Recent Advances in Thermal and Nonthermal Ablative Technologies of the Thyroid

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Background

The use of ultrasound-guided ablation procedures to treat both benign and malignant tumors of the thyroid gland has gained significant popularity over the past few decades. The field of endocrinology is rapidly expanding to include alternatives to surgery and active surveillance. The main appeal is that it is minimally invasive and avoids the need for a general anesthetic, an incision, the downtime associated with surgical recovery, or the development of hypothyroidism. These advancements have progressed towards improving outcomes, decreasing complications and mainly, enhancing patient’s quality of life.

Both thermal and nonthermal ablative techniques exist, with thermal ablation being the most widespread in use. Thermal ablative techniques include Radiofrequency Ablation (RFA), Laser ablation (LA), microwave ablation (MWA), and high intensity focused ultrasound (HIFU) whereas nonthermal ablative approaches include chemical ablation (mainly ethanol), and less commonly cryoablation, and irreversible electroporation. Each approach differs accordingly with pros and cons to each technique and the shared goal of targeting thyroid nodules precisely with minimal collateral damage to the surrounding healthy tissues.

As the field of thyroidology continues to evolve, newer studies will emerge that improve our understanding of the long term effects of thermal and nonthermal ablation. Expectations for the future include advanced monitoring techniques that use state-of-the-art imaging and sensing technologies. Personalized treatments are also expected, with ablation parameters tailored to individual patients. The integration of AI algorithms into these systems could revolutionize treatment and improve the work flow. AI’s roles include generating personalized treatment plans based on patient data, real-time adjustment of ablation parameters, and predictive models for outcome estimation. Other future directions will include robust studies to investigate the effects of nonthermal ablation such as cryoablation and electrocorporation to see how effectively these techniques overcome some of the limitations of thermal ablation.

This Research Topic welcomes contributions of any type (review articles, original papers, case discussions, clinical opinions) on the following topics around thermal ablative technologies:
- Recent developments in thermal ablative technologies
- Integration of advanced imaging modalities into thermal ablative technologies
- Combination of thermal ablative technologies with other treatment modalities
- Patient-specific computational models to optimize treatment planning and predict tissue response
- Nanotechnology integration
- Potential applications of thermal ablation beyond tumor treatment
- Long-term follow-up studies of thermal ablation treatments of benign or malignant thyroid nodules
- Recurrent laryngeal nerve monitoring with thermal ablation in the awake patient
- The use of Artificial Intelligence to improve work flow and nodule selection

Keywords: thermal ablation, radiofrequency ablation, laser ablation, microwave ablation, monitoring

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