Image-guided percutaneous ablation therapies for local recurrences of thyroid tumors

The incidence of thyroid carcinoma has increased steadily over the last few decades. Most differentiated thyroid carcinomas (DTC) are cured thanks to the initial treatment with surgery and radioiodine therapy. Nevertheless, neck lymph node metastases are found in a few of these patients during their long-term clinical and ultrasound follow-up. In some of these cases radioiodine treatment may not be effective in eradicating nodal metastases due to scant 131-I uptake. Additionally, a few of these patients undergo repeated neck explorations and/or resections. Based on these considerations and on the frequently indolent course of DTC neck metastases, a non-surgical therapeutic approach should be considered to control small local foci of DTC. There is increasing interest in mini-invasive image-guided procedures that can be performed under local anesthesia which do not affect the performance status of the patient. Image-guided minimally invasive ablative therapies delivered by using needle-like applicators include both thermal and non-thermal source techniques. Over the past 25 years, these therapies have gained widespread attention and, in many cases, broad clinical acceptance as methods for treating focal malignancies. In an attempt to overcome the limitations of treating certain unresectable tumor types not amenable to a further surgical treatment, a few investigators have reported successfully combining percutaneous therapies with other oncologic treatment strategies (combined treatments). In this review, we reported mini-invasive techniques more commonly employed in selected cases to ameliorate local compressive symptoms, control hormonal production, and reduce the volume of neoplastic tissue prior to traditional palliative treatment.