https://orcid.org/0000-0001-9333-2765
In their remarkable paper Mo et al. showed the benefits of using a percutaneous microwave ablation (MWA) procedure to treat benign thyroid nodules [Citation1]. Interestingly, they found that clinical outcomes for benign lesions treated with MWA might differ according to not only factors such as volume or radiological access, but also nodule characteristics (solid, mainly solid or mainly cystic). This work illustrates the necessity of correctly studying the nodules before attempting an MWA procedure. Defining the best nodule characteristics is important, as implementing novel technologies to improve results when treating nodules with larger cystic composition or macrocalcifications might not be a sound therapeutical strategy.
In general terms, we all know that minimally invasive treatments (surgical or radiologic) do have a positive impact on our patients compared to standard/classical open surgery. However, does this also apply to thyroid nodules? It seems MWA would be an alternative to treat some benign thyroid nodules, offering good results in terms of volume reduction, operation-related complications, efficacy and safety, even when compared with other methods such as high-intensity focused ultrasound (HIFU), laser ablation (LA), radiofrequency ablation (RFA) and thyroidectomy.
Aesthetics play an important role in the patients’ decision making, especially for women who would prefer less invasive strategies to avoid the classical anterior surgical neck scar. From that point of view, the surgeons have made an effort to develop new approaches and implemented novel technologies such as the robotic transaxillary procedure, the video assisted thyroidectomy (VATS) or, more recently, the transoral thyroidectomy [Citation2–4]. Although these novel approaches have shown benefits, we need to emphasize that operative times, costs and postoperative consequences after surgery do not favor this approach when treating benign nodules. MWA treatment of thyroid lesions could achieve a therapeutic effect comparable to these aforementioned types of surgery and also protect thyroid function, avoid surgical damage to the patient's body and significantly reduce complications. For this reason, MWA may significantly reduce nodule-related symptoms and nodule volume with a more rapid recovery, more pleasing aesthetic outcomes and less physiologic disruption in a more cost-effective way compared to surgical treatments [Citation5,Citation6]. Other aspects that have been compared are operation times, longer hospital stays, a higher rate of neck pain after surgery and a higher rate of fever compared to MWA groups [Citation5]. However, MWA treatment may imply long-term follow-up and a higher rate of complications should those nodules need surgery eventually.
Recently, other technologies have appeared to optimize MWA treatments. Limited by two-dimensional (2D) imaging, needle placement can be challenging and require advanced skills. Robotic systems could overcome these limitations [Citation7]. The three-dimensional (3D) image-guided robotic-assisted systems could provide, like in the liver treatment, an appealing alternative option that enables the physician to perform consistent, accurate therapy with improved treatment effectiveness. Ideally, adding some sort of laryngeal nerve monitoring during treatment and including better pain control could be an absolute optimization of the treatment of these patients.
Finally, the prevalence of papillary thyroid microcarcinoma (PTMC), which has increased rapidly all around the world, may be palliated with optimal early ultrasound-guided ablation therapy [Citation8]. However, to fully understand the clinical applications of MWA, more investigations are needed. The efficacy and the safety of US-guided ablation in treating PTMC should be considered carefully [Citation8–10].
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Reprints will not be available from the author.
Author contributions
RV and MB did all the commentary.
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References
- Mo H, Wei L, Hui Y, Li Z. Microwave ablation of visible benign thyroid nodules with different internal characteristics: a comparative study with follow-up results. J Invest Surg. 2020. In press.
- Piccoli M, Mullineris B, Gozzo D, et al. Evolution strategies in transaxillary robotic thyroidectomy: considerations on the first 449 cases performed. J Laparoendosc Adv Surg Tech A. 2019;29(4):433–440. doi:https://doi.org/10.1089/lap.2019.0021.
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- Ding M, Tang X, Cui D, et al. Clinical outcomes of ultrasound-guided radiofrequency ablation for the treatment of primary papillary thyroid microcarcinoma. Clin Radiol. 2019;74(9):712–717. doi:https://doi.org/10.1016/j.crad.2019.05.012.]