FIRST MICROWAVE THERMAL ABLATION OF A BENIGN THYROID NODULE IN FRANCE

Medical and surgical innovation is an ongoing priority at the American Hospital of Paris, in order to offer patients the best in French and American medicine. Microwave thermal ablation, seldom used in Europe, is a promising and innovative treatment method for benign nodules that may reduce their size by approximately 65 to 85%. “Our goal,” explained Dr. Monpeyssen, “is to explore and validate this new technique’s potential and feasibility so it can be offered to patients. As pioneers in the alternative treatment of benign thyroid nodules via thermal ablation, we want to continue on this innovative path with the use of microwaves.”

Microwave thermal ablation is becoming more widespread. It is employed at least as often as radiofrequency and laser ablation methods to treat benign nodules and, in the near future, thyroid micro-cancers and recurrences in the neck that are surgically inaccessible or detected in patients who have already undergone multiple neck operations. Studies published to date show that microwaves are effective over the long term, with no risk of recurrence or metastases. “The simultaneous availability of these different ablation techniques will make it possible to lower costs and therefore ensure improved access for patients to alternative procedures,” said Dr. Ben Hamou.

Surgery has long been considered the first-line treatment for thyroid nodules. However, it is not without risks, which include voice modification, hypothyroidism and hypoparathyroidism. Moreover, surgery leaves a more or less visible neck scar, which can sometimes be avoided thanks to alternative surgical techniques such as robotic surgery. The use of iodine-131 is reserved for functioning nodules and must be used in compliance with radiation protection rules. Minimally invasive techniques like percutaneous ethanol injection (PEI) have become a reliable and effective alternative making it possible to target only the nodule while preserving the rest of the thyroid gland.

Thermal ablation is a procedure that uses heat to destroy the tissue. Before the recent use of microwaves, the American Hospital of Paris had developed three other techniques:

1. Laser: radiant energy transmitted by a fiber is inserted into a needle to raise the temperature.
2. Radiofrequency: energy emitted by a generator is carried to the nodule via an electrode.
3. High-intensity focused ultrasound, or HIFU: High-intensity focused ultrasound, or HIFU: energy generated by high-intensity focused ultrasounds is delivered through the skin. This technique is used for small nodules.

Regardless of the technique used, all thermal ablation procedures take place in a dedicated interventional room. The practitioner works under ultrasound guidance and treats the nodule without touching the rest of the thyroid gland. The procedure is painless or quasi-painless thanks to local anesthesia, sometimes supplements with an analgesia (requiring the presence of an anesthesiologist). Besides the risk of hematoma, complications only occur in 2% of cases, and are typically minor. The patient is treated externally or in our outpatient department (maximum stay of 6 hours).

Nodules are a frequently-occurring condition affecting the thyroid (a butterfly-shaped gland located in the front of the neck). They are solid lumps that sometimes contain fluid, made up of thyroid cells in most cases. Thyroid nodules can cause discomfort or pain and may lead to hyperthyroidism. In 5% of cases, they are cancerous.