When patients ask Dr. Randolph what RFA is like, he tells them they already know because it’s quite similar to the US-guided needle biopsy they just had. (Every patient who has RFA has already had a needle biopsy.) “You could have a little discomfort, generally, but we give people an ice pack for a few minutes and a bandage whether they had a needle biopsy or the ultrasound-guided radiofrequency ablation,” he said.
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March 2022Dr. Steward said that, in his experience, the procedure for patients is analogous to the US-guided needle biopsy, but more invasive, causing more localized discomfort when the thermal energy is delivered. “It takes it up a notch and generally requires more extensive local anesthesia,” he said, adding that sometimes patients can hear it crack or sizzle and feel warmth. Afterward, there may be localized swelling, edema, or bruising.
Equipment Requirements
The basic equipment needed for RFA includes the radiofrequency generator (power source, with pump for circulating cooling fluid), grounding pads, single-use electrodes specifically designed for thyroid application, and an ultrasound machine with an ultrasound probe. There are currently two U.S. commercial vendors, both of which supply equipment that’s manufactured in Korea, according to Dr. Orloff.
I think if it’s going to be offered, it’s important that patients understand that they may have to pay out of pocket. —David L. Steward, MD
“The electrode comes in different active tip sizes—5, 7, and 10 mm—with choice of tip size dependent on size and location of the nodule to be treated,” said Dr. Sinclair. “In addition to these basics, I also use local anesthesia, syringes, needles, skin prep, drapes, and sterile ultrasound covers.”
According to the AHNS report, smaller electrodes are used for nodules in high-risk locations or beside critical structures and those that require a high degree of control in the treatment area. For nodules greater than 4 cm, using the 10-mm electrode reduces ablation time. These different electrode sizes are available in a single device.
The majority of thyroid RFA cases use monopolar electrodes, but bipolar electrodes, in which current passes between the electrodes at only the tip of the device and deliver more focused energy, are also available. There is some evidence that these more focused devices may be safer for use in pregnant patients or those with implanted cardiac electrical devices. While not yet FDA approved, these electrodes are used clinically in Europe and Asia. Innovations such as unidirectional ablation electrodes insulated in a way that creates a narrower ablation and virtual needle tracking systems have also been developed to make monitoring the electrode tip easier and may benefit clinicians learning the RFA technique (Head Neck. 2022;44:633-660).