Microwave ablation for large benign thyroid nodules: a proposal for a new approach: “the fluid-motion technique”

• Published in: Updates in surgery Vol. 76; no. 1; pp. 239 - 244
• Main Authors: Aliberti, C., Impellizzeri, H., Inama, M., Moretto, G., Vitali, A., Balduzzi, A., Toaiari, M., Francia, G., Casaril, A.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 2024
• Subjects: Catheter Ablation - methods; Humans; Medicine; Medicine & Public Health; Microwaves - therapeutic use; Original Article; Radiofrequency Ablation; Retrospective Studies; Surgery; Thyroid Nodule - diagnostic imaging; Thyroid Nodule - surgery; Treatment Outcome; Minimally invasive techniques; Microwave ablation; Benign thyroid nodules
• ISSN: 2038-131X; 2038-3312
• DOI: 10.1007/s13304-023-01663-9

Introduction
Most thyroid nodules are benign, and treatment is primarily indicated for patients with symptoms or cosmetic concerns related to nodular volume. Recently, there has been growing interest in nonsurgical and minimally invasive techniques for the treatment of symptomatic benign thyroid nodules, including microwave ablation (MWA).
AIMS
This study aims to evaluate the effectiveness, efficacy, and safety of ultrasound-guided uncooled MWA in the treatment of benign symptomatic thyroid nodules, using a new ablation technique called the "fluid-motion technique."
Materials and methods
From April 2021 to February 2023, a total of 150 patients with benign thyroid nodules were treated using MWA at the Endocrine Surgery Unit of Pederzoli Hospital, Peschiera del Garda (Italy), with 102 of them being followed-up for at least 6 months.
Results
Before treatment, the mean major diameter was 38.4 ± 10.0 mm, and the mean volume was 13.6 ± 10.5 mL. At 1 month, the mean volume was 6.8 ± 6.2 mL, and at 3 months, it was 4.6 ± 4.1 mL. The mean Volume Reduction Rate (VRR) at 3 months was 61.1 ± 22.0%. Of the nodules, 17 (17%), 65 (66%), and 20 (19%) had volumes ≤ 10, 10.1–20, and ≥ 20.1 mL, respectively. For these nodules, the mean VRR at 3 and 6 months was 55.3 ± 16%, 63.4 ± 24.8%, 72 ± 26.9% and 68.0 ± 11.2%, 73.5 ± 18.3%, and 81.6 ± 15.8%, respectively.
Conclusion
Our study shows that ultrasound-guided MWA is an effective and safe minimally invasive treatment for benign thyroid nodules. The goal is to achieve a VRR that can reduce symptoms and improve cosmetic appearance.