DOI QR코드

DOI QR Code

양성갑상선결절에 대한 효과적이고 안전한 고주파절제의 적용

Effective and Safe Application of Radiofrequency Ablation for Benign Thyroid Nodules

  • 성진용 (대림성모병원 갑상선센터 영상의학과)
  • Jin Yong Sung (Department of Radiology, Thyroid Center, Daerim St. Mary's Hospital)
  • 투고 : 2023.06.07
  • 심사 : 2023.06.30
  • 발행 : 2023.09.01

초록

고주파절제는 외모상의 문제나 경부 압박 증상을 유발하는 양성갑상선결절에 대한 대표적인 비수술적 치료법으로 시술은 효과적이면서도 안전하게 시행되어야 한다. 이 종설은 갑상선고주파절제에 대한 권고안들과 연구 논문들을 참조하여 대상 환자 선정, 시술 전 평가 및 치료 계획, 치료 원리 및 치료 기구, 시술법, 합병증 등에 대한 정보를 제공하려는 목적으로 작성되었다. 특히 시술법에 많은 부분을 할애해 시술 시행에 실질적인 도움을 주고자 한다.

Radiofrequency ablation (RFA) has been a representative, non-surgical treatment for benign thyroid nodules that cause cosmetic problems or compression symptoms. The procedure of RFA should be performed effectively and safely. This review discusses the patient selection, pre-procedure evaluation and planning, principles, devices, techniques, and complications with reference to the guidelines and research on thyroid RFA. In particular, this review will devote to introduce RFA techniques and to provide practical help in the implementation of this procedure.

키워드

참고문헌

  1. Papini E, Monpeyssen H, Frasoldati A, Hegedus L. 2020 European thyroid association clinical practice guideline for the use of image-guided ablation in benign thyroid nodules. Eur Thyroid J 2020;9:172-185
  2. Papini E, Pacella CM, Solbiati LA, Achille G, Barbaro D, Bernardi S, et al. Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid (MITT) group. Int J Hyperthermia 2019;36:376-382
  3. Na DG, Lee JH, Jung SL, Kim JH, Sung JY, Shin JH, et al. Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations. Korean J Radiol 2012;13:117-125
  4. Kim JH, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, et al. 2017 thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology. Korean J Radiol 2017;19:632-655
  5. Baek JH, Na DG, Lee JH, Jung SL, Sung JY, Sim JS, et al. Korean society of thyroid radiology recommendations for radiofrequency ablation of thyroid nodules. Available at. https://www.thyroidimaging.kr/bbs/index.html?code=pds&category=A&gubun=&page=2&number=6&mode=view&keyfield=&key=. Published 2009. Accessed September 6, 2023
  6. Orloff LA, Noel JE, Stack BC Jr, Russell MD, Angelos P, Baek JH, et al. Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: an international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association. Head Neck 2022;44:633-660
  7. Dobnig H, Zechmann W, Hermann M, Lehner M, Heute D, Mirzaei S, et al. Radiofrequency ablation of thyroid nodules: "good clinical practice recommendations" for Austria : an interdisciplinary statement from the following professional associations: Austrian Thyroid Association (OSDG), Austrian Society for Nuclear Medicine and Molecular Imaging (OGNMB), Austrian Society for Endocrinology and Metabolism (OGES), Surgical Endocrinology Working Group (ACE) of the Austrian Surgical Society (OEGCH). Wien Med Wochenschr 2020;170:6-14
  8. Ha EJ, Baek JH, Che Y, Chou YH, Fukunari N, Kim JH, et al. Radiofrequency ablation of benign thyroid nodules: recommendations from the Asian Conference on Tumor Ablation Task Force. Ultrasonography 2021;40:75-82
  9. Sung JY, Baek JH, Jung SL, Kim JH, Kim KS, Lee D, et al. Radiofrequency ablation for autonomously functioning thyroid nodules: a multicenter study. Thyroid 2015;25:112-117
  10. Baek JH, Lee JH, Valcavi R, Pacella CM, Rhim H, Na DG. Thermal ablation for benign thyroid nodules: radiofrequency and laser. Korean J Radiol 2011;12:525-540
  11. Goldberg SN. Radiofrequency tumor ablation: principles and techniques. Eur J Ultrasound 2001;13:129-147
  12. Lee J, Shin JH, Hahn SY, Park KW, Choi JS. Feasibility of adjustable electrodes for radiofrequency ablation of benign thyroid nodules. Korean J Radiol 2020;21:377-383
  13. Park HS, Baek JH, Park AW, Chung SR, Choi YJ, Lee JH. Thyroid radiofrequency ablation: updates on innovative devices and techniques. Korean J Radiol 2017;18:615-623
  14. Ahn HS, Kim SJ, Park SH, Seo M. Radiofrequency ablation of benign thyroid nodules: evaluation of the treatment efficacy using ultrasonography. Ultrasonography 2016;35:244-252
  15. Huh JY, Baek JH, Choi H, Kim JK, Lee JH. Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session--prospective randomized study. Radiology 2012;263:909-916
  16. Baek JH, Ha EJ, Choi YJ, Sung JY, Kim JK, Shong YK. Radiofrequency versus ethanol ablation for treating predominantly cystic thyroid nodules: a randomized clinical trial. Korean J Radiol 2015;16:1332-1340
  17. Ha EJ, Baek JH, Lee JH. Moving-shot versus fixed electrode techniques for radiofrequency ablation: comparison in an ex-vivo bovine liver tissue model. Korean J Radiol 2014;15:836-843
  18. Park HS, Baek JH, Choi YJ, Lee JH. Innovative techniques for image-guided ablation of benign thyroid nodules: combined ethanol and radiofrequency ablation. Korean J Radiol 2017;18:461-469
  19. Lim HK, Lee JH, Ha EJ, Sung JY, Kim JK, Baek JH. Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients. Eur Radiol 2013;23:1044-1049
  20. Jeong SY, Baek JH, Chung SR, Choi YJ, Chung KW, Kim TY, et al. Radiofrequency ablation of benign thyroid nodules: the value of anterolateral hydrodissection. Ultrasonography 2023;42:432-439
  21. Shin JH, Baek JH, Ha EJ, Lee JH. Radiofrequency ablation of thyroid nodules: basic principles and clinical application. Int J Endocrinol 2012;2012:919650
  22. Laeseke PF, Sampson LA, Brace CL, Winter TC 3rd, Fine JP, Lee FT Jr. Unintended thermal injuries from radiofrequency ablation: protection with 5% dextrose in water. AJR Am J Roentgenol 2006;186(5 Suppl):S249-S254
  23. Chung SR, Baek JH, Choi YJ, Lee JH. Thermal ablation for the management of papillary thyroid microcarcinoma in the era of active surveillance and hemithyroidectomy. Curr Oncol Rep 2022;24:1045-1052
  24. Sim JS, Baek JH, Lee J, Cho W, Jung SI. Radiofrequency ablation of benign thyroid nodules: depicting early sign of regrowth by calculating vital volume. Int J Hyperthermia 2017;33:905-910
  25. Jung SL, Baek JH, Lee JH, Shong YK, Sung JY, Kim KS, et al. Efficacy and safety of radiofrequency ablation for benign thyroid nodules: a prospective multicenter study. Korean J Radiol 2018;19:167-174
  26. Baek JH, Lee JH, Sung JY, Bae JI, Kim KT, Sim J, et al. Complications encountered in the treatment of benign thyroid nodules with US-guided radiofrequency ablation: a multicenter study. Radiology 2012;262:335-342
  27. Ha EJ, Baek JH, Lee JH. The efficacy and complications of radiofrequency ablation of thyroid nodules. Curr Opin Endocrinol Diabetes Obes 2011;18:310-314
  28. Wang JF, Wu T, Hu KP, Xu W, Zheng BW, Tong G, et al. Complications following radiofrequency ablation of benign thyroid nodules: a systematic review. Chin Med J (Engl) 2017;130:1361-1370
  29. Chung SR, Suh CH, Baek JH, Park HS, Choi YJ, Lee JH. Safety of radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: a systematic review and meta-analysis. Int J Hyperthermia 2017;33:920-930
  30. Ha EJ, Baek JH, Lee JH. Ultrasonography-based thyroidal and perithyroidal anatomy and its clinical significance. Korean J Radiol 2015;16:749-766
  31. Kim C, Lee JH, Choi YJ, Kim WB, Sung TY, Baek JH. Complications encountered in ultrasonography-guided radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers. Eur Radiol 2017;27:3128-3137
  32. Ha EJ, Baek JH, Lee JH, Kim JK, Shong YK. Clinical significance of vagus nerve variation in radiofrequency ablation of thyroid nodules. Eur Radiol 2011;21:2151-2157
  33. Shin JE, Baek JH, Ha EJ, Choi YJ, Choi WJ, Lee JH. Ultrasound features of middle cervical sympathetic ganglion. Clin J Pain 2015;31:909-913
  34. Chung SR, Baek JH, Choi YJ, Lee JH. Management strategy for nerve damage during radiofrequency ablation of thyroid nodules. Int J Hyperthermia 2019;36:204-210
  35. Lee MK, Baek JH, Chung SR, Choi YJ, Lee YM, Kim TY, et al. Effectiveness of injecting cold 5% dextrose into patients with nerve damage symptoms during thyroid radiofrequency ablation. Endocrinol Metab (Seoul) 2020;35:407-415
  36. Ha EJ, Baek JH, Lee JH, Sung JY, Lee D, Kim JK, et al. Radiofrequency ablation of benign thyroid nodules does not affect thyroid function in patients with previous lobectomy. Thyroid 2013;23:289-293
  37. Hong MJ, Baek JH, Choi YJ, Lee JH, Lim HK, Shong YK, et al. Radiofrequency ablation is a thyroid function-preserving treatment for patients with bilateral benign thyroid nodules. J Vasc Interv Radiol 2015;26:55-61
  38. Shin JH, Jung SL, Baek JH, Kim JH. Rupture of benign thyroid tumors after radio-frequency ablation. AJNR Am J Neuroradiol 2011;32:2165-2169
  39. Chung SR, Baek JH, Sung JY, Ryu JH, Jung SL. Revisiting rupture of benign thyroid nodules after radiofrequency ablation: various types and imaging features. Endocrinol Metab (Seoul) 2019;34:415-421