Luigi Solbiati MD, Abstract Co-Author: Nothing to Disclose

Giovanni Mauri MD, Presenter: Nothing to Disclose

Luca Cova MD, Abstract Co-Author: Nothing to Disclose

Tiziana Ierace MD, Abstract Co-Author: Nothing to Disclose

Claudio Maurizio Pacella MD, Abstract Co-Author: Nothing to Disclose

Alberto Baroli, Abstract Co-Author: Nothing to Disclose

Giuseppe Lomuscio, Abstract Co-Author: Nothing to Disclose

We report our experience with percutaneous US-guided interstitial laser ablation for metachronous cervical nodal metastases from papillary thyroid carcinoma following total thyroidectomy and central + laterocervical lymph node

Twenty-three metachronous metastatic nodes (mean size 1.2 cm; range 0.6-2.6 cm) in 19 patients previously (13 to 54 months earlier) undergone thyroidectomy and central + laterocervical lymph node dissection were treated with percutaneous US-guided interstitial laser ablation with a 1,064 nm Nd:YAG laser operating in continuous wave mode (EchoLaser X4, Esaote, Genoa, Italy). All cases were negative at 131I whole body scan, but had marked uptake at 18F-FDG PET and elevated serum levels of thyroglobulin (Tg). Under local anesthesia a 300 m quartz fiberoptic guide was placed into the node through a 21G needle. Nodes were treated with one (17 cases) or two (6) fiber insertions, each one with 3 W power for 400-600 sec (total energy applied ranging from 1,200 to 1,800 joules). After withdrawing the fiber, contrast-enhanced US (CEUS) was performed to assess the lack of enhancement in the treated lesion. All cases were followed at 3 and 6 months with B-mode US, CEUS, 18F-FDG PET and assessment of serum levels of Tg.

Laser ablation was technically feasible and well tolerated in all patients, with no either immediate or late complications. In 21/23 (91.3%) nodes complete ablation (disruption of the parenchymal structure at B-mode US, lack of enhancement at CEUS, no uptake at 18F-FDG PET with normalization of peak standard uptake value (SUV) and > 90% decrease of Tg serum levels) was achieved. In 2 cases residual uptake at 18F-FDG PET with abnormal SUV was found and laser ablation was repeated.

Percutaneous US-guided interstitial laser ablation seems to be an effective, low cost and safe therapeutic tool for the treatment of metachronous nodal metastases from papillary thyroid carcinoma in the neck which would otherwise require often challenging further resections.

Interstitial laser ablation seems to be safe and effective for the treatment of metachronous nodal metastases from papillary thyroid carcinoma in the neck

Solbiati, L, Mauri, G, Cova, L, Ierace, T, Pacella, C, Baroli, A, Lomuscio, G, Percutaneous US-guided Interstitial Laser Ablation of  Metastatic Lymph Nodes in the Neck from Papillary Thyroid Carcinoma Following Thyroidectomy and Lymphadenectomy.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11014527.html