SE Symposium-Endocrine (1-7

SE1-1

THYROID NODULES: CONSENSUS & CONTROVERSY

HOSSEIN GHARIB, M.D., MACP, MACE

Professor of Medicine, Mayo Clinic College of Medicine; Past President, American Association of Clinical Endocrinologists; Past President, American Thyroid Association

This presentation includes a critical review and commentary on the recently published guidelines by the AACE (American Association of Clinical Endocrinologists) & ATA (American Thyroid Association), as well as, a discussion of a recent survey on management of thyroid nodules. We will aspiration biopsy).

The AACE uses a 3-tier system for US risk assessment vs a 5-tier system by ATA. We shall System, and their impact on nodule management. Several molecular markers are now available for use in indeterminate cytology; the guidelines differ in recommending their application. We shall discuss criteria on how to select nodules for FNA. Recently, some advocate active surveillance for nodules <1 cm with suspicious US appearance, whereas others favor performing FNA and proceeding with surgery if malignant. Follow up of benign thyroid nodule and note that thyroxine suppressive therapy is no longer recommended. Finally, we will compare the risk of cancer in solitary vs MNG and alcohol ablation for cystic lesions.

SE1-2

CONSENSUS AND CONTROVERSIES OF MANAGEMENT OF THYROID MICROCARCINOMA.

YOUNG-KEE SHONG, M.D., PH.D.

Professor, Asian Medical Center, University of Ulsan, Seoul, Korea

In Korea, the incidence of thyroid cancer increased explosively in the early 2000s, and reached a plateau in the early 2010s. Most cases of newly diagnosed thyroid cancer are small indolent microcarcinoma and could be good candidates for active surveillance (AS) instead of immediate surgery. Many considerations must be taken into account for establishing selection criteria for candidates for AS of papillary thyroid microcarcinoma (PTMC), including the characteristics of the tumor, the patient, and the medical team. If possible, AS of PTMC should be a part of a prospective clinical trial to ensure long-term safety and to identify clinical and/or molecular markers of the progression of PTMC. Biological behaviors learned from the previous surgical interventions for PTMC will be discussed. And the concept, application, caveats, unanswered questions, and future perspectives of AS of PTMC will be discussed. For appropriately selected patients with PTMC, AS can be a good alternative to immediate surgery.

SE1-3

NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC AND ROBOTIC THYROID SURGERY: THE PROMISING RESULT WITH IDEAL OUTCOMES

YU HSIEN, CHEN1

1 Keelung Chang Gung Memorial hospital, Taiwan

Introduction: Transoral thyroid surgery was regarded as minimally invasive surgery and provide HD view and wristed instruments that rotate far greater than human hand. Therefore, it could provide better peri-neural dissection. Here, we present the experience of transoral robotic thyroidectomy by a single surgeon.

Material &Method: From JAN 2018 to JUN 2018, 24 patients received transoral robotic thyroidectomy vestibular approach using da Vinci Xi for benign and malignant thyroid nodules. The robotic arms were docking through oral vestibular and right axilla. The indication includes benign thyroid nodules < 8 cm and malignant thyroid nodules < 2 cm. The Surgical outcomes were retrospectively reviewed.

Results: 24 patients ( 19 females, 5 males; mean age 41.75 ± 11.67 (range, 20-62) years) received transoral robotic thyroidectomy. 3 patients received bilateral total thyroidectomy, 6 patients received left lobectomy, 15 patients received right lobectomy. 10 cases have cancer include papillary carcinoma and papillary microcarcinoma. 2 cases have NIFTP (Noninvasive follicular thyroid neoplasm with papillary-like nuclear features). 12cases have benign thyroid nodules. The mean operation time was 350.75 ± 92.60 mins. The mean hospital stay was 2.95 ± 1.08 days. The VAS pain score was Day0: 2.30 ± 0.55 ; POD1: 1.91 ± 0.88 ; POD2: 1.91 ± 0.82 . POD3: 1.71 ± 0.82. no reports of vocal cord palsy, surgical site infection or numbness of lower lip.

Conclusion: Transoral robotic thyroidectomy is a feasible natural orifice thyroid surgery with little complication and excellent cosmetic result.

SE2-1

AI AND ROBOTICS – KEY TO ERA OF SMART MEDICINE

LI-CHEN FU

Engineering, Dept. of Computer Science & Information Eng., National Taiwan University

Intelligence (AI), and people in the world realized this mostly after AlphaGo has burst its gigantic power in playing chess beating the top-notch chess players from all over the world. Since then, AI has step-by-step steadily changed our life almost in every aspect, and successful evidences have been observed, e.g etc. Through analysis of the big data, this new AI tide leads people’s lives to the better stage by leveraging the so-to-speak collective intelligence. As for Robotics, thanks to quick AI development, service robots have become more popularly working in our human living environment, after overcoming all sorts of uncertainties encountered while the robots are serving the humans.

Given this new era of human world full of various AI technologies and smart robot agents, it is not surprising that mankind’s life expectancy as well as life quality will be augmented since humans will be constantly guarded within a system of precision medicine, preventive medicine, and social service robots. For example, AI enhanced medical imaging, disease forecast, safe drug prescription, mental healthcare, clinical decision support, and so on and so forth will help people be more aware of their possible health threats in much earlier stage (so as to prevent them) and be treated by far more smart therapeutic measures after their health conditions are threatened (in order to get better cures). For more to come, the elderly will be accompanied and cared by a bunch of smart robot agents even when the supporting younger generation simply become more and more scarce resources. We believe that the futuristic “Society 5.0” proposed by Japan in 2016 can be gradually realized in this new era where mankind will live with health, joy, and prosperity.

SE2-3

THE ARTIFICIAL INTELLIGENCE IN BIOINFORMATICS ALGORITHMS

1,2CHIEN-YU CHEN

1Taiwan AI Labs, 2Department of Bio-Industrial Mechatronics Engineering, National Taiwan University, Taiwan, R.O.C.

The techniques of machine learning and deep learning play an important role in the design of three examples of using machine learning or deep learning in analyzing biomedical data. The first microarrays or RNA sequencing (RNA-seq). The second example illustrates how pattern mining and classification can be used to analyze protein sequences and structures, including predictions of functionally important residues and structure characteristics. The last example shows the recent in analyzing personal genomes for precision medicine. All the above-mentioned methods will be released in TaiGenomics, a newly AI genomic platform developed by Taiwan AI Labs, for biomedical applications in the near future

SE3-1

DIFFERENTIAL DIAGNOSIS, INVESTIGATION AND THERAPY OF ADRENAL INCIDENTALOMAS

YU-WEN SU

Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C..

suspected adrenal disease. Earlier autopsy studies suggested a prevalence ranging from 1.0-8.7%, and increases to 10% in the elderly population. Therefore, it become one of the most common encountered clinical complaint in endocrinology clinic nowadays.

The most critical part in investigation of adrenal incidentaloma is to recognize possible malignant over-secretion is another important issue. Both recognizing malignancy, and confirming hormone secretion status are crucial for further decision making for treatment and follow up schedule. While established hormone hypersecretion syndrome, including Cushing syndrome, Conn’s syndrome, and pheochromocytoma are indications for surgery, there is still an area of uncertainty concerning tumor with “possible autonomous cortisol secretion”, previously denoted as “subclinical Cushing’ syndrome”.

In this section, we aim to provide a comprehensive overview on the differential diagnosis, investigation, and decision for therapy based on current guidelines and clinical evidence.

SE3-2

INTERVENTIONAL RADIOLOGY OF THE ADRENAL GLANDS: CURRENT STATUS

C-C CHANG

Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

Adrenal venous sampling (AVS) was introduced in late 1960s as a test to distinguish unilateral from bilateral primary aldosteronism (PA). AVS is held to be the “gold standard” diagnostic procedure for assessing lateralization of aldosterone secretion and thereby identifying the surgically curable forms of primary aldosteronism.

The successful cannulation of both adrenal veins continues to be challenging clinical issues. Adequate adrenal sampling is based on higher cortisol concentration compared with peripheral sampling. Dyna-CT and on-site quick cortisol assay could be helpful to improve the successful rate.

Cortisol hypersecretion is not uncommon condition in patients with PA. Conventional criteria for lateralization could be challenged due to underestimated lateralization index in AVS. Adjusted criteria should be considered.

AVS could be applied for lateralization of the adrenal gland with autonomous cortisol secretion and ACTH-independent Cushing’s syndrome.

The development of AVS relies on cooperation with teammates in Taiwan Primary Aldosteronism Investigation (TAIPAI) study group. We have gradually improved the performance on AVS that can be dedicated to the academic research.

SE3-3

UPDATE OF ADRENAL TUMORS: SURGERY OF ADRENAL TUMOR

SHUO-MENG WANG

Fu Jen Catholic University Hospital, Fu Jen Catholic University, Taiwan, R.O.C.

Technically there are two categories of recognized techniques by which a surgeon can remove an adrenal gland. Most small tumors can now be removed using minimally invasive techniques such as the posterior approach, or more frequently, the newly developed laparoscopic approach.

Open Surgical Techniques for Adrenalectomy with standard trans-Abdominal, thoraco-abdominal, posterior, or retroperitoneal approach. In large tumor (>10 cm) and tumors which are known to be malignant are almost never removed by minimally invasive operations, rather a more formal exploration and resection are required.

Laparoscopic Adrenalectomy. The laparoscopic approach for adrenal resection allows small to moderately sized tumors to be removed using scopes and very small incisions. This technique is tolerated very well and has been shown to have the least amount of postoperative pain and require the shortest hospital stay. This is now the preferred method for removal of small to moderate size adrenal tumors whether they produce hormones or not. Robotic-assisted laparoscopic adrenalectomy is an adrenalectomy method.

SE4-1

THYROID & PREGNANCY

HOSSEIN GHARIB, M.D., MACP, MACE

Professor of Medicine, Mayo Clinic College of Medicine; Past President, American Association of Clinical Endocrinologists; Past President, American Thyroid Association

Thyroid function changes in pregnancy are many and profound. TSH remains the best thyroid test and it is recommended that all women ingest 250 mcg iodine daily. Although universal screen is not suggested, thyroid testing should be considered for women with risk factors for pregnancy complications.

Management of subclinical hypothyroidism (SCH) is a matter of debate and it is not established that SCH adversely affects normal fetal neuro-psychologic development. Recent ATA guidelines positive euthyroid women.

Serum TSH may be suppressed in up to 30% of normal pregnant women, often requiring no intervention. Gestational thyrotoxicosis is usually mild and transient, and can be treated with trimester and methimazole for second & third trimesters. TSH & TT4 should be checked at 4 weeks and TT4/FT4 kept high-normal or just above-normal pregnancy range. In case of intolerance to ATD or poor thyroid control, thyroidectomy, best performed during the second trimester, is a good alternative. The use of radioiodine is absolutely contraindicated in pregnancy.

Postpartum thyroiditis (PPT) includes hyper- or hypothyroidism during one year after delivery. Commonly, hyper- is followed by hypothyroidism, with a return to a euthyroid state all within a few months. Symptomatic treatment with beta blockers is sometimes necessary. Of note, ATD use is safe for breastfeeding infants. While TRAb is negative in PPT, TPOAb is often positive and women with

SE4-2

THYROID DISEASE AND LACTATION

SHYANG-RONG SHIH

Department of Internal Medicine, National Taiwan University School of Medicine; Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital

Abnormal maternal thyroid status can impact milk letdown and the ability to successfully with breast feeding. As long as adequate nutrition, such as milk, is provided, maternal hypothyroidism itself is not harmful to the breast-feeding infant. Women experiencing poor lactation should have TSH measured. Subclinical and overt hypothyroidism should be treated in lactating women seeking to breastfeed.

Radioactive iodine is concentrated in breast milk. The use of 131I is contraindicated during lactation. The decision to treat hyperthyroidism in lactating women is guided by the same principles applied to non-lactating women. Low to moderate doses of propylthiouracil (PTU) and methimazole (MMI)/carbimazole are safe in breastfeeding infants. Maximal daily doses of 20mg MMI or 450mg PTU are suggested. The lowest effective dose of anti-thyroid drugs (ATDs) was advised. Growth and development should be monitored in breastfed children of women who are treated with ATDs. But routine assessment of the thyroid function in children is not recommended. should be avoided for the concern of inducing hypothyroidism in infants.

SE4-3

THE INFLUENCE OF IODINE TO PREGNANT/NEONATE’S THYROID

1C-J HUANG, 2F-F WANG

1Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C. 2Department of Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan, R.O.C.

Iodine is an essential micronutrient needed for thyroid hormone synthesis. It is especially important in pregnancy and early life due to its influence on brain development. Iodine deficiency intellectual impairments, growth retardation, and thyroid dysfunction with or without goiter. Cretinism and severe brain injuries are serious consequences of severe iodine deficiency during gestation; children’s cognition, intelligence quotient, and school performances. In iodine-deficient regions, iodine supplementation to pregnant women has been shown to reduce cretinism, perinatal death, and infant mortality and improve the indexes of maternal thyroid function. Due to increased urinary iodine excretion during pregnancy and the fetal dependency on maternal iodine intake for thyroid hormone synthesis, the daily iodine requirement suggested by the World Health Organization (WHO) in pregnancy is 250 150

Iodine insufficiency can lead to serious consequences as well as iodine over-nutrition in pregnancy. The American Thyroid Association (ATA) has recently lowered the tolerable upper intake level of iodine in pregnancy to 500 g per day, a level much less than the level of 1100 g for adults in adaptation to large amounts of iodine intake to prevent the occurrence of hyperthyroidism, namely the acute Wolff-Chaikoff effect. However, some individuals may have problem escaping from the acute Wolff-Chaikoff effect, rendering them susceptible to hypothyroidism under excessive iodine intake. The fetus is especially vulnerable to large amounts of iodine because the ability to escape from the acute Wolff-Chaikoff effect does not mature until around 36 weeks of gestation. Long-term excessive iodine intake in pregnancy may lead to thyroid dysfunction, either hyper- or hypothyroidism. Prenatal iodine supplementation during gestation may be a simple, safe, and effective strategy to maintain optimal iodine status without causing under or over nutrition.

SE5-1

TREATMENT STRATEGY FOR PROLACTINOMA

EUN JIG LEE, M.D., PH.D.

President of Korean Endocrine Society, Professor of Endocrinology; Chairman, Department of Medicine; Yonsei University, College of Medicine; Chief Physician, Department of Medicine; Severance Hospital

A prolactinoma diagnosis is most likely to be made when serum prolactin levels are greater than 200 ng/ml. However, when serum prolactin levels are lower than 200 ng/ml and above normal range, a differential diagnosis should be considered, including intake of various medications, polycystic ovarian syndrome, hypothyroidism, chronic renal failure, severe head trauma, and non-functioning pituitary adenoma (NFPA), which may also compress the pituitary stalk and cause hyperprolactinemia. Taken together, hyperprolactinemia with the existence of pituitary adenoma is consistent with prolactinoma; however, it is not a clear diagnosis of prolactinoma. Most patients with prolactinoma respond well to dopamine agonist (DA) therapy. DA therapy lowers serum prolactin levels and effectively reduces tumor size. However, although serum prolactin levels can be lowered by DA treatment in patients with NFPAs, a reduction of tumor size is not achieved in the majority of patients. When hyperprolactinemic pituitary macroadenoma with serum prolactin levels lower than 200 ng/ml patients with hyperprolactinemic pituitary tumors do not respond to DA therapy. These patients require surgery. Determination of the timing of surgery is important because long-term use of DAs may cause complications during the operative and post-operative periods, such as persistent hyperprolactinemia because of incomplete tumor excision and hypopituitarism because of damage to the normal gland. In this session, we will discuss on optimized management of hyperprolactinemic pituitary tumors and also try to build an appropriate therapeutic strategy.

SE5-2 THE 4TH EDITION (2017) OF WHO CLASSIFICATION OF PITUITARY TUMORS

SHIH-CHIEH LIN

Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital

The 4th edition of WHO classification of endocrine tumors had made several changes in the (1) using transcription factors of pituitary adenohypophyseal cell lineages like PIT-1 (pituitary (2) changes to the histological grading of pituitary neuroendocrine tumors with the elimination of “atypical adenoma” null-cell adenoma (4) group of tumors arising in the posterior pituitary with thyroid transcription factor-1 (TTF-1) expression including pituicytoma, granular cell tumor of the posterior pituitary, and spindle cell oncocytoma

of pituitary neuroendocrine tumors and only save for unusual tumors. Evaluation of tumor proliferation potential, by mitotic count and Ki-67 labeling index, and tumor invasion is strongly recommended on individual case basis to identify clinically aggressive adenomas.

SE5-3

RECENT EVOLUTION OF ENDOSCOPIC ENDONASAL SURGERY FOR TREATMENT OF PITUITARY ADENOMAS

S-H YANG

Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.

Pituitary adenoma is a common intracranial tumor, accounting for 10-15% of all brain neoplasms. Except prolactinoma, the first line treatment for symptomatic pituitary tumors is surgery. There are two approaches to reach the sellar region: transcranial and transsphenoidal. The first recorded pituitary surgery was performed in 1893. Initially in the early 20th century, transsphenoidal operation was favored by neurosurgeons for its less invasiveness, but later transcranial operation became the predominant approach for its superior exposure and clear surgical view. Following the introduction of the use of endoscope further optimizes the surgical management of pituitary adenomas via the transsphenoidal route.

During surgery, endoscope enters from the nostril into the sphenoidal sinus. Televised video shows a panoramic view of pituitary fossa, as well as parasellar, suprasellar and infrasellar space. New degrees of lens (0, 30, 45, 70 degrees) allows further visualization of the orbit, anterior skull base, pterygoid fossa, clivus, and craniocervical junction. Under endoscopic control, specially designed angled instruments facilitate dissection and resection of pituitary tumor from optic nerves, intracranial vessels and other critical neurovascular structures, which could only be reached in the past by the more invasive transcranial skull base approach. Because of these technical advancement, functional tumors like corticotroph and somatotroph adenoma can be removed along with a surrounding pseudocapsule to achieve higher rate of endocrine remission for patients with Cushing disease and acromegaly. For nonfunctional tumors, complete tumor resection for optic nerve decompression is more likely, while the normal gland can be better visualized for preservation of pituitary function. Following tumor removal, reconstruction of sellar and skull base defect poses special challenge. A multi-layered reconstruction with nasoseptal flap, gasket seal/button graft, and synthetic tissue sealant drastically lowers the rate of CSF leakage. Finally, a surgical team consisting of neurosurgeon and ENT surgeon can fully exploit the advantages of endoscopic transsphenoidal surgery, especially for giant pituitary adenoma and other complex skull base lesions.

SE6-1

RECENT UPDATE IN BASIC SCIENCE OF OSTEOPOROSIS

WEI-YIH CHIU

Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Wnt signaling plays an important role in development and maintenance of many organs and tissues, including bone. Although Wnt proteins signal through several pathways to regulate cell growth, inhibitors, activators, modulators, phosphatases, kinases and other components. However, the protein While there are several receptors (low-density lipoprotein receptor–related proteins), and over twenty activators known as the Wnts, and several inhibitors such as sclerostin, dickkopf and secreted frizzled with different factors and the role of this pathway in bone development and function.

SE6-2

UPDATE IN EPIDEMIOLOGY AND DIAGNOSIS OF OSTEOPOROSIS

JAWL-SHAN HWANG, MD

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital

Osteoporosis is a major public health problem in many countries, as well as in Taiwan. It’s the most common metabolic bone disorder, characterized by a decrease in bone mass and deterioration in skeletal microarchitecture, which lead to increased fragility and susceptibility to fractures. The fractures associated with osteoporosis have been proven to cause considerable disability, loss of quality of life and mortality. Patients who have one osteoporotic fracture are at increased risk for having another osteoporotic fracture develop. The risk of fragility fractures is multifactorial and is related to the strength of bone, and non-skeletal factors contributing to the incidence and impact of trauma. It is increasing in prevalence and remains largely underdiagnosed and undertreated in Taiwan.

In epidemiology study for women and men aged 65 years old and over, 19.8% and 12.5%, respectively, had more than one vertebral fracture in Taiwan, and estimated that 30% of postmenopausal women had osteoporosis based on bone mineral density. The National Nutrition Survey in Taiwan reported that for men and women over the age of 50, the prevalence of osteoporosis was 23.9% and 38.3%, respectively. From the 1996-2002 NHI data, overall incidence of hip fractures in those individuals over 65 years of age had increased from 496 to 644 per 100,000 per year. It is at least one osteoporosis associated fractures. The mortality rate of hip fractures in the elderly within the first year for women and men is about 15% and 22%, respectively. However, 2006-2007 NHI data showed that only 27% of hip fracture patients received BMD examinations, and 34% received drug treatment of osteoporosis. Many patients were not given the opportunity to have appropriate osteoporosis assessments and not being treated. The awareness of osteoporosis management among patients and physicians clearly needs to be improved.

Osteoporosis diagnosis includes low-impact fractures made via clinical history. The most common sites of bone fractures include distal forearm, hip, or vertebrae (compression fracture). Clinically, it is possible to screen for osteoporosis by a physical examination. However, X-ray or BMD

SE6-3

RECENT ADVANCES IN PHARMACEUTICAL TREATMENT OF OSTEOPOROSIS

Denosumab and bisphosphonates are the most commonly used antiresorptive drugs in Taiwan. Denosumab has been proven to be effective and safe up to 10 years. A recent concern is the multiple vertebra fracture and rapid bone loss after discontinuation. Probably shifting to another antiresorptive, such as a bisphosphonate is necessary. A recent study showed that for osteopenic postmenopausal women, infusion of zolendronic acid every 18 months for 6 years resulted in effective increase of bone density and reduction of bone fracture incidence. Furthermore, cancer incidence of all cause mortality was also reduced.

The only currently available bone forming agent in Taiwan is teriparetide. It is a potent drug for osteoporosis, and has been proven to have no additive effect if given at same time with bisphosphorals. However, a recent series of studies showed that combined use of teriparatide and denosumab rersulted in additive increases of bone density, yet the antifracture data is not available.

The concept of treat-to-target is based on the analysis that after bone density recovered upto a accompanies by a small further reduction of fracture risk only. It must be aware that after reaching this target, if no medication is used, there would be a rapid bone loss and increase of bone fracture rate. Enen after the so called drug holiday for bisphophontes, fracture risk would increase gradually if the patient is left untreated. Long term management plan thus is appropriate for all the osteoporotic patients.

SE7-1

THYROID RADIOFREQUENCY ABLATION: PAST PRESENT AND FUTURE

JUNG HWAN BAEK, M.D., PH.D.

Professor of Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; President of the Korean Society of Thyroid Radiology

Ultrasound (US)-guided ablations such as radiofrequency ablation (RFA), laser ablation (LA), ethanol ablation (EA), microwave ablation (MWA) and high intensity focused ultrasound (HIFU) ablation have been used to treat benign thyroid nodules, recurrent thyroid cancers and even primary thyroid microcarcinoma.

Korean Society of Thyroid Radiology (KSThR) introduced first recommendation in 2012 and we revised it 2018. The basic and advanced concept of thyroid RFA have been established throughout they recently introduced their opinion about thyroid RFA.

In this review, I will introduce the basic concept of thermal ablations focusing on the thyroid RFA and explain the development of the procedures. Furthermore, I will show the current status of thyroid thyroid practice.

SE7-2

RFA IN THYROID DISEASES: THE VIEW OF ENDOCRINOLOGIST IN TAIWAN

aMING-TSANG LEE, M.D., b*CHIH-YUAN WANG , M.D., PH.D.

aDivision of Endocrinology, Department of Internal Medicine, Far-Eastern Memorial Hospital, Taipei, Taiwan b* Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

Radiofrequency ablation (RFA) is a minimally invasive technique, used with ultrasound or computed tomography guidance, which can produce tissue coagulation necrosis in various kinds of tumors in the human body. In the past ten years, more and more studies about radiofrequency ablation in benign thyroid nodules have been published. Reviewing these studies, we noticed that the effectiveness of ablation was higher when it was performed with the “moving-shot technique“ via an internally cooled electrode. A consensus statement published from the Korean Society of Radiology also suggested the “moving-shot technique“ as a standard ablation procedure for benign thyroid nodule ablation in Korea. In Taiwan, most symptomatic benign nodules are currently treated with surgical removal. Radiofrequency ablation for mass lesions is primarily performed for the treatment of metastatic hepatic tumors. In our case, we have attempted to introduce radiofrequency ablation for benign thyroid nodules to Taiwan. Because endocrinologists in Taiwan were not familiar with this technique, we adopted a stepwise approach in learning how to perform radiofrequency ablation. We conducted ex vivo animal ablation exercises to gain experience in setting the radiofrequency generator for the right ablation mode and appropriate power output. The thyroid nodule volume reduction rate after 1-year of follow-up was about 50% in this case. The most important thing we learned from this

SE7-3

THE DEVELOPMENT OF RFA OF THYROID DISEASE: TECHNIQUE AND PATENT IN TAIWAN

W-H HSIEH, H-H LU

Bio-IT Technology Division, Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Taiwan, R.O.C.

OBJECTIVE: Radiofrequency ablation (RFA) has been adopted as a minimally invasive therapy in treating the early liver cancers to achieve the curative outcome and been also reported to be safe and effective for treating benign thyroid nodules. Currently the commercial RFA systems in Taiwan are all imported from other countries. The development of the RFA system in Taiwan was investigated so as to learn the current status and its applications on the treatment of thyroid nodules.

METHOD: We searched for the patents of intellectual property office and technology development programs of Ministry of Economic Affairs (MOEA) with the keywords of “ablation” and/ or “thyroid”. The results related to the RFA were collected and the associated apparatus and methods were analyzed.

RESULT: Industrial Technology Research Institute (ITRI) recently developed a RFA system e.g. output power of up to 200W, internal cooling, temperature monitoring, and impedance control algorithm. Metal Industries Research & Development Centre (MIRDC), on the other hand, developed a percutaneous electromagnetic thermablate system. The major application of both systems is for the liver tumors. ITRI, however, developed an image guide apparatus and needle electrodes for the RFA of thyroid nodules.

CONCLUSION: In summary, research institutes in Taiwan showed the capability of developing the RFA system and the accessories for treating thyroid nodules, while the major application of RFA seems remain for treating liver tumors.