UK’s NICE Issues Guidance on Percutaneous Ultrasound-Guided Microwave Ablation for Treating Symptomatic Benign Thyroid Nodules

November 16, 2022—The United Kingdom’s National Institute for Health and Care Excellence (NICE) has published an interventional procedures guidance [IPG743] document on use of percutaneous ultrasound-guided microwave ablation for symptomatic benign thyroid nodules.

As outlined on the NICE website, the guidance states:

1. Evidence on the safety of percutaneous ultrasound-guided microwave ablation for symptomatic benign thyroid nodules shows some well-recognized complications. Evidence on efficacy is adequate. Therefore, this procedure can be used provided standard arrangements are in place for clinical governance, consent, and audit.
2. Patient selection should be done by a multidisciplinary team.
3. This procedure should only be done by a clinician with experience in the procedure and specific training in thyroid ultrasound.
4. Patients should be assessed to exclude thyroid cancer before the procedure.
5. Immediate support should be available to deal with airway complications.

As stated in the guidance, the NICE professional experts and committee conducted a rapid review of the published literature on the efficacy and safety of this procedure. The evidence was derived from 11 sources, including three systematic reviews, four nonrandomized comparative studies, and four case series. Additionally, the committee received and discussed one submission from a patient organization as well as two commentaries from patients who have had this procedure.

The committee’s summary of the evidence is provided online with other relevant literature listed in the appendix of the overview, which found:

• Key efficacy outcomes are symptom relief, cosmetic improvement, and nodule volume reduction.
• Key safety outcomes are pain, bleeding, damage to adjacent structures, and inadvertent treatment of malignant nodules.

The guidance advises that the procedure can be done with cooled and uncooled microwave ablation devices. Most of the evidence the committee reviewed on the safety and efficacy of the procedure came from cooled microwave ablation devices. The committee was informed that using uncooled microwave ablation devices means smaller needles can be used, noted the guidance.

In a separate announcement, Terumo Europe NV welcomed the NICE guidance because it broadens access to minimally invasive alternatives to surgery available to patients with symptomatic benign thyroid nodules. Terumo Europe, based in Belgium, is the exclusive distributor in the EMEA region of the Tato and TatoPro microwave thermal ablation systems that are manufactured by Italy-based Biomedical srl.

Terumo stated that the NICE endorsement of the treatment is a complement to the “2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules” published by Enrico Papini, MD, et al in European Thyroid Journal (2020;9:172-185). The company further noted that two recently published studies by Yildirim and Karakas concluded that uncooled microwave ablation with the Tato system is an effective and safe method for the treatment of benign thyroid nodules that preserves thyroid function.

In the Terumo Europe press release, Eduardo Crespo, MD, commented, “Nowadays, microwave technology is widely used in liver, lung, and kidney ablation. 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 18 G with a length of 8 cm, to be used at limited power. Moreover, a 17-G antenna is also available to treat larger nodules in one session, avoiding the need for patients to come back for multiple treatments.” Dr. Crespo is Chief of the Radiology Department at Hospital Universitario Fundación Jimenez Diaz in Madrid, Spain.

Camillo Aliberti, MD, added, “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.” Dr. Aliberti is Head of the Diagnostic and Interventional Radiology Department at L'Ospedale Pederzoli in Peschiera del Garda, Italy.