTcpertechnetate) lower than prior to ablation (p < 0.05). Correlating reduction of volume and ^99mTc-uptake, Pearson's r was 0.41 (p < 0.05) for nodules imaged with ^99mTc-MIBI and –0.98 (p < 0.05) for ^99mTc-pertechnetate. According to scintigraphy 99.6 ± 22.6% of the determined target area could be successfully ablated. Conclusions: MWA can be considered as an efficient, low-risk and convenient new approach to the treatment of benign thyroid nodules. Furthermore, scintigraphy seems to serve as a potential prognostic tool for the later morphological outcome, allowing rapid evaluation of the targeted area in post-ablative examination.

Zusammenfassung

Schilddrüsenknoten sind ein häufiges klinisches Problem. Wie andere minimal-invasive Techniken stellt die perkutane Mikrowellenablation (MWA) einen viel versprechenden neuen Therapieansatz dar. Das Ziel dieser retrospektiven Studie ist es herauszufinden, ob ein Zusammenhang zwischen Volumenabnahme nach drei Monaten und ^99mTc-Uptake- Abnahme des therapierten Schilddrüsenknotens besteht. Patienten, Methoden: 14 Patienten mit 18 Knoten wurden mit MWA behandelt. Das prä-ablative Prozedere umfasste Ultraschalluntersuchung, funktionelle Bildgebung mit ^99mTc-Pertechnetat und ^99mTc- MIBI. Nach 24 Stunden wurde erneut ein Szintigramm angefertigt, um das Ergebnis der Behandlung auf funktioneller Ebene zu beurteilen. Nach drei Monaten erfolgte die Verlaufskontrolle, bei der sonographisch die Reduktion des Knotenvolumens erfasst wurde. Ergebnisse: Die relative Reduktion des Knotenvolumens betrug nach drei Monaten 55,4 ± 17,9% (p < 0,05). Der ^99mTc-Uptake war 24 Stunden nach der Behandlung um 45,2 ± 31,9% (^99mTc-MIBI) bzw. 35,7 ± 20,3% (^99mTc-Pertechnetat) verringert (p < 0,05). Die statistische Korrelation von Volumenreduktion und ^99mTc-Uptake ergab r-Werte von 0,41 (^99mTc-MIBI) bzw. –0,98 (^99mTcpertechnetate) (p < 0,05). Zudem konnten gemäß Szintigraphie 99,6 ± 22,6% des definierten Zielareals abladiert werden. Schlussfolgerung: Die MWA kann als effizienter und risikoarmer neuer Therapieansatz zur Behandlung benigner Schilddrüsenknoten angesehen werden. Weiterhin scheint es möglich, die Szintigraphie als prognostisches Hilfsmittel und auch zur raschen post-ablativen Beurteilung des Zielvolumens heranzuziehen.

Keywords

Microwave ablation - functional imaging - thyroid nodules - scintigraphy - ^99mTc-pertechnetate - ^99mTc-MIBI

Schlüsselwörter

Mikrowellenablation - funktionelle Bildgebung - Schilddrüsenknoten - Szintigraphie - ^99mTc-Pertechnetat - ^99mTc-MIBI

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