Unlocking Insights: Prof. Jennifer Kuo on Thyroid Microwave Ablation-ECO Medical Technology

Unlocking Insights: Prof. Jennifer Kuo on Thyroid Microwave Ablation

2023-11-29 00:00

In the realm of interventional endocrinology, Professor Jennifer Kuo stands as a leading authority. Hailing from Columbia University, she has been dedicated to advancing the frontiers of thyroid ablation techniques.

Now, let's delve into our conversation with Prof. Kuo as she shares her insights and practical wisdom on thyroid microwave ablation.

How do you approach discussing Microwave Ablation (MWA) with patients?

Dr. Kuo: When discussing treatment options with my patients, we usually consider active surveillance, thyroid lobectomy, or thermal ablation. I see no significant difference between Radiofrequency (RF) and Microwave in terms of thermal ablation. Depending on the patient and the nodule, we can consider whether RF or Microwave may be more appropriate or advantageous. Most patients trust my judgment in selecting the best modality. Both methods are conceptually similar; they just use different forms of energy. Patients generally accept this explanation easily. Choosing the right modality is crucial for both the physician and the patient.

What criteria do you use to select patients for the MWA procedure?

Dr. Kuo: In terms of selecting Microwave specifically, I usually do so in three scenarios: for larger nodules, more vascular nodules, and to some extent the redo procedures. Microwave energy is more efficient, allowing us to ablate larger areas in a shorter time. Toxic nodules are typically more vascular, which makes microwave ablation a preferable option. Even non-toxic nodules with good blood supply—these also tend to be the larger ones, with bigger vessels—are suitable for Microwave ablation. The redo cases where previously ablated areas are challenging to penetrate are ideal for Microwave. This method is often more comfortable for patients, as it avoids the need for high energy levels.

During the MWA procedure, how do patients typically respond?

Dr. Kuo: Patients do tolerate the MWA procedure better, possibly because it requires less energy. The highest I go is 40 watts and I can get a very efficient ablation. In other modalities, 40 watts is probably the least I go and I’m more often using 50 watts. For larger nodules, the energy requirement increases to 60 or even 70 watts, which can be uncomfortable for patients. Many of my patients undergoing Microwave treatment even fall asleep during the procedure.

Do you have any insights or recommendations for medical professionals looking to incorporate microwave ablation into their practice?

Dr. Kuo: Mastery of ultrasound and biopsy skills is fundamental before beginning any thermal ablation procedures. For those learning on microwave, I recommend starting with larger nodules. I advise against choosing a 2 cm nodule for your first case. It might seem a good size, but effectively, you'll only have a 1 cm working dimension, which doesn't provide enough space to practice the moving shot technique. This is crucial with microwave because of its speed—you don’t want to stay in a particular area for too long. Choose larger nodules where you can work in the center, away from critical structures like the capsule or the trachea. Once you are facile with moving shot, the rest follows. If you start with large nodules and give yourself plenty of room to work and refine your technique in the center, then I think the risk of potential injury will be minimized.

How do you see the role of microwave ablation evolving in the treatment of thyroid nodules and other thyroid conditions in the future?

Dr. Kuo: In my view, microwave has a definite place in thermal ablation. It is an additional tool that increases our flexibility in treating a wide range of thyroid nodules. There are clear situations where microwave is preferable to other modalities. I don't see these thermal ablation methods as competitors but as complementary tools useful in different scenarios. I think it’s about using the right tool, the right skillset, for the right patient.

Some people question the use of microwave ablation: microwave seemingly has more complications and there is just not much literature on outcomes. However, if you look at the literature more carefully, you’ll see that there is a lot of inconsistency in the microwave literature.

Unlike RFA where most physicians are suing the same approach and technique, there is a lot variation in microwave: some employ a fixed technique for microwave ablation, while others use moving shot approach, which is akin to the method used in radiofrequency ablation.

Use of different techniques can have tremendous effects on outcomes and complication rates. Use of a fixed technique may lead to higher complication rates, particularly with smaller ablations where hydrodissection is not performed. This can also result in suboptimal outcomes, as trying to fit a single spherical zone of ablation may not suit the actual shape of the nodule.

I believe an ‘apples-to-apples’ comparison using the same technique in the literature could more accurately illuminate how microwave energy might be just as effective as radiofrequency energy for ablation of thyroid nodules when used appropriately. It’s just about selecting the right energy for the right patient. Physicians can then convey this knowledge to patients, even those who are unfamiliar with microwave ablation, in a comprehensible way.

We extend our sincere gratitude to Prof. Jennifer Kuo for generously sharing her insights on thyroid microwave ablation.

If you're eager to explore more about thyroid microwave ablation, connect with us for further insights, training opportunities, and updates. Follow our account for the latest advancements in the field or drop us an email at ecomedicalusa@njeco.com.cn. Together, we can continue to make a meaningful impact on the world of thyroid health.