Radiofrequency ablation of benign thyroid nodules: value of the anterolateral hydrodissection technique

Jeong, So Yeong; Baek, Jung Hwan; Chung, Sae Rom; Choi, Young Jun; Chung, Ki-Wook; Kim, Tae Yong; Lee, Jeong Hyun

doi:.0.0.0

Original Article

Radiofrequency ablation of benign thyroid nodules: value of the anterolateral hydrodissection technique

So Yeong Jeong^1,2

, Jung Hwan Baek²

, Sae Rom Chung²

, Young Jun Choi²

, Ki-Wook Chung³

, Tae Yong Kim⁴

, Jeong Hyun Lee²

¹Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
²Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
³Departments of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
⁴Departments of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Corresponding Author: Jung Hwan Baek ,Tel: 82-2-3010-4348, Fax: 82-2-476-0090, Email: radbaek@naver.com

Received: February 7, 2023; Accepted: April 3, 2023. Published online: April 3, 2023.

ABSTRACT

Purpose:
To evaluate the technical feasibility, efficacy, and safety of the anterolateral hydrodissection (ALHD) technique in radiofrequency ablation (RFA) for benign thyroid nodules.
Methods:
Between November 2019 and April 2020, 39 patients underwent 41 sessions of RFA with the ALHD technique for treatment of benign thyroid nodules. ALHD was performed with cold (0°C–4°C) 5% dextrose solution during RFA to minimize pain and secure sufficient safety margins from critical neck structures. The initial ablation ratio(IAR) was measured to evaluate the technique’s efficiency. Ultrasound examinations, symptoms, and cosmetic scores were evaluated pre-procedure and at 6 and 12 months post-procedure. Procedure-related pain during RFA and complications were evaluated.
Results:
The mean index nodule volume was 20.5±21.6ml. ALHD was technically feasible in all patients. The mean IAR was 90.7±8.3%, and significant reductions in mean nodule volume were noted at 6- and 12-month follow-up (P<0.001, 63.9±19.0%, and 76.3±18.9%, respectively). After the procedures, symptom and cosmetic scores showed significant improvement at 6- and 12-month follow-up (P<0.001). Pain during the procedure was well-controlled with ALHD in all patients. After the initial use of 5–10 ml of lidocaine at the start of the procedure, no further lidocaine injection was given to any of the patients. Transient voice change was observed in one patient, but the patient recovered spontaneously within 30 minutes.
Conclusion:
The ALHD technique was technically feasible and effective in all patients, achieving a mean IAR of 90.7%. The ALHD technique also had a pain-relieving effect, resulting in only low amounts of lidocaine administration being required during the procedure.

Keywords: Radiofrequency Ablation; Thyroid nodule; Thyroid gland