This document discusses techniques for ablating benign thyroid nodules using laser and percutaneous ethanol injection (PEI). It presents results from studies on using PEI to sclerose thyroid cysts and ablate solid nodules, showing reductions in cyst volume of over 75% and improvements in local symptoms. Laser ablation is also discussed as an alternative minimally invasive technique, with results from a randomized trial showing a 42.7% decrease in nodule volume compared to no significant change with medication alone. Both techniques are presented as less invasive options than surgery for selected patients.

1. HOW TO SCLEROSE THYROID CYSTS AND HOW TO ABLATE SOLID THYROID NODULES WITH LASER Enrico Papini Department of Endocrinology, Regina Apostolorum Hospital - Albano, Roma Azienda Ospedaliera Sant’Eugenio La Patologia Nodulare della Tiroide Roma, 5 Novembre 2011

4. P 0.61 JCEM 1998 P=0.001 P=0.61

9. Prevalently cystic nodule: FNA Recurrence one month after complete drainage

12. Macroscopic appearance of an AFTN resected two days after PEI treatment

13. PEI treatment: histological changes

14. Pre-treatment Vol: 17.6 ml After ethanol infusion Vol: 10 ml 1 month after PEI Vol: 3.6 ml 12 months Vol: 0.4 ml Thyroid cysts: volume changes after PEI

15. Pre-treatment: Vol: 13.7 ml After ethanol infusion: Vol: 9.1 ml 12 months: Vol: 3.3 ml Reduction: 76% Complex nodules: volume changes after PEI

18. Efficacy of PEI treatment: AFTN detectable serum TSH at a 5-yr follow-up AFTN > 5 ml AFTN < 5 ml 40% 60% 20.4% 79.6% 95 cases

19. baseline baseline 5 years 5 years cysts AFTN Solid nodules showed a lower volume reduction and an increased risk of side-effects due to ethanol seeping. P<0,0001 P<0,001

25. Radiology, 2000 Histologic examination: central cavitation area, rim of carbonization, coagulative necrosis, peripheral edema.

26. Laser ablation procedure

28. 62 patients randomized 12-month follow-up to 3 Groups PLA (Group 1) 42.7% decrease L-T4 (Group 2) NS decrease Follow-up (Group 3) NS increase

30. T0 T6 T12 T0 T6 T12 GROUP 1 GROUP 2 Volume changes (ml) at 12 months P<0,0001

31. Volume Changes (percentage) T12 T12 T6 T6 GROUP 1 GROUP 2 P < 0,0001

32. Changes in Simptoms Score after LA Prevalence of local symptoms decreased from 81% of cases at baseline to 26% at the 12-month control. No significant change was reported in Group 2.

33. DISCOMFORT INDUCED BY LA PROCEDURE

35. Mini-invasive procedures: are less invasive than surgery for selected patients?

36. Certainly is less expensive

37. One step into a possible future?

38. Other Thermoablation techniques: the “moving shot” radiofrequency ablation

41. Thank you