Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement

Radiofrequency (RF) induces thermal injury into the target lesion by means of an alternating electric field, produced by an electrode needle connected to an external radiofrequency generator. Tissue necrosis is achieved around the needle tip, through the heating induced by rapid ion movement, in a controlled fashion. First RF ablation studies on thyroid nodules were performed with a 17-gauge internally cooled electrode needle [19–21] or with a 14-gauge device, equipped with expandable hooks to obtain a more extended ablation area [22–24]. After local anesthesia, the needle is inserted into the target nodule through a small incision. The application of RF energy requires several minutes to produce tissue necrosis, without moving the needle (“fixed-electrode procedure”). When the ablation area is obtained, the needle can be removed or relocated in a different part of the lesion, if necessary, to complete the ablation treatment. Radiofrequency ablation and other nonsurgical, minimally invasive, US-guided techniques may play an important role in the management of nodular thyroid disease today and in future clinical practice. This statement was made to clarify this role and to make it consistent in Italian centers for thyroid disease. Focusing on radiofrequency thermal ablation after a comprehensive evaluation of pieces of scientific evidence and experts’ opinions and suggestions, the panel approved several indications for this technique in thyroid pathology, with complete or partial agreement among experts, trying to define the most appropriate treatment in different clinical conditions.