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 Table of Contents  
REVIEW ARTICLE
Year : 2014  |  Volume : 11  |  Issue : 3  |  Page : 89-93

Non-invasive and percutaneous ablation of nontoxic solid nodules


Department of Endocrinology, Army Hospital Research & Referral, Delhi Cantt, New Delhi, India

Date of Web Publication13-Aug-2014

Correspondence Address:
Narendra Kotwal
Department of Endocrinology, Army Hospital Researcch & Referral, Delhi Cantt, New Delhi - 110 010
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.138551

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  Abstract 

Thyroid nodules (TNs) are commonly seen in the general population with a prevalence of about 4% by palpation and about 10-41% by ultrasound. Most of the TNs are benign. Surgery and radioiodine therapy have been the mainstay of therapy in compressive TNs. Surgery has its own complications and hence, the quest for a non-invasive modality of treatment remains. Radiofrequency ablation, ethanol ablation and laser ablation are the non-invasive methods of treating a benign TN. Also, microwave ablation and high intensity focused ultrasound have recently been tried in the treatment of TNs. In this review, we will be discussing the above newer and emerging modalities in the non-invasive ablation of non-toxic nodules.

Keywords: a0 blation, ethanol, laser, microwave, radiofrequency, thyroid nodules


How to cite this article:
Kotwal N, Pandit A. Non-invasive and percutaneous ablation of nontoxic solid nodules. Thyroid Res Pract 2014;11:89-93

How to cite this URL:
Kotwal N, Pandit A. Non-invasive and percutaneous ablation of nontoxic solid nodules. Thyroid Res Pract [serial online] 2014 [cited 2019 Dec 15];11:89-93. Available from: http://www.thetrp.net/text.asp?2014/11/3/89/138551


  Introduction Top


Thyroid nodules (TNs) are very commonly seen in general population with a prevalence of about 4% by palpation and up to 10-41% with use of ultrasound. [1] Majority of the TNs are benign [2] and few of the benign nodules warrant treatment for pressure symptoms and for cosmetic reasons. Surgery and radioiodine therapy have been the mainstay of therapy in the compressive TNs but surgical complications have been reported in around 7-10% of cases. [3] Also, the risk of thyroid surgery is definitely more in the elderly population and it is refused by many. Medical therapy using levothyroxine used in non-functioning TNs achieves very little goiter shrinkage and also, the risk of suppressing thyroid stimulating hormone remains. [4] Non-surgical or minimally invasive methods of treating TN are being investigated. Ethanol ablation (EA), percutaneous radiofrequency ablation (RFA), and laser ablation (LA) have been used. Recently, high intensity focused ultrasound (HIFU) and microwave ablation as thermal ablation have been tried. In this review, we will be discussing the non-invasive modes of treating solid TN's.


  Radiofrequency ablation Top


RFA first tried in the treatment of liver cancer [5] and was introduced in the treatment of TNs in 2006. Kanauchi et al. in 2001 [6] demonstrated in pigs that percutaneous RFA induced necrosis of thyroid tissue. Mallery et al. [7] in 2003 successfully used RFA for treating hyperthyroidism in cats though, the effect was transient.

Principle of RFA

RFA uses the heat generated from high frequency alternating electric current between 200 kHz and 1200 kHz. The radio-frequency waves pass through the electrode and agitate the tissue ions around the electrode. They generate frictional heat and increase the temperature in the tissue, resulting in the destruction of the tissue. Furthermore, the conduction heat from the ablated area can damage the tissue away from the electrode in a slower fashion. Frictional heat and conduction heat are the two basic principles of RFA.

Procedure

The moving shot technique has been recommended to optimize the efficacy and minimize the complications. The TNs are divided into multiple conceptual units and the nodule is ablated unit by unit. The electrode is placed in the deepest portion of the nodule and then moved backwards in the superficial direction. The extent of the ablated area is determined by the echogenic changes. It is performed under ultrasonographic guidance after local anesthesia usually using the Trans isthmic area. This approach has several advantages like clear view of the electrode in the transverse ultrasound view and minimal heat exposure to the danger area that is near the recurrent laryngeal nerve and/or the esophagus. [8]

Evidence

Many studies have demonstrated the safety and the efficacy of RFA. [3],[9],[10],[11],[12] In a recently published study in December 2012, demonstrated the efficacy and safety of RFA in both toxic and non-toxic solid nodule compared to no treatment at all. They demonstrated a reduction in TN volume of up to 94% at the end of 9 months and also, reduction in the pressure symptoms. [3] These results were similar to a randomized prospective study by Baek et al. [13] In another follow-up study of 126 benign TNs in 111 patients over 4 years, reported a decrease in the TN volume of up to 93.5% at the end of 4 years. [14] In a large series study of 236 patients demonstrated a volume reduction of up to 84% in 6 months. 91% of nodules were reduced by 50% indicating therapeutic success. [10] The greatest volume reduction was observed in the 1 st month post RFA with further declining volume as the time passes. [10],[13] It has been demonstrated that a single session of RFA is sufficient to decrease the thyroid volume and ameliorate the cosmetic and the pressure symptoms. [13] A recurrence rate of 5.6% was found over a follow-up of 4 years though, none of the nodules grew to a size larger than its initial volume. [14] Complete ablation of periphery is important to prevent the marginal tumor regrowth which may be required in larger nodules and the moving shot technique has been proposed as a suitable method. [9],[13],[15] RFA is also effective in treatment of benign predominantly cystic TNs with a residual solid component in patients whose clinical problems were incompletely resolved after EA. [16] RFA is effective in solid nodules in patients with incompletely resolved clinical problems after EA indicating that RFA is effective for both solid and cystic component. [17] Recently, Korean society of thyroid radiology have published a consensus statement regarding the use of thermal ablation laser and radiofrequency in TNs. [18]

Complications

In a retrospective study conducted on 1459 patients who underwent RFA, the complication rate was 3.3% and major complication rate was 1.4%. Major complications were voice change, brachial plexus injury, tumor rupture, and permanent hypothyroidism. Minor complications were hematoma, skin burn, and vomiting. [19] Pain was the most common complaint reported post-procedure and around 5.5% patients required analgesics for the same. [10] Kim et al. reported that recurrent laryngeal nerve injury after RFA was 3.3%. [11] Knowledge of the danger triangle and the variations in the vagus nerve can help prevent the recurrent laryngeal injury. Hematomas can be prevented by local compression. Nodule rupture usually occurs due to hematoma in the TN and can be conservatively managed with antibiotics and/or analgesics.


  Laser ablation Top


LA concept was initially described in 1983 by Bown. [20]

Principle

Light is delivered interstitially by implanting a laser fiber directly into tissues. Interstitial LA is a thermal technique aiming at conversion by tissue into heat of light produced by sources such as neodymium-yttrium aluminum garnet with a wavelength of 1064 nm or continuous (820 nm) diode laser. The delivered photons cause increase in the temperature followed by the denaturation of the irradiated cells. LA induces a zone of coagulative necrosis with well-defined margins when temperature exceeds 60°C (threshold for protein denaturation) with irreversible tissue destruction and with no viable tissue remaining inside. [21]

Evidence

Based on experimental studies in animals a first feasibility was conducted in 2000 by Pacella et al. [22] Many uncontrolled trials have demonstrated the efficacy of LA in TNs. [23],[24],[25] In a large series of 122 patients were followed up for a period of 3 years. The thyroid volume decreased by 50% in a wide size range of nodules. [26] In another prospective randomized study by Dossing et al. showed that a single treatment with ultrasound guided LA reduced the thyroid volume by almost 50%. The incremental effect of additional laser was minimal. [27] A randomized controlled trial showed that nodules decreased significantly by 22% after 2 weeks and by 44% after 30 weeks. [28] In another randomized controlled trial demonstrated a volume reduction >50% was found in 33.3% of cases. [29] A study in 2009 demonstrated a dose response relationship of LA. [30] Also, a recent study has demonstrated that only high energy (>400-500 J/ml of nodular tissue to be treated) of laser energy is needed for it to be effective over time. [31] Also, the concern regarding the histopathological changes seen in TN after LA was studied in a series of 22 patients followed up for 18 months. It was demonstrated that LA treatment is safe and can be followed up with fine needle aspiration cytology. [32] Similar results were found by Cakir et al. [33] In comparative study between LA and RFA found that LA as well as RFA are suitable for singular TNs and induces reproducible clinically relevant lesions in an appropriate application time. The maximum inducible lesion volumes by LA are significantly larger than by RFA with the devices used herein. [34]

Complications

Complications associated with LA are rare and usually temporary. Transient dysphonia, pain, fever, mild burns and skin infections have been reported. [21]


  Ethanol ablation Top


EA was first used for a successful renal cyst ablation in 1981 [35] and subsequently was demonstrated to be effective in treatment of hepatic cysts, [36] malignant liver lesions, [37] and also primary hyperparathyroidism. [38] Ethanol causes thyroid tissue destruction by complex mechanisms like coagulative necrosis, vascular thrombosis, and hemorrhagic infarction. [39] Livraghi et al. first demonstrated the use of EA in hyper functioning TNs in 1990. [40] Since then, EA has been established as a first line treatment for benign cystic TNs. However, the data regarding use of EA in solid nodules is variable and depends on the nodule size, volume of ethanol instilled, and nodule toxicity. [41],[42],[43] In a recently published study, however, demonstrated a success rate of 60% in solid nodules. Nodular vascularity and the degree of intranodular echo staining after EA on color Doppler sonography were useful in predicting the success rate for benign predominantly solid nodules. [44] Limitations include repeated use of EA, painful despite local anesthesia, fever, periglandular fibrosis or dysphonia. A sudden increase in the intranodal pressure can cause leakage of ethanol extranodally. [45]


  Newer modalities Top


Microwave thermal ablation

Microwave ablation uses electromagnetic energy typically operated at 915 MHz or 2.45 GHz causing tissue destruction using thermal energy. When electromagnetic energy is applied over the tissue, the energy is used to force molecules to continuously realign with the applied field. This rotation of molecules represents an increase in kinetic energy and hence, an elevation in local tissue temperatures. [46] Microwave ablation has been used for the treatment of hepatic malignancies, [47] lung malignancies, [48] lung cancer. [49] Its use in TN ablation has been demonstrated recently. In recently published study in January 2013, a total of 477 benign TNs in 222 patients underwent microwave ablation. A volume-reduction ratio greater than 50% was observed in 82.3% of index nodules, and 30.7% of index nodules disappeared 6 month after the ablation. They did not report any major complications. [50] Another study demonstrated a volume reduction ratio of up to 45%. One case report of laryngeal nerve palsy and tracheal cartilage necrosis after microwave ablation has been reported. [51]


  High intensity focused ultrasound Top


HIFU relies on the same principle as ultrasound. When focused ultrasound waves pass through a tissue it causes local rise of temperature to cause tissue necrosis. [52] In 1950 Fry et al. demonstrated the use of HIFU by producing lesions in the brains of cats and monkeys. [53],[54] It has been used in the treatment of benign prostratic hyperplasia, liver cancer. Prostrate cancer. [52] Esnault et al. have conducted the first human feasibility study on 25 patients. Among the 25 patients, 16 patients showed a significant response on ultrasound. They did not report any complications. [55] Though, it appears as an exciting prospect much research is needed yet.


  Conclusions Top


The non-invasive and the percutaneous methods like LA and RFA are a good alternative to benign solid TNs, especially in patients refusing surgery and those with cosmetic problems. EA though, effective in cystic nodules, its use in solid nodules is limited with the conflicting data available. The newer modalities are all an interesting prospect in our never ending search for an ideal alternative to surgery which is minimally invasive, though, further studies need to determine its efficacy in the treatment of TN's.

 
  References Top

1.Weiss RE, Lado-Abeal J. Thyroid nodules: Diagnosis and therapy. Curr Opin Oncol 2002;14:46-52.  Back to cited text no. 1
    
2.Tan GH, Gharib H. Thyroid incidentalomas: Management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 1997;126:226-31.  Back to cited text no. 2
    
3.Faggiano A, Ramundo V, Assanti AP, Fonderico F, Macchia PE, Misso C, et al. Thyroid nodules treated with percutaneous radiofrequency thermal ablation: A comparative study. J Clin Endocrinol Metab 2012;97:4439-45.  Back to cited text no. 3
    
4.Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006;12:63-102.  Back to cited text no. 4
    
5.Rossi S, Di Stasi M, Buscarini E, Cavanna L, Quaretti P, Squassante E, et al. Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am 1995;1:73-81.  Back to cited text no. 5
    
6.Kanauchi H, Mimura Y, Kaminishi M. Percutaneous radio-frequency ablation of the thyroid guided by ultrasonography. Eur J Surg 2001;167:305-7.  Back to cited text no. 6
    
7.Mallery KF, Pollard RE, Nelson RW, Hornof WJ, Feldman EC. Percutaneous ultrasound-guided radiofrequency heat ablation for treatment of hyperthyroidism in cats. J Am Vet Med Assoc 2003;223:1602-7.  Back to cited text no. 7
    
8.Shin JH, Baek JH, Ha EJ, Lee JH. Radiofrequency ablation of thyroid nodules: Basic principles and clinical application. Int J Endocrinol 2012;2012:919650.  Back to cited text no. 8
    
9.Baek JH, Moon WJ, Kim YS, Lee JH, Lee D. Radiofrequency ablation for the treatment of autonomously functioning thyroid nodules. World J Surg 2009;33:1971-7.  Back to cited text no. 9
    
10.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;18:1244-50.  Back to cited text no. 10
    
11.Kim YS, Rhim H, Tae K, Park DW, Kim ST. Radiofrequency ablation of benign cold thyroid nodules: Initial clinical experience. Thyroid 2006;16:361-7.  Back to cited text no. 11
    
12.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;19:219-25.  Back to cited text no. 12
    
13.Baek JH, Kim YS, Lee D, Huh JY, Lee JH. Benign predominantly solid thyroid nodules: Prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition. AJR Am J Roentgenol 2010;194:1137-42.  Back to cited text no. 13
    
14.Lim HK, Lee JH, Ha EJ, Sung JY, Kim JK, Baek JH. Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients. Eur Radiol 2013;23:1044-9.  Back to cited text no. 14
    
15.Baek JH, Lee JH, Valcavi R, Pacella CM, Rhim H, Na DG. Thermal ablation for benign thyroid nodules: Radiofrequency and laser. Korean J Radiol 2011;12:525-40.  Back to cited text no. 15
    
16.Jang SW, Baek JH, Kim JK, Sung JY, Choi H, Lim HK, et al. How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: Role of radiofrequency ablation. Eur J Radiol 2012;81:905-10.  Back to cited text no. 16
    
17.Lee JH, Kim YS, Lee D, Choi H, Yoo H, Baek JH. Radiofrequency ablation (RFA) of benign thyroid nodules in patients with incompletely resolved clinical problems after ethanol ablation (EA). World J Surg 2010;34:1488-93.  Back to cited text no. 17
    
18.Na DG, Lee JH, Jung SL, Kim JH, Sung JY, Shin JH, et al. Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: Consensus statement and recommendations. Korean J Radiol 2012;13:117-25.  Back to cited text no. 18
    
19.Baek JH, Lee JH, Sung JY, Bae JI, Kim KT, Sim J, et al. Complications encountered in the treatment of benign thyroid nodules with US-guided radiofrequency ablation: A multicenter study. Radiology 2012;262:335-42.  Back to cited text no. 19
    
20.Bown SG. Phototherapy in tumors. World J Surg 1983;7:700-9.  Back to cited text no. 20
    
21.Papini E, Bizzarri G, Pacella CM. Percutaneous laser ablation of benign and malignant thyroid nodules. Curr Opin Endocrinol Diabetes Obes 2008;15:434-9.  Back to cited text no. 21
    
22.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;217:673-7.  Back to cited text no. 22
    
23.Døssing H, Bennedbaek FN, Karstrup S, Hegedüs L. Benign solitary solid cold thyroid nodules: US-guided interstitial laser photocoagulation - Initial experience. Radiology 2002;225:53-7.  Back to cited text no. 23
    
24.Pacella CM, Bizzarri G, Spiezia S, Bianchini A, Guglielmi R, Crescenzi A, et al. Thyroid tissue: US-guided percutaneous laser thermal ablation. Radiology 2004;232:272-80.  Back to cited text no. 24
    
25.Papini E, Guglielmi R, Bizzarri G, Pacella CM. Ultrasound-guided laser thermal ablation for treatment of benign thyroid nodules. Endocr Pract 2004;10:276-83.  Back to cited text no. 25
    
26.Valcavi R, Riganti F, Bertani A, Formisano D, Pacella CM. Percutaneous laser ablation of cold benign thyroid nodules: A 3-year follow-up study in 122 patients. Thyroid 2010;20:1253-61.  Back to cited text no. 26
    
27.Døssing H, Bennedbaek FN, Hegedüs L. Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules: One versus three treatments. Thyroid 2006;16:763-8.  Back to cited text no. 27
    
28.Gambelunghe G, Fatone C, Ranchelli A, Fanelli C, Lucidi P, Cavaliere A, et al. A randomized controlled trial to evaluate the efficacy of ultrasound-guided laser photocoagulation for treatment of benign thyroid nodules. J Endocrinol Invest 2006;29:RC23-6.  Back to cited text no. 28
    
29.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;17:229-35.  Back to cited text no. 29
    
30.Ritz JP, Lehmann KS, Zurbuchen U, Knappe V, Schumann T, Buhr HJ, et al. Ex vivo and in vivo evaluation of laser-induced thermotherapy for nodular thyroid disease. Lasers Surg Med 2009;41:479-86.  Back to cited text no. 30
    
31.Gambelunghe G, Fede R, Bini V, Monacelli M, Avenia N, D'Ajello M, et al. Ultrasound-Guided Interstitial Laser Ablation for Thyroid Nodules Is Effective Only at High Total Amounts of Energy: Results From a Three-Year Pilot Study. Surg Innov 2012 Sep 17. [Epub ahead of print]  Back to cited text no. 31
    
32.Piana S, Riganti F, Froio E, Andrioli M, Pacella CM, Valcavi R. Pathological findings of thyroid nodules after percutaneous laser ablation : A series of 22 cases with cyto-histological correlation. Endocr Pathol 2012;23:94-100.  Back to cited text no. 32
    
33.Cakir B, Topaloglu O, Gul K, Agac T, Aydin C, Dirikoc A, et al. Effects of percutaneous laser ablation treatment in benign solitary thyroid nodules on nodule volume, thyroglobulin and anti-thyroglobulin levels, and cytopathology of nodule in 1 yr follow-up. J Endocrinol Invest 2006;29:876-84.  Back to cited text no. 33
    
34.Ritz JP, Lehmann KS, Schumann T, Knappe V, Zurbuchen U, Buhr HJ, et al. Effectiveness of various thermal ablation techniques for the treatment of nodular thyroid disease - Comparison of laser-induced thermotherapy and bipolar radiofrequency ablation. Lasers Med Sci 2011;26:545-52.  Back to cited text no. 34
    
35.Bean WJ. Renal cysts: Treatment with alcohol. Radiology 1981;138:329-31.  Back to cited text no. 35
    
36.Bean WJ, Rodan BA. Hepatic cysts: Treatment with alcohol. AJR Am J Roentgenol 1985;144:237-41.  Back to cited text no. 36
    
37.Livraghi T, Giorgio A, Marin G, Salmi A, de Sio I, Bolondi L, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: Long-term results of percutaneous ethanol injection. Radiology 1995;197:101-8.  Back to cited text no. 37
    
38.Harman CR, Grant CS, Hay ID, Hurley DL, van Heerden JA, Thompson GB, et al. Indications, technique, and efficacy of alcohol injection of enlarged parathyroid glands in patients with primary hyperparathyroidism. Surgery 1998;124:1011-9.  Back to cited text no. 38
    
39.Crescenzi A, Papini E, Pacella CM, Rinaldi R, Panunzi C, Petrucci L, et al. Morphological changes in a hyperfunctioning thyroid adenoma after percutaneous ethanol injection: Histological, enzymatic and sub-microscopical alterations. J Endocrinol Invest 1996;19:371-6.  Back to cited text no. 39
    
40.Livraghi T, Paracchi A, Ferrari C, Bergonzi M, Garavaglia G, Raineri P, et al. Treatment of autonomous thyroid nodules with percutaneous ethanol injection: Preliminary results. Work in progress. Radiology 1990;175:827-9.  Back to cited text no. 40
    
41.Goletti O, Monzani F, Lenziardi M, Lippolis PV, De Negri F, Caraccio N, et al. Cold thyroid nodules: A new application of percutaneous ethanol injection treatment. J Clin Ultrasound 1994;22:175-8.  Back to cited text no. 41
    
42.Bennedbaek FN, Hegedüs L. Alcohol sclerotherapy for benign solitary solid cold thyroid nodules. Lancet 1995;346:1227.  Back to cited text no. 42
    
43.Zingrillo M, Collura D, Ghiggi MR, Nirchio V, Trischitta V. Treatment of large cold benign thyroid nodules not eligible for surgery with percutaneous ethanol injection. J Clin Endocrinol Metab 1998;83:3905-7.  Back to cited text no. 43
    
44.Kim DW, Rho MH, Park HJ, Kwag HJ. Ultrasonography-guided ethanol ablation of predominantly solid thyroid nodules: A preliminary study for factors that predict the outcome. Br J Radiol 2012;85:930-6.  Back to cited text no. 44
    
45.Guglielmi R, Pacella CM, Bianchini A, Bizzarri G, Rinaldi R, Graziano FM, et al. Percutaneous ethanol injection treatment in benign thyroid lesions: Role and efficacy. Thyroid 2004;14:125-31.  Back to cited text no. 45
    
46.Ahmed M, Brace CL, Lee FT Jr, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology 2011;258:351-69.  Back to cited text no. 46
    
47.Liang P, Wang Y, Yu X, Dong B. Malignant liver tumors: Treatment with percutaneous microwave ablation - Complications among cohort of 1136 patients. Radiology 2009;251:933-40.  Back to cited text no. 47
    
48.Liang P, Wang Y, Zhang D, Yu X, Gao Y, Ni X. Ultrasound guided percutaneous microwave ablation for small renal cancer: Initial experience. J Urol 2008;180:844-8.  Back to cited text no. 48
    
49.Wolf FJ, Grand DJ, Machan JT, Dipetrillo TA, Mayo-Smith WW, Dupuy DE. Microwave ablation of lung malignancies: Effectiveness, CT findings, and safety in 50 patients. Radiology 2008;247:871-9.  Back to cited text no. 49
    
50.Yue W, Wang S, Wang B, Xu Q, Yu S, Yonglin Z, et al. Ultrasound guided percutaneous microwave ablation of benign thyroid nodules: Safety and imaging follow-up in 222 patients. Eur J Radiol 2013;82:e11-6.  Back to cited text no. 50
    
51.Feng B, Liang P, Cheng Z, Yu X, Yu J, Han Z, et al. Ultrasound-guided percutaneous microwave ablation of benign thyroid nodules: Experimental and clinical studies. Eur J Endocrinol 2012;166:1031-7.  Back to cited text no. 51
    
52.Kennedy JE, Ter Haar GR, Cranston D. High intensity focused ultrasound: Surgery of the future? Br J Radiol 2003;76:590-9.  Back to cited text no. 52
    
53.Fry WJ, Mosberg WH Jr, Barnard JW, Fry FJ. Production of focal destructive lesions in the central nervous system with ultrasound. J Neurosurg 1954;11:471-8.  Back to cited text no. 53
    
54.Fry WJ, Barnard JW, Fry EJ, Krumins RF, Brennan JF. Ultrasonic lesions in the mammalian central nervous system. Science 1955;122:517-8.  Back to cited text no. 54
    
55.Esnault O, Franc B, Ménégaux F, Rouxel A, De Kerviler E, Bourrier P, et al. High-intensity focused ultrasound ablation of thyroid nodules: First human feasibility study. Thyroid 2011;21:965-73.  Back to cited text no. 55
    



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  In this article
Abstract
Introduction
Radiofrequency a...
Laser ablation
Ethanol ablation
Newer modalities
High intensity f...
Conclusions
References

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