(A312) The Guiding "B's" for Successful Thyroid Nodule Radio-Frequency Ablation

Introduction: The landscape of thyroid nodule management has been slowly changing since the introduction of radiofrequency ablation (RFA) for thyroid nodules in 2006, particularly for benign nodules. RFA is a non-invasive technique that uses frictional and conductive heat to cause coagulative necrosis of local soft tissue. When directed into a thyroid nodule it has been shown to produce a 80-90% volume reduction and favorable cosmetic outcomes. Techniques have been introduced in the literature to achieve adequate ablative coverage while minimizing thermal damage to surrounding structures, including the transisthmic approach, hydrodissection principle, and the moving-shot technique. While these techniques help with procedural planning, there is a gap in knowledge on how to efficiently perform the RFA maneuver. Herein, we introduce “The Five B’s for Successful Thyroid RFA” to guide interventionalists as they adopt this novel procedure.

Methods: Under ultrasound guidance we perform perithyroidal injections with 1% lidocaine with epinephrine around the thyroid and along the expected path of the RFA needle. A superficial puncture is made with an 11 blade scalpel in a natural skin crease. The RFA probe is inserted and ablation is carried out in serial fashion with further passes done from deep to superficial progressing from superior to inferior. Care is taken to first identify the “Bevel” of the needle, along with the “Barrel” or shaft of the needle. Next, we ensure an adequate “Buffer” between key structures from the hydrodissection. As we proceed with the ablation, we watch for hyperechoic “Bubbles”. Lastly, we move “Back” to continue serial ablations within the nodule.

Results: We have recorded high-definition video in addition to high resolution images that highlight these guiding principles for RFA of thyroid nodules.

Conclusions: In conjunction with previously published RFA technique strategies, The adoption of “The Five B’s” and identifying the, “bevel, barrel, buffer, bubbles, and back” during thyroid RFA, even the most novice interventionalist can be guided to ensure accurate and safe thyroid nodule ablation.