NICE publishes a guidance supporting the use of percutaneous ultrasound-guided microwave ablation for symptomatic benign thyroid nodules

Terumo Europe welcomes the positive guidance released by the National Institute for Health and Care Excellence (NICE) mentioning that microwave ablation can be used provided standard arrangements are in place for clinical governance, consent, and audit. This is positive news as it broadens access to minimally invasive alternatives to surgery available to patients with symptomatic benign thyroid nodules.

The guidance describes ultrasound-guided percutaneous microwave ablation for symptomatic benign thyroid nodules as a minimally invasive procedure that can be performed in an outpatient setting using local anaesthesia. The aim is to reduce symptoms and improve cosmetic appearance by making the nodule smaller while preserving thyroid function, and with fewer complications than surgery.

This guidance is part of NICE’s interventional procedure programme which considers whether interventional procedures are safe and work well enough for wider use in the NHS. A comprehensive review of the literature and consultations with clinical experts and patient representatives informed the decision of the committee.

This is a positive endorsement of the treatment and a complement to the 2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules.

The NICE document also reports that using uncooled microwave ablation devices means thinner needles can be used.

“Nowadays microwave technology is widely used in liver, lung, and kidney ablation,” says Dr Eduardo Crespo, chief of radiology department at Hospital Universitario Fundación Jimenez Diaz in Madrid, Spain. “So far, the main gap to approach thyroid ablation has been the lack of thinner and shorter probes, to avoid potential damage to the adjacent nerves, which could lead to complications. Within the TATOpro antennae range, Terumo Interventional Systems introduced a dedicated thyroid antenna as thin as 18G with a length of 8cm, to be used at limited power. Moreover, a 17G antenna is also available to treat larger nodules in one session, avoiding the need for patients to come back for multiple treatments.”

Two recent publications by Yildirim and Karakas (2022), concluded that uncooled microwave ablation with the TATO system is an effective and safe method for the treatment of benign thyroid nodules that preserves the thyroid function.

Dr Camillo Aliberti, head of diagnostic and interventional radiology department Hospital Pederzoli, Peschiera del Garda, Italy, further explains: “In comparison to radiofrequency technology, microwaves are not influenced by tissue impedance and are less influenced by blood flow (heath sink effect). Microwaves are quicker in coagulating the treated area, requiring less antenna repositioning and producing a very small amount of vapor which allows a good visibility under ultrasound guidance and precise ablation execution, enabling any type of nodule (solid, cystic, or mixed) to be treated.”

Terumo Interventional Systems offers dedicated workshops to support professional education for physicians willing to start the service.

This news story has been sponsored by the companies concerned and does not represent the views or opinions of RAD Magazine.