ATA Guidelines Tools

4 Treatment Table 1. Summary of Criteria for Thermal Ablation of Benign Thyroid Nodules Minimum necessary criteria Relative contraindications Absolute contraindications Dominant nodule contributing to cosmetic or compressive disturbance; OR autonomously functioning nodule causing subclinical or clinical hyperthyroidism Benign cytology on fine needle or core biopsy Ultrasound risk stratification for malignancy categorized as very low to intermediate Lack of personal risk factors for malignancy Clear comprehension and realistic expectations of the ablation procedure, expected outcomes, potential complications, and alternatives Ultrasonographic suspicion for malignancy Cytologically indeterminate biopsy result with negative molecular markers a Papillary microcarcinoma without high risk features b Multinodular goiter with significant bilateral nodularity c Significant substernal extension Vocal cord paralysis contralateral to ablative side Pregnancy d Pacemaker or implantable cardiac defibrillator d Clotting or bleeding disorder On anti-coagulant or anti-platelet therapy and unable to cease pre- procedure Cytologically indeterminate biopsy result with positive molecular markers a Known malignancy >1.5 cm in size b Treatment of areas not able to be visualized on ultrasound a Prospective trials are currently underway to evaluate the safety of using thermal ablation techniques in indeterminate nodules with benign molecular markers. At the current time, data remain limited and treatment of indeterminate nodules is not advised unless under clinical trial protocol. b ermal ablation may be used safely and effectively in primary papillary thyroid microcarcinoma, but data in larger tumors remain limited and the treatment of such lesions is not currently advised. c In multinodular goiter, staged procedures could be considered. d Radiofrequency ablation (RFA) bipolar applicators and microwaves may be considered in these patient populations. Table 2. Ablation Safety Checklist for Early and Late Pre- procedural Workflow Early pre-procedural Patient selection • Symptomatic patient • Low to intermediate risk ultrasound features • Benign cytolog y • Patient desires treatment • Patient has realistic expectations with regards to what one session of ablation can achieve

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