Endocrine Abstracts

Background

The incidence of papillary thyroid cancers is increase in last decades due to easier ultrasound diagnosis. The papillary thyroid cancers metastasize via lymphatics to the lymph nodes of the central and later cervical neck compartment. According to 2015 ATA guidelines, the recurrence rate is less 1–2% [2]. The treatment of choice in lymph node recurrences is surgery, but it is burdened by a higher rate of complications (25% of recurrent laryngeal nerve palsy) [2]. Therefore, laser ablation of recurrent lymph nodes has been recognized as an alternative treatment with minimal invasiveness, low complication rate and curative effect [3].

Cases presentation

We report 6 cases of patients undergoing total thyroidectomy for papillary thyroid cancer diagnosed with fine needle aspiration cytology (FNAC) positive for malignant cells. All patients underwent metabolic radiotherapy, as indicated in the ATA guidelines, and experienced a lymph node recurrence 12–18 months after therapy. The diagnosis of relapse was made with ultrasound suspicion, FNAC with dosage of Thyroglobulin in the eluate. Three patients had a recurrence in the IV compartment, one in Vb compartment and two patients had a recurrence in the III compartment. The patients were treated with ModìLite^TM laser ablative session using a multisource laser system (EchoLaser, Elesta SpA, Calenzano, Italy) with 1064 nm wavelength. The laser energy per each patient was delivered by a single 300 µm flat tip fiber introduced in target tissue through 21G Introduce needle. Hydrodissection of the lesion with 9% saline was performed in all patients. The energy delivered was 1560.28 ± 3213.84 Joule (Power, 3W). No major or minor complications were reported. At one-month follow-up, a volumetric reduction of the lesion of 39.67 ± 3.07% was reported. At 3 months of 48.83 ± 2.63% and at 6 months of 58.67 ± 3.07%. At 6 months, a fine needle aspiration was performed, negative for malignant cells and with a negative dosage of Thyroglobulin in the eluate.

Conclusion

Our experience has shown that laser ablation is an effective alternative to surgical treatment.

References

1. La Vecchia C, et al. Thyroid cancer mortality and incidence: a global overview. Int J Cancer. 2015;136:2187–95.

2. Haugen BR, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26(1):1–133.

3. Gharib H, et al. Clinical review: nonsurgical, image-guided, minimally invasive therapy for thyroid nodules. J Clin Endocrinol Metab. 2013;98:3949–57.