Thyroid nodule thermoablation: at Ospedale Galeazzi-Sant’Ambrogio an alternative to traditional surgery for thyroid tumors

Thermal ablation is a procedure that uses heat to destroy diseased tissues. In oncology, it has been used for several years to treat tumors in the liver, kidneys, lungs, and more recently, the thyroid.

“Under ultrasound guidance,” explains Dr. Mauri, “we insert an extremely thin needle into the tumor. The thermal energy emitted by the needle destroys it, while preserving the surrounding healthy tissue.

The procedure is performed under local anesthesia, on a day surgery basis, without the need for surgical incision, and the patient can go home the same day.”

Thermal ablation is recommended for papillary microcarcinomas, which account for about 70-80% of malignant thyroid tumors. These tumors are generally small (less than 1 cm), have slow growth, and are confined to the thyroid gland, making thermal ablation an optimal option.

Thermal ablation can also be performed on benign nodules that, while not dangerous, can grow in size, becoming visible and, in some cases, cause issues with swallowing or breathing.

“This procedure,” continues Dr. Mauri, “represents a minimally invasive therapeutic option that offers patients an effective and safe solution, minimizing the physical and psychological trauma associated with traditional surgery.

Furthermore, unlike traditional surgery, this technique allows for the preservation of thyroid function.”

However, thermal ablation treatment is constantly evolving, and clinical studies are exploring new applications for larger tumors or more advanced stages. As Mauri states, “We are working to extend the use of thermal ablation to larger tumors and more complex clinical situations.”

Traditional surgical treatment for thyroid tumors, such as thyroidectomy, involves the total or partial removal of the thyroid gland, resulting in the lifelong need for hormone replacement therapy.

In contrast, thermal ablation of nodules offers the possibility of preserving thyroid function, sparing patients from the lifelong intake of synthetic hormones. This represents a significant advantage in terms of post-treatment quality of life.

In summary, the main advantages of treatment with thermal ablation include:

• Procedure performed under local anesthesia, in a day surgery setting, without surgical incisions.
• The procedure is painless or involves only mild discomfort, which disappears within a few hours.
• There are fewer complications associated with traditional surgery.
• The treatment does not require incisions, thus reducing the risk of infections and visible scarring.
• Thyroid function is completely preserved.

Although thermal ablation was initially developed as a treatment for benign thyroid nodules, in recent years it has evolved into an effective option for malignant tumors, particularly for papillary carcinoma.

Thanks to technological advancements and the precision of ultrasound guidance, it is now possible to treat small malignant thyroid tumors with this minimally invasive technique.

“Devices specifically designed for thermal ablation of the neck have only recently been developed, allowing us to apply the technique with great precision even in delicate areas like the thyroid,” emphasizes Dr. Mauri. “The success of this technique has prompted the scientific community to include it in European guidelines for minimally invasive treatments for thyroid cancer.

Indeed, thermal ablation has been recognized by the European Thyroid Association (ETA) and the Cardiovascular and Interventional Society of Europe (CIRSE), which have included the technique among the recommended therapeutic options in cases of papillary microcarcinoma confined to the thyroid.”

“The thermal ablation treatment for the thyroid represents a significant advancement for Interventional Radiology at our hospital,” concludes Prof. Luca Maria Sconfienza, Head of the Diagnostic and Interventional Radiology Unit.

“At IRCCS Ospedale Galeazzi - Sant’Ambrogio, we have long been offering minimally invasive therapeutic treatments guided by imaging, such as percutaneous irrigation for calcific tendinopathy, ultrasound-guided treatment of tendinopathies, and bone and soft tissue biopsies. The great advantage of these procedures is that hospitalization is not required, allowing patients to quickly return to their daily activities.

Looking to the future, our hospital will continue to invest in technological innovation and minimally invasive procedures to provide patients with increasingly safe, effective solutions that respect their quality of life.”