Introduction
Although patients with papillary thyroid carcinoma have very favorable courses of treatment, based on risk factors, locoregional recurrence to the neck can range from 20% to 60%.1
In cases where surgery is contraindicated or refused by the patient for recurrent thyroid malignancy, the American Thyroid Association guidelines propose radiofrequency ablation (RFA) as a possible treatment option. RFA has emerged as an effective treatment option for various solid types of cancer.2
In 2 recent studies conducted in Korea and China, RFA has been shown to be safe and effective for the management of cervical lymph node metastases of papillary thyroid cancer.1,3 There are very limited data from the United States on the use of RFA for the treatment of cervical lymph node metastases in papillary thyroid cancer.4
Case Description
We present a patient with a history of well-differentiated papillary cancer who had cervical metastatic disease. A 37-year-old woman with metastatic disease had a lymph node at level IV on the right that measured 1.0 × 0.5 × 0.8 cm. Recurrence was confirmed by ultrasound-guided fine needle aspiration cytology and serum thyroglobulin (Tg) washout. The patient refused surgery and elected to have RFA for treatment. The pretreatment Tg level was 1.5 mg/dL.
Technique
RFA was performed using an RFA system (STARmed Co Ltd) using an 18-gauge internally cooled electrode that was 7 cm in length with a 0.7-cm active tip. The electrode was powered by the VIVA RF generator (STARmed Co Ltd) at 30 W of power. Local anesthesia with lidocaine was used to provide adequate analgesia.
A hydrodissection was performed to protect the surrounding normal tissue. A fixed ablation technique was used given the small lesion and absence of significant space for a moving shot technique. The ablated area showed hyperechogenicity because of thermal ablation, and the electrode was repositioned to continue the ablation in a different region. Untreated sections of the node were targeted until the node was completely ablated.
Results
Follow-up ultrasound imaging at 6 months showed a reduction in the size of the target node such that it was no longer visible on ultrasound. The posttreatment Tg level was undetectably low at <0.1 ng/dL.
Conclusions
RFA can be performed in a private, outpatient endocrinology practice as a treatment option for recurrent papillary thyroid cancer in select cases.
Disclosure
The authors have no multiplicity of interest to disclose.
Supplementary Material
References
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