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Radiofrequency and Ethanol Ablation for Thyroid
S114
Ultrasound in Medicine and Biology
T9-16-IN05 Ultrasound-Guided Percutaneous Laser Ablation of Unifocal Papillary Thyroid Microcarcinoma Weiwei Zhan Ultrasound Department, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Papillary thyroid microcarcinoma (PTMC) is usually associated with a favourable outcome. Management of PTMC varies from observation to total thyroidectomy and post-operative radioiodine therapy, but occasionally becomes a dilemma for patients who are unwilling to undergo surgery or are at high risk for surgery. Although the nature of PTMC is indolent, a few cases of local spread or distant metastases have also been reported in the long-term follow-up. Percutaneous laser ablation (PLA) is a minimally invasive technique that has been widely applied to benign thyroid nodules and demonstrated to be effective for reducing the volume of benign nodules. In our study, ultrasound-guided PLA was applied in treatment of unifocal PTMC. Conventional ultrasound and contrast enhanced ultrasound were used to evaluate the target lesion before and after PLA. Cytology and pathology were used to evaluate the efficacy of PLA. Short-term and long-term follow up was also performed after PLA. Ultrasound-guided PLA is an effective and safe method for treating unifocal PTMC. T9-16-IN06 Radiofrequency and Ethanol Ablation for Thyroid Jung Hwan Baek Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Thyroid nodules are common in clinical practice. Most thyroid nodules are benign and treatment is unnecessary; however treatment is required for cosmetic or symptomatic reasons. For cystic and predominantly cystic thyroid nodules, ethanol ablation (EA) has been suggested as a first line non-surgical treatment. However EA is ineffective for solid thyroid nodules. To overcome these drawbacks of EA, thermal ablation techniques, such as laser ablation (LA) and radiofrequency ablation (RFA), have been suggested. The goal of this lecture is to review the role of the ethanol and thermal ablations and determine how to select the best treatment modality among the different techniques currently available (EA, LA and RFA) based on the clinical evidence. Free Paper OPT9-001 Problems of Thyroid Ultrasound Screening–Based on the Results of Thyroid Screening Conducted at Our Facility 25 Years Ago in Japan Koji Takebe, Takashi Arai Department of Breast and Thyroid Surgery, Takebe Breast Surgery Clinic, Japan Objectives: Surgical cases of papillary thyroid cancer have increased in many countries recently. The main factor is that the ultrasound examination device is widely used. Improved image quality is also a factor. We present the results of thyroid cancer screening through ultrasound examinations performed 25 years ago and mention the problem of over-diagnosis in thyroid cancer screening. Methods: From 1990 to 1995, we presented the results of our ultrasound screening for thyroid cancer in Kagawa Prefecture, Japan (1 million people). The subjects were 11,189 women with no neck symptoms. They were examined using a surface ultrasonic apparatus. After detecting
Volume 43, Number S1, 2017 abnormalities, fine needle aspiration cytology was carried out. If the patient were diagnosed with cancer, a lobectomy was performed with a side neck lymph node dissection. Results: 140 cases of thyroid cancer were detected in this screening. The histological type of all detected cancer was papillary carcinoma. The detection rate of tumors with diameters of 3mm or more was 3.6%; 10mm or more was 0.88%; 15mm in the tumor diameter was 0.27%. Lymph node metastasis was observed 33% in tumors sized 39mm, 56% in tumors sized 1014mm, and 94% in tumors sized 15mm or more.If we enforce the thyroid cancer screening by ultrasound examination, the detection of thyroid cancer in 3mm or more is 3600 per 100,000 women, the detection of 10mm or more is 880 per 100,000 women. But the annual number of suffering from thyroid cancer in Japan is approximately only 7 per 100,000 women. The deviation between the two is very large. We inferred that small papillary thyroid cancer is passed without problems accompanied by lymph node metastasis. For thyroid cancer screening using ultrasound, the problem of over-diagnosis is raised. Conclusions: The detection of thyroid cancer through aggressive use of ultrasound is not recommended. Surgical indications of subclinical thyroid cancer should be determined with restraint. Asymptomatic small papillary carcinoma should be regarded as innocuous. OPT9-002 To Establish the True Positive Percentage of Cases Where Ultrasound Detected Nodules in Sestamibi Negative Cases of Hyperparathyroidism. Retrospective Data from A Single Institution’’ Alka Ashmita Singhal,1 Sanjay Baijal,1 Deepak Sarin,2 Ambrish Mithal,3 Sunil Mishra,3 Shafi Kuchay,3 Beena Bansal,3 Parjeet Kaur,3 Sowrabh Arora,2 Jasjeet Wasir3 1 Department of Medanta Division of Radiology And Nuclear Medicine, Medanta The Medicity, India, 2Department of Head And Neck Oncosurgery, Medanta The Medicity, 3Division of Endocrinology and Diabetes, Medanta The Medicity Objectives: To evaluate the value addition of ultrasound, over sestamibi scan in patients with hyperparathyroidism. To establish the percentage of cases where ultrasound detected nodules in sestamibi negative cases of hyperparathyroidism. Methods: Retrospective study from year 2013 to 2017. A total of 250 patients of Hyperparathyroidism who had both ultrasound and Sestamibi scan for parathyroid localization and were operated at our institution were included. Ultrasound localized parathyroid as a hypoechoic ovoid nodule with arc of vascularity. Diagnostic findings were recorded. Among them 175 patients (70%) were positive on both Sestamibi Scan and Ultrasound and 65 patients (26%) were Sestamibi negative and were detected on ultrasound. Remaining 10 patients were negative on both ultrasound and Sestamibi. Of which 5 patients (2%) had Methionine PET & 5 patients (2%) had no further imaging done. Results: Of the 250 patients,175 patients (70%) were positive on both Sestamibi Scan & Ultrasound and 65 patients (26%) were Sestamibi negative & were positive on ultrasound only. Remaining 10 (4%) patients were positive on Sestamibi, but negative on ultrasound. Of which in 5 patients (2%) the nodules were located in the mediastinum and 5 (2%) patients the nodules were located in neck. Of the nodules localized on both Sestamibi and ultrasound 173 patients (98.8%) were true positive at Surgery. Of the nodules localized only on ultrasound 61 patients (93.8%) were true positive at surgery. Ultrasound Detected Nodules in Sestamibi Negative Cases in 26% Cases and of Which True Positive at Surgery Were 24.4%. Conclusions: Ultrasound finds true positive parathyroid nodules in significant number of Sestamibi Negative cases (24.4 % in our study) and finds additional nodules in cases where sestamibi showed only one
Ultrasound in Medicine and Biology
T9-16-IN05 Ultrasound-Guided Percutaneous Laser Ablation of Unifocal Papillary Thyroid Microcarcinoma Weiwei Zhan Ultrasound Department, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Papillary thyroid microcarcinoma (PTMC) is usually associated with a favourable outcome. Management of PTMC varies from observation to total thyroidectomy and post-operative radioiodine therapy, but occasionally becomes a dilemma for patients who are unwilling to undergo surgery or are at high risk for surgery. Although the nature of PTMC is indolent, a few cases of local spread or distant metastases have also been reported in the long-term follow-up. Percutaneous laser ablation (PLA) is a minimally invasive technique that has been widely applied to benign thyroid nodules and demonstrated to be effective for reducing the volume of benign nodules. In our study, ultrasound-guided PLA was applied in treatment of unifocal PTMC. Conventional ultrasound and contrast enhanced ultrasound were used to evaluate the target lesion before and after PLA. Cytology and pathology were used to evaluate the efficacy of PLA. Short-term and long-term follow up was also performed after PLA. Ultrasound-guided PLA is an effective and safe method for treating unifocal PTMC. T9-16-IN06 Radiofrequency and Ethanol Ablation for Thyroid Jung Hwan Baek Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Thyroid nodules are common in clinical practice. Most thyroid nodules are benign and treatment is unnecessary; however treatment is required for cosmetic or symptomatic reasons. For cystic and predominantly cystic thyroid nodules, ethanol ablation (EA) has been suggested as a first line non-surgical treatment. However EA is ineffective for solid thyroid nodules. To overcome these drawbacks of EA, thermal ablation techniques, such as laser ablation (LA) and radiofrequency ablation (RFA), have been suggested. The goal of this lecture is to review the role of the ethanol and thermal ablations and determine how to select the best treatment modality among the different techniques currently available (EA, LA and RFA) based on the clinical evidence. Free Paper OPT9-001 Problems of Thyroid Ultrasound Screening–Based on the Results of Thyroid Screening Conducted at Our Facility 25 Years Ago in Japan Koji Takebe, Takashi Arai Department of Breast and Thyroid Surgery, Takebe Breast Surgery Clinic, Japan Objectives: Surgical cases of papillary thyroid cancer have increased in many countries recently. The main factor is that the ultrasound examination device is widely used. Improved image quality is also a factor. We present the results of thyroid cancer screening through ultrasound examinations performed 25 years ago and mention the problem of over-diagnosis in thyroid cancer screening. Methods: From 1990 to 1995, we presented the results of our ultrasound screening for thyroid cancer in Kagawa Prefecture, Japan (1 million people). The subjects were 11,189 women with no neck symptoms. They were examined using a surface ultrasonic apparatus. After detecting
Volume 43, Number S1, 2017 abnormalities, fine needle aspiration cytology was carried out. If the patient were diagnosed with cancer, a lobectomy was performed with a side neck lymph node dissection. Results: 140 cases of thyroid cancer were detected in this screening. The histological type of all detected cancer was papillary carcinoma. The detection rate of tumors with diameters of 3mm or more was 3.6%; 10mm or more was 0.88%; 15mm in the tumor diameter was 0.27%. Lymph node metastasis was observed 33% in tumors sized 39mm, 56% in tumors sized 1014mm, and 94% in tumors sized 15mm or more.If we enforce the thyroid cancer screening by ultrasound examination, the detection of thyroid cancer in 3mm or more is 3600 per 100,000 women, the detection of 10mm or more is 880 per 100,000 women. But the annual number of suffering from thyroid cancer in Japan is approximately only 7 per 100,000 women. The deviation between the two is very large. We inferred that small papillary thyroid cancer is passed without problems accompanied by lymph node metastasis. For thyroid cancer screening using ultrasound, the problem of over-diagnosis is raised. Conclusions: The detection of thyroid cancer through aggressive use of ultrasound is not recommended. Surgical indications of subclinical thyroid cancer should be determined with restraint. Asymptomatic small papillary carcinoma should be regarded as innocuous. OPT9-002 To Establish the True Positive Percentage of Cases Where Ultrasound Detected Nodules in Sestamibi Negative Cases of Hyperparathyroidism. Retrospective Data from A Single Institution’’ Alka Ashmita Singhal,1 Sanjay Baijal,1 Deepak Sarin,2 Ambrish Mithal,3 Sunil Mishra,3 Shafi Kuchay,3 Beena Bansal,3 Parjeet Kaur,3 Sowrabh Arora,2 Jasjeet Wasir3 1 Department of Medanta Division of Radiology And Nuclear Medicine, Medanta The Medicity, India, 2Department of Head And Neck Oncosurgery, Medanta The Medicity, 3Division of Endocrinology and Diabetes, Medanta The Medicity Objectives: To evaluate the value addition of ultrasound, over sestamibi scan in patients with hyperparathyroidism. To establish the percentage of cases where ultrasound detected nodules in sestamibi negative cases of hyperparathyroidism. Methods: Retrospective study from year 2013 to 2017. A total of 250 patients of Hyperparathyroidism who had both ultrasound and Sestamibi scan for parathyroid localization and were operated at our institution were included. Ultrasound localized parathyroid as a hypoechoic ovoid nodule with arc of vascularity. Diagnostic findings were recorded. Among them 175 patients (70%) were positive on both Sestamibi Scan and Ultrasound and 65 patients (26%) were Sestamibi negative and were detected on ultrasound. Remaining 10 patients were negative on both ultrasound and Sestamibi. Of which 5 patients (2%) had Methionine PET & 5 patients (2%) had no further imaging done. Results: Of the 250 patients,175 patients (70%) were positive on both Sestamibi Scan & Ultrasound and 65 patients (26%) were Sestamibi negative & were positive on ultrasound only. Remaining 10 (4%) patients were positive on Sestamibi, but negative on ultrasound. Of which in 5 patients (2%) the nodules were located in the mediastinum and 5 (2%) patients the nodules were located in neck. Of the nodules localized on both Sestamibi and ultrasound 173 patients (98.8%) were true positive at Surgery. Of the nodules localized only on ultrasound 61 patients (93.8%) were true positive at surgery. Ultrasound Detected Nodules in Sestamibi Negative Cases in 26% Cases and of Which True Positive at Surgery Were 24.4%. Conclusions: Ultrasound finds true positive parathyroid nodules in significant number of Sestamibi Negative cases (24.4 % in our study) and finds additional nodules in cases where sestamibi showed only one