RE: 2017 Thyroid Radiofrequency Ablation Guideline: The Korean Society of Thyroid Radiology

Dear Editor,

With great interest, we read the article “2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology” (1). In recent years, both Korea and Italy have published recommendations for treating thyroid nodules with radiofrequency ablation (RFA) (2,3). Since 2009, the Korean Society of Thyroid Radiology (KSThR) has continuously updated the recommendations regarding thyroid RFA. The 2017 guidelines proposed by the KSThR include indications, pre-procedural evaluations, procedures, post-procedural monitoring, efficacy, and safety with abundant meaningful evidences.

In the present article, in addition to the trans-isthmic approach and moving-shot technique, which are two basic techniques for thyroid RFA, the authors briefly mention vascular ablation techniques, which have been introduced to minimize marginal regrowth. Park et al. (4) have proposed vascular ablation techniques, including the arteryfirst and marginal venous ablation techniques, to improve the efficacy of thyroid RFA. According to our experience, it is not uncommon to find marginal veins surrounding thyroid nodules; however, finding a feeding artery is significantly less likely. Additionally, we must question whether or not it is safe to ablate a feeding artery without covering it with sufficient isthmic tissue or to ablate the marginal veins without ablating the feeding artery. We also believe that vascular ablation techniques may not be simple for beginners and could result in a greater number of bleeding complication events. However, we noted the recommendations as interesting and would like to thank the authors for this highly beneficial work.

Based on our preliminary experience with thyroid RFA, we believe that the recommendations for thyroid RFA reported by the KSThR are appropriate for clinical practice and that the proposed key issues may provide a more comprehensive review for doctors interested in thyroid RFA.