EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

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Management guidelines for patients with thyroid nodules and differentiated thyroid cancer.

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to come to a consensus on the management of thyroid nodules identified with thyroid ultrasonography (US), with particular focus on which nodules should be subjected to US-guided fine needle aspiration and which thyroid nodules need not be subjected to fine-needle aspiration. The panel met in Washington, DC, October 26–27, 2004, and created this consensus statement. The recommendations in this consensus statement, which are based on analysis of the current literature and common practice strategies, are thought to represent a reasonable approach to thyroid nodular disease. © RSNA, 2005

Management of thyroid nodules detected at US: Society of radiologists in ultrasound consensus conference statement

http://biblioteca.asmn.re.it/pubblicazioni/Endocr%20Pract%202010%20(16%20Suppl%201)1%2043.pdf

American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of thyroid Nodules

American association of Clinical Endocrinologists, American college of endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update

PURPOSE: To evaluate percutaneous interstitial laser photocoagulation (ILP) as a palliative treatment of recurrent thyroid carcinoma untreatable with surgery or radioiodine administration. MATERIALS AND METHODS: By using 18 resected thyroid glands, the volume and histologic pattern of ILP-induced thyroid damage were assessed. In vivo treatment feasibility was evaluated by using a low-energy laser in two volunteers before thyroidectomy for huge autonomously functioning nodules. With ultrasonographic (US) monitoring, a 21-gauge spinal needle was inserted into the thyroid nodules. A 300-μm quartz fiberoptic guide was inserted through the needle lumen, and the fiber tip was placed in direct contact with the tissue. Laser irradiation was performed with a 1.064-nm Nd:YAG laser in surgically resected glands, which were treated with 2, 3, 5, or 7 W. RESULTS: Tissue ablation was well-defined histologically, and its area was related to laser irradiation parameters (range, 0–26 mm). No correlation was found between ...

Thyroid tissue: US-guided percutaneous interstitial laser ablation-a feasibility study.

PURPOSE: To evaluate in vivo the safety and effectiveness of percutaneous laser thermal ablation (LTA) in the debulking of thyroid lesions. MATERIALS AND METHODS: Twenty-five adult patients at poor surgical risk with cold nodules (n = 8), autonomously hyperfunctioning thyroid nodules (n = 16), or anaplastic carcinoma (n = 1) underwent LTA. One to four 21-gauge spinal needles were inserted with ultrasonographic (US) guidance into the thyroid lesions. A 300-μm-diameter quartz optical fiber was advanced through the sheath of the needle. Nd:YAG laser was used with output power of 3–5 W. Side effects, complications, and clinical and hormonal changes were evaluated at the end of LTA and during follow-up. Linear regression analysis was used to investigate the correlation between energy delivered and reduction in nodule volume. Volume of induced necrosis and reduction in nodule volume were assessed with US or computed tomography. RESULTS: LTA was performed without difficulties in 76 LTA sessions. After treatment ...

Thyroid tissue: US-guided percutaneous laser thermal ablation.

Aim of the study. To compare clinical and ultrasound (US) changes induced in cold thyroid nodules by US-guided percutaneous laser ablation (PLA) versus follow-up or levothyroxine (LT4) suppressive therapy. Methods: 62 patients randomly assigned to a single PLA (Group 1), LT4 (Group 2), or follow-up (Group 3). Entry criteria: euthyroid patients with a solid thyroid nodule >5 mL and benign cytological findings. Treatment: Group 1: PLA was performed with a 1.064 μm neodymium yttrium-aluminum-garnet laser with output power of 3 W for 10 minutes; Group 2: the LT4 dose was adjusted to induce thyrotropin suppression; Group 3: no treatment. Results. In Group 1 a significant nodule reduction was found 6 and 12 months after PLA (delta volume: −42.7 ± 13.6%; p = 0.001). A reduction >50% was found in 33.3% of cases. In Group 2 a nonsignificant nodule shrinkage was observed. A nonsignificant volume increase was observed in Group 3. Improvement of local symptoms was registered in 81.2% of patients in Group 1 vs. 13.3% ...

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Treatment of benign cold thyroid nodules: a randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up.

PURPOSE: To evaluate the safety, local effectiveness, and long-term results of laser thermal ablation (LTA) in the treatment of small hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Ninety-two biopsies proved small HCCs (range, 0.8–4.0 cm) in 74 patients who were treated percutaneously with LTA in an outpatient clinic. A laser at a power of 5.0 W was coupled with one to four fibers that were advanced through 21-gauge needle(s) for 6–12 minutes. All lesions were evaluated with computed tomography (CT) for changes in size and vascular pattern, recurrence rates, and cumulative survival rates. Patients were examined for complications. RESULTS: No major complications occurred in 117 LTA sessions, with an average of 1.3 sessions per tumor. At 3 months, CT scans showed a nonenhancing area (complete necrosis) in 89 (97%) of 92 lesions. During follow-up (range, 6–66 months; mean, 25.3 months), 84 tumors (91%) decreased in size. The local recurrence rates (range, 1–5 years) ranged from 1.6% to 6.0%. Recurren...

/pdf/laser-thermal-ablation-in-the-treatment-of-small-1u09uup2nw.pdf

Laser thermal ablation in the treatment of small hepatocellular carcinoma: results in 74 patients.

PURPOSE: To determine the potential long-term effectiveness of laser thermal ablation (LTA) followed by transcatheter arterial chemoembolization (TACE) in the percutaneous ablation of large hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Thirty large HCCs 3.5–9.6 cm in diameter (mean diameter, 5.2 cm) and 15 small HCCs 0.8–3.0 cm (mean diameter, 1.9 cm) were treated with ultrasonographically guided LTA with TACE and with LTA alone, respectively, in 30 patients: 19 with a solitary large HCC, and 11 with one to three additional synchronous small HCCs. A 1.064-μm neodymium yttrium-aluminium-garnet (Nd-YAG) laser at a power of 5.0 W was coupled with one to four quartz optic fibers that were advanced through 21-gauge needles. Segmental TACE was performed 30–90 days after LTA. All lesions were evaluated for change in size at computed tomography (CT), α-fetoprotein (AFP) levels, recurrence rates, and cumulative survival rates. RESULTS: No major complications occurred in 127 LTA sessions. CT showed complet...

Sara Pacella

Papers

Thyroid tissue: US-guided percutaneous interstitial laser ablation-a feasibility study.

Thyroid tissue: US-guided percutaneous laser thermal ablation.

Treatment of benign cold thyroid nodules: a randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up.

Laser thermal ablation in the treatment of small hepatocellular carcinoma: results in 74 patients.

Hepatocellular carcinoma: long-term results of combined treatment with laser thermal ablation and transcatheter arterial chemoembolization.