Table 3.
Summary of recommendations
| Key question | Recommendation | Evidence level | Delphi score | Grading of recommendation |
|---|---|---|---|---|
| 1. What are the indications for RFA for benign thyroid nodules? | 1-1. RFA is indicated for patients with benign thyroid nodules complaining of symptomatic or cosmetic problems. | Moderate | 9 | Strong |
| 1-2. Thyroid nodules should be confirmed as benign on at least two US-guided FNA or CNB before RFA. | Moderate | 8 | Strong | |
| 1-3. A single benign diagnosis on FNA or CNB is sufficient when the nodule has US features highly specific for benignity (isoechoic spongiform nodule or partially cystic nodules with intracystic comet tail artifact). | High | 8 | Strong | |
| 1-4. A single benign diagnosis on FNA or CNB is sufficient for confirmation of a benign nodule identified as an AFTN. | Low | 8 | Weak | |
| 1-5. RFA can be indicated for AFTN, either toxic or pre-toxic. | Moderate | 8 | Weak | |
| 2. What are the indications for RFA for recurrent thyroid cancers? | 2. RFA can be performed for curative or palliative purposes in recurrent thyroid cancers at the thyroidectomy bed and cervical lymph nodes for patients at high surgical risk or who refuse surgery. | Moderate | 9 | Strong |
| 5. What is the appropriate laboratory and imaging evaluation for patients with symptomatic benign thyroid nodule or recurrent thyroid cancer before RFA? | 3. Before RFA of a symptomatic benign thyroid nodule or recurrent thyroid cancer, a pre-procedural checklist should be evaluated (Table 4). | Moderate | 8 | Weak |
| 6. What is the appropriate recommendation for patients taking anticoagulants or anti-platelet drugs before RFA? | 4. Before RFA, patients with a bleeding tendency, such as those taking anticoagulation medications or those with disorders affecting the coagulation cascade, should be thoroughly evaluated, and any problems should be corrected. | Low | 10 | Weak |
| 7. What is the appropriate technique for RFA of benign thyroid nodules? | 5-1. For pain control of RFA of benign thyroid nodules, local anesthesia, rather than general anesthesia or deep sedation, is recommended. Perithyroidal lidocaine injection is recommended as the local anesthesia technique. | Moderate | 8 | Strong |
| 5-2. For RFA of benign thyroid nodules, the trans-isthmic approach method and moving-shot technique are recommended as the standard procedure. | Moderate | 8.5 | Strong | |
| 8. What is the appropriate technique for RFA of recurrent thyroid cancers? | 6. For RFA of recurrent thyroid cancers, perilesional lidocaine injection, the hydrodissection technique, and the moving-shot technique are recommended as standard techniques. | Low | 8 | Weak |
| 9. What is the appropriate clinical, laboratory, and imaging evaluation for nonfunctioning benign thyroid nodules after RFA? | 7. After RFA for nonfunctioning benign thyroid nodules, clinical, laboratory, and imaging checklists should be evaluated (Table 7). | Moderate | 8 | Weak |
| 10. What is the appropriate clinical, laboratory, and imaging evaluation for AFTN after RFA? | 8. After RFA for AFTN, clinical, laboratory, and imaging checklists should be evaluated (Table 7). | Moderate | 8 | Weak |
| 13. What is the appropriate composition of benign thyroid nodules for RFA? | 9-1. RFA is recommended as the first-line treatment method for solid and predominantly solid nodules, although it is also an effective treatment method to manage non-functioning thyroid nodules, regardless of the degree of solidity. | Moderate | 8 | Strong |
| 9-2. EA is recommended as the first-line treatment method for cystic and predominantly cystic nodules. RFA can be recommended as the next step in cases with incomplete resolved symptoms or recurrence following EA. | High | 9 | Strong | |
| 14. Is a single treatment enough for patients with non-functioning thyroid nodules? | 10. Depending on the size and location of the nodule, additional treatment may be required. Additional treatment may be considered if the nodule shows marginal regrowth or if cosmetic or symptomatic problems are incompletely resolved. | Moderate | 8 | Strong |
| 18. Is RFA a safe and tolerable procedure? | 11. RFA is safe and well-tolerated and is associated with a low incidence of complications when performed by experienced operators. | High | 9 | Strong |
RFA, radiofrequency ablation; US, ultrasoound; FNA, fine-needle aspiration; CNB, core-needle biopsy; AFTN, autonomously functioning thyroid nodule; EA, ethanol ablation.