Pathological Findings of Thyroid Nodules After Percutaneous Laser Ablation
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Pathological Findings of Thyroid Nodules After Percutaneous Laser Ablation A Series of 22 Cases with Cyto-histological Correlation Simonetta Piana & Fabrizio Riganti & Elisabetta Froio & Massimiliano Andrioli & Claudio M. Pacella & Roberto Valcavi
Published online: 14 January 2012 # Springer Science+Business Media, LLC 2012
Abstract Ultrasound (US)-guided percutaneous laser ablation (LA) of benign thyroid nodules may be a potential alternative to surgery in patients with compressive symptoms, at high surgical risk, or in patients who refuse to undergo surgery. We evaluated the morphological effects of LA procedure on 22 patients and compared the cytological findings before and after LA with the histological features on surgical specimens. Twenty-two (4.9%; 19 women, three men, mean age 53.2 years) out of 452 patients treated with LA for benign thyroid nodules in our Hospital underwent surgery after LA procedure, either because nodule regrowth (treatment failure, n017) or indeterminate cytology (Thy3) after LA (n05). Morphological findings varied according to the time between LA and surgical intervention. Within 2 months, the area was occasionally cavitated and filled in with dark amorphous material. The inflammatory response was abundant and composed of neutrophils, lymphocytes, and macrophages. After 18 months or more since LA, the expected laser-induced histologic changes in thyroid morphology consisted of a well-defined area surrounded by a fibrous capsule and filled in by amorphous material. No significant pathologic features were found in the thyroid tissue adjacent to the treated area. Histological evaluation of thyroid tissues after LA shows that thermal damage is restricted to the ablated area, with no involvement of the nearby parenchyma. Our long-term histopathological S. Piana (*) : E. Froio Department of Pathology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy e-mail: [email protected] F. Riganti : M. Andrioli : C. M. Pacella : R. Valcavi Department of Endocrinology – Thyroid Disease Center, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
findings indicate that LA treatment of benign thyroid nodules is safe, and patients undergoing LA may also be followed up by fine needle aspiration. Keywords Thyroid . Nodules . Percutaneous laser ablation . FNA
Introduction According to current guidelines [1, 2], patients with benign thyroid nodular disease can undergo either no treatment or partial/total thyroid surgery, depending on nodule size, growth, or symptoms. Percutaneous laser ablation (LA), a well-known minimally invasive approach for the treatment of focal malignancies [3], has been proposed as an alternative strategy for reducing the size of both non-functioning and hyper-functioning benign thyroid nodules [4–18]. It is a non-surgical, well-tolerated approach and the effects induced by thermal energy are controlled without damage to the surrounding tissue [4–8]. The usefulness of this procedure in reducing the volume of benign thyroid nodules has been demonstrated in sever
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