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Ultr Ultrasound-guided asound-guided percutaneous rradiofrequency adiofrequency ablation for benign th thyroid yroid nodules Interventional procedures guidance Published: 22 June 2016 nice.org.uk/guidance/ipg562
Your responsibility This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.
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Recommendations
1.1
Current evidence on the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation for benign thyroid nodules is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
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Ultrasound-guided percutaneous radiofrequency ablation for benign thyroid nodules (IPG562)
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Indications and current treatments
2.1
Thyroid nodules may be cystic, colloid, hyperplastic, adenomatous or cancerous. The majority of thyroid nodules are benign and they are often asymptomatic. There may be a single thyroid nodule (solitary nodule) or multiple thyroid nodules (multinodular goitre). Thyroid nodules can cause an overactive thyroid, which affects the normal production of thyroxine or triiodothyronine.
2.2
Treatment of benign thyroid nodules may be necessary if they are symptomatic or causing cosmetic problems. Conventional treatment includes suppressive levothyroxine therapy or surgery. More recently, other approaches that are less invasive than conventional surgery have been introduced, such as ethanol ablation and percutaneous laser ablation.
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The procedure
3.1
Radiofrequency ablation is a minimally invasive technique that aims to reduce symptoms and improve cosmetic appearance, while preserving thyroid function, and with fewer complications than surgery.
3.2
Before treatment, the thyroid nodule is confirmed as benign, typically by the use of 2 fine-needle aspiration biopsies. Ultrasound-guided percutaneous radiofrequency ablation for benign thyroid nodules is usually done in an outpatient setting using local anaesthesia. The patient lies in the supine position with moderate neck extension. A radiofrequency electrode is inserted into the nodule using ultrasound guidance to visualise the electrode during the procedure. Once in position, the radiofrequency electrode is activated to heat and destroy the tissue.
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Efficacy
This section describes efficacy outcomes from the published literature that the Committee considered as part of the evidence about this procedure. For more detailed information on the evidence, see the interventional procedure overview. 4.1
In a systematic review of 284 patients with benign thyroid nodules treated by radiofrequency ablation (RFA), the mean nodule volume reduced by 9.8 ml after the procedure (95% confidence interval [CI] −13.83 to −5.72; 9 studies,
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Ultrasound-guided percutaneous radiofrequency ablation for benign thyroid nodules (IPG562) n=284 nodules; I2=98% [significant heterogeneity]). In a randomised controlled trial (RCT) of 84 patients with benign solid thyroid nodules, the mean nodule volume reduced from 24.5(±19.6) ml at baseline to 8.6(±9.5) ml at 6-month follow-up (p
