Assessment of fibro-sclerotic changes in the thyroid gland from a surgical perspective. Part IV

Introduction. SMinimally invasive techniques for the treatment of thyroid disorders based on various physical energy modalities provide targeted local destruction of focal lesions with subsequent volume reduction. The resulting morphological changes depend on the type of exposure and structural characteristics of thyroid nodules and determine long-term treatment outcomes.

Objective. To analyze published data on the effectiveness and technical aspects of minimally invasive treatment methods and to assess the patterns of fibro-sclerotic changes in thyroid tissue and nodular formations.

Methods. A literature review was performed using the eLIBRARY, PubMed, Web of Science and Scopus databases with keywords related to fibrosis, sclerosis and various ablation techniques applied to thyroid pathology. Publications focusing on both immediate and long-term morphological outcomes were included in the analysis.

Results. Despite differences in mechanisms of action, minimally invasive methods lead to the formation of coagulative necrosis followed by fibrosis, sclerosis and, in some cases, calcification. Over time, morphological changes become similar and are associated with partial or complete regression of nodules. The extent and rate of these processes may vary depending on the technique used and the initial structure of the treated lesion.

Conclusion. Minimally invasive treatment modalities represent a promising direction in thyroid surgery; however, further studies are required to clarify the patterns of morphological changes and to evaluate long-term outcomes and clinical effectiveness

1. Studen K.B., Domagała B., Gaberšček S., Zaletel K., Hubalewska-Dydejczyk A. Diagnosis and management of thyroid nodules and goiter – current perspectives. Endocrine, 2025, vol. 87, no 1, pp. 39–47. https://doi.org/10.1007/s12020-024-04015-8

2. Aleksandrov Yu.K., Mogutov M.S., Patrunov Yu.N., Sencha A.N. Minimally invasive thyroid surgery. M. : Medicine, 2005, 288 p. (In Russ.)

3. Huber T.C., Park A.W. Radiofrequency ablation of benign thyroid nodules. Seminars in Interventional Radiology, 2021, vol. 38, no 3, pp. 377–381. https://doi.org/10.1055/s-0041-1731377

4. Gambelunghe G., Stefanetti E., Avenia N., De Feo P. Percutaneous ultrasound-guided laser ablation of benign thyroid nodules: results of 10-year follow-up in 171 patients. Journal of the Endocrine Society, 2021, vol. 5, no 7, p. bvab081. https://doi.org/10.1210/jendso/bvab081

5. Zu Y., Liu Y., Zhao J., et al. A cohort study of microwave ablation and surgery for low-risk papillary thyroid microcarcinoma. International Journal of Hyperthermia, 2021, vol. 38, no 1, pp. 1548–1557. https://doi.org/10.1080/02656736.2021.1996643

6. Borsukov A.V., Ivanov Yu.V., Kosova A.A., Andreeva O.V., Amirov A.Kh. First experimental results in electrochemical lysis of thyroid nodules. Clinical and Experimental Thyroidology, 2009, vol. 5, no 1, pp. 41–46. (In Russ.)

7. Palyga I., Palyga R., Mlynarczyk J., Kopczynski J., Gozdz S., Kowalska A. The current state and future perspectives of high intensity focused ultrasound (HIFU) ablation for benign thyroid nodules. Gland Surgery, 2020, vol. 9, Suppl. 2, pp. S95–S104. https://doi.org/10.21037/gs.2019.10.16

8. Hu Q.L., Kuo J.H. Choice in ablative therapies for thyroid nodules. Journal of the Endocrine Society, 2023, vol. 7, no 7, p. bvad078. https://doi.org/10.1210/jendso/bvad078

9. Cesareo R., Pacella C.M., Pasqualini V., et al. Laser ablation versus radiofrequency ablation for benign non-functioning thyroid nodules: six-month results of a randomized, parallel, open-label trial (LARA trial). Thyroid, 2020, vol. 30, no 6, pp. 847–856.

10. Matella M., Hunter K., Balasubramanian S., Walker D.C. Multi-scale model development for electrical properties of thyroid and parathyroid tissues. IEEE Open Journal of Engineering in Medicine and Biology, 2023, vol. 5, pp. 661–669.

11. Baek J.H., Lee J.H., Valcavi R., Pacella C.M., Rhim H., Na D.G. Thermal ablation for benign thyroid nodules: radiofrequency and laser. Korean Journal of Radiology, 2011, vol. 12, no 5, pp. 525–540. https://doi.org/10.3348/kjr.2011.12.5.525

12. Bernardi S., Stacul F., Zecchin M., Dobrinja C., Zanconati F., Fabris B. Radiofrequency ablation for benign thyroid nodules. Journal of Endocrinological Investigation, 2016, vol. 39, no 9, pp. 1003–1013. https://doi.org/10.1007/s40618-016-0469-x

13. Cesareo R., Palermo A., Pasqualini V., Manfrini S., Trimboli P., Stacul F., Fabris B., Bernardi S. Radiofrequency ablation on autonomously functioning thyroid nodules: a critical appraisal and review of the literature. Frontiers in Endocrinology, 2020, vol. 11, p. 317. https://doi.org/10.3389/fendo.2020.00317

14. Russotto F., Fiorentino V., Pizzimenti C., Micali M.G., Franchina M., Pepe L., Riganati G., Giordano W., Magliolo E., Ristagno S., Rossi E.D., Tuccari G., Martini M., Ieni A., Fadda G. Histologic evaluation of thyroid nodules treated with thermal ablation: an institutional experience. International Journal of Molecular Sciences, 2024, vol. 25, no 18, p. 10182. https://doi.org/10.3390/ijms251810182

15. Gharib H., Papini E., Garber J.R., et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules – 2016 update. Appendix. Endocrine Practice, 2016, vol. 22, no Suppl. 1, pp. 1–60.

16. Privalov V.A., Seliverstov O.V., Revel-Muroz Zh.A., Lappa A.V., Demidov A.K., Faizrakhmanov A.B. Percutaneous laser-induced thermotherapy of nodular goiter. Surgery, 2001, no 4, pp. 10–13. (In Russ.)

17. Nikfarjam M., Muralidharan V., Malcontenti-Wilson C., Christophi C. Progressive microvascular injury in liver and colorectal liver metastases following laser-induced focal hyperthermia therapy. Lasers in Surgery and Medicine, 2005, vol. 37, pp. 64–73. https://doi.org/10.1002/lsm.20194

18. Piana S., Riganti F., Froio E., Andrioli M., Pacella C.M., Valcavi R. Pathological findings of thyroid nodules after percutaneous laser ablation: a series of 22 cases with cyto-histological correlation. Endocrine Pathology, 2012, vol. 23, no 2, pp. 94–100. https://doi.org/10.1007/s12022-012-9192-0

19. Liu H., Dang Y., Wang Z., Chai X., Ren Q. Laser-induced collagen remodeling: a comparative study in vivo on mouse model. Lasers in Surgery and Medicine, 2008, vol. 40, no 1, pp. 13–19. https://doi.org/10.1002/lsm.20587

20. Yue W., Wang S., Wang B., Xu Q., Yu S., Yonglin Z., Wang X. Ultrasound-guided percutaneous microwave ablation of benign thyroid nodules: safety and imaging follow-up in 222 patients. European Journal of Radiology, 2013, vol. 82, no 1, pp. e11–e16. https://doi.org/10.1016/j.ejrad.2012.07.020

21. Pfannenstiel A., Iannuccilli J., Cornelis F.H., Dupuy D.E., Beard W.L., Prakash P. Shaping the future of microwave tumor ablation: a new direction in precision and control of device performance. International Journal of Hyperthermia, 2022, vol. 39, no 1, pp. 664–674. https://doi.org/10.1080/02656736.2021.1991012

22. Xia B., Yu B., Wang X., Ma Y., Liu F., Gong Y., Zou X., Lei J., Su A., Wei T., Zhu J., Lu Q., Li Z. Conspicuousness and recurrence related factors of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules. BMC Surgery, 2021, vol. 21, no 1, p. 317. https://doi.org/10.1186/s12893-021-01312-1

23. Esnault O., Franc B., Menegaux F., et al. High-intensity focused ultrasound ablation of thyroid nodules: first human feasibility study. Thyroid, 2011, vol. 21, pp. 965–973. https://doi.org/10.1089/thy.2011.0141

24. Zhou Y.F. High-intensity focused ultrasound in clinical tumor ablation. World Journal of Clinical Oncology, 2011, vol. 2, no 1, pp. 8–27. https://doi.org/10.5306/wjco.v2.i1.8

25. Karpov O.E., Vetshev P.S., Zhivotov V.A. Ultrasound ablation of tumors – current state and prospects. Bulletin of the N.I. Pirogov National Medical and Surgical Center, 2008, vol. 3, no 2, pp. 77–82. (In Russ.)

26. Schlesinger D., Benedict S., Diederich C., Gedroyc W., Klibanov A., Larner J. MR-guided focused ultrasound surgery, present and future. Medical Physics, 2013, vol. 40, no 8, p. 080901. https://doi.org/10.1118/1.4811136

27. Von Euler H., Strahle K., Thorne A., Yongqing G. Cell proliferation and apoptosis in rat mammary cancer after electrochemical treatment (EChT). Bioelectrochemistry, 2004, vol. 62, no 1, pp. 57–65. https://doi.org/10.1016/j.bioe-lechem.2003.10.008

28. Ivanov Yu.V., Popov D.V., Solov'ev N.A., Zlobin A.I. First results of experimental application of electrochemical lysis in surgical endocrinology. Bulletin of the N.I. Pirogov National Medical and Surgical Center, 2010, vol. 5, no 2, pp. 18–23. (In Russ.)

29. Lv Y., Zhang Y., Huang J., Wang Y., Rubinsky B. A study on nonthermal irreversible electroporation of the thyroid. Technology in Cancer Research & Treatment, 2019, vol. 18. https://doi.org/10.1177/1533033819876307