Ultraschallgeführte lokalablative Verfahren zur Behandlung von Schilddrüsenläsionen

Zusammenfassung

Ultraschallgeführte lokalablative Verfahren kommen als Ergänzung zur chirurgischen Therapie und Radiojodtherapie zunehmend in der Routinebehandlung von Schilddrüsenknoten zur Anwendung. Bei rein zystischen und überwiegend zystischen Herdbefunden liegen gute Erfahrungen mit der Instillationstherapie (Ethanol-/Polidocanol-Ablation) vor. Die neueren thermoablativen Techniken, zu denen die Radiofrequenzablation (RFA), die Mikrowellenablation (MWA), die Laserablation (LA) und der hochintensive fokussierte Ultraschall (HIFU) zählen, erreichen mittels Temperaturen von über 60 °C eine lokale Proteindenaturierung im Zielareal. Unter permanenter Ultraschallkontrolle kann so selektiv die Volumenreduktion lokal symptomatischer oder fokal hyperfunktioneller Befunde zur Erlangung von Beschwerdefreiheit induziert werden. Während bereits vielfältige Evidenz für die effektive und sichere Anwendung verschiedener lokalablativer Techniken geschaffen werden konnte, liegen künftige Herausforderungen in der Initiierung komparativer prospektiver Studien sowie standardisierter Curricula zur Schulung und kontinuierlichen Qualitätssicherung. Ferner wird es zukünftig angezeigt sein, die in Deutschland bei Patienten mitunter noch wenig bekannten lokalablativen Techniken im Aufklärungsgespräch als etablierte Alternative oder Ergänzung zu bestehenden Therapieformen anzuführen.

Abstract

Ultrasound-guided ablation techniques have been increasingly introduced into routine treatment of thyroid lesions as a complement to existing surgical therapies and radioiodine treatment. In cystic or predominantly cystic lesions instillation therapy (ethanol/polidocanol ablation) has yielded good results. Novel thermal ablation techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA) and high intensity focused ultrasound (HIFU), induce irreversible cellular effects by locally applying temperatures ≥ 60 °C to the targeted thyroid region. Lesions causing local symptoms or focal hyperfunctionality can thus be selectively treated under continuous sonographic monitoring. While a considerable body of evidence supports the efficacy and safety of various local ablative techniques, future challenges lie in initiating comparative prospective trials and in standardizing clinical practice, training and continuous quality assessment on a regional and superregional level. In the future, it shall be indicated to include local ablative techniques – so far not known to all patients in Germany – into the informed decision-making process as a suitable alternative or supplement to existing therapies.

Schlüsselwörter

Schilddrüsenknoten - tomografischer Ultraschall - Thermoablation - Radiofrequenzablation - Ethanolablation

Keywords

thyroid nodule - tomographic ultrasound - thermal ablation - radiofrequency ablation - ethanol ablation

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