ĐỒNG THUẬN CHUYÊN GIA VỀ ĐIỀU TRỊ NHÂN TUYẾN GIÁP BẰNG PHƯƠNG PHÁP ĐỐT SÓNG CAO TẦN (RFA)
Nội dung chính của bài viết
Tóm tắt
Background:
Radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option for benign thyroid nodules and selected malignant thyroid diseases. While international guidelines—particularly from the Korean Society of Thyroid Radiology (KSThR)—have provided comprehensive recommendations, a nationally adapted consensus reflecting local clinical practice and resource availability remains necessary.
Objective:
To develop a Vietnamese expert consensus on the indications, pre-procedural evaluation, technical considerations, post-procedural assessment, and safety of ultrasound-guided radiofrequency ablation for benign thyroid nodules, low-risk primary papillary thyroid carcinoma, and recurrent thyroid carcinoma.
Methods:
This consensus was developed through a multidisciplinary expert panel including endocrinologists, nuclear medicine physicians, head and neck surgeons, interventional radiologists, and pathologists. Recommendations were formulated based on a systematic review of the literature, with particular emphasis on KSThR, Korean Thyroid Association, American Thyroid Association, and recent meta-analyses. The strength of recommendations was graded according to available evidence and expert agreement.
Results:
RFA is recommended as an effective and safe treatment for symptomatic benign thyroid nodules, autonomously functioning thyroid nodules, selected low-risk papillary thyroid carcinoma in carefully chosen patients, and locoregional recurrent thyroid carcinoma in patients who are poor surgical candidates or refuse surgery. Clear criteria for patient selection, imaging evaluation, technical execution, and post-ablation follow-up are presented. When performed by experienced operators in specialized centers, RFA demonstrates high volume reduction rates, favorable local tumor control, preservation of thyroid function, and low complication rates.
Conclusion:
This Vietnamese expert consensus provides standardized, evidence-based recommendations for thyroid RFA tailored to local clinical practice. RFA represents a valuable therapeutic option in appropriately selected patients and should be integrated into multidisciplinary thyroid disease management algorithms.
Chi tiết bài viết
Tài liệu tham khảo
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2. Choi SJ, Jeong WK, Jo AJ, Choi JA, Kim MJ, Lee M, et al. Methodology for Developing Evidence-Based Clinical Imaging Guidelines: Joint Recommendations by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency. Korean J Radiol. 2017;18(1):208–16.
3. Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, et al. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol. 2021 Dec 1;22(12):2094–123.
4. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid Off J Am Thyroid Assoc. 2016 Jan;26(1):1–133.
5. 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 Apr;194(4):1137–42.
6. 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 July;34(7):1488–93.
7. 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 May;81(5):905–10.
8. Deandrea M, Limone P, Basso E, Mormile A, Ragazzoni F, Gamarra E, et al. US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules. Ultrasound Med Biol. 2008 May;34(5):784–91.
9. Eng OS, Potdevin L, Davidov T, Lu SE, Chen C, Trooskin SZ. Does nodule size predict compressive symptoms in patients with thyroid nodules? Gland Surg. 2014 Nov;3(4):232–6.
10. Banks CA, Ayers CM, Hornig JD, Lentsch EJ, Day TA, Nguyen SA, et al. Thyroid disease and compressive symptoms. The Laryngoscope. 2012 Jan;122(1):13–6.
11. Shin JH, Baek JH, Chung J, Ha EJ, Kim J hoon, Lee YH, et al. Ultrasonography Diagnosis and Imaging-Based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol. 2016 June 1;17(3):370–95.
12. Anand B, Ramdas A, Ambroise MM, Kumar NP. The Bethesda System for Reporting Thyroid Cytopathology: A Cytohistological Study. J Thyroid Res. 2020 Apr 16;2020:8095378.
13. Na DG, Baek JH, Jung SL, Kim J hoon, Sung JY, Kim KS, et al. Core Needle Biopsy of the Thyroid: 2016 Consensus Statement and Recommendations from Korean Society of Thyroid Radiology. Korean J Radiol. 2017;18(1):217–37.
14. McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery. 2007 Dec;142(6):837–44; discussion 844.e1-3.
15. Mehanna R, Murphy M, McCarthy J, O’Leary G, Tuthill A, Murphy MS, et al. False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. The Laryngoscope. 2013 May;123(5):1305–9.
16. Agcaoglu O, Aksakal N, Ozcinar B, Sarici IS, Ercan G, Kucukyilmaz M, et al. Factors that affect the false-negative outcomes of fine-needle aspiration biopsy in thyroid nodules. Int J Endocrinol. 2013;2013:126084.
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