High-Intensity Focused Ultrasound for Localized Thyroid-Tissue Ablation: Preliminary Experimental Animal Study

Objective: Thyroid surgery is common and complications are not rare. High-intensity focused ultrasound (HIFU) could be a possible minimally invasive alternative to surgery. The aim of this study was to assess the feasibility of using HIFU to obtain localized ablation of thyroid tissue without affecting neighboring structures. Methods: The ewe was chosen as the model because its thyroid is easily accessible, with a size comparable to the human gland. An HIFU device designed to treat human prostate cancer was used. Eight ewes were anesthetised and their thyroids were ablated with ultrasound-guided HIFU. HIFU was generated by a 3-MHz spherical piezocomposite transducer that delivered an average of 24 (range, 9–44) ultrasound pulses per lobe covering a mean volume of 0.7 cm3 (range, 0.2–1.8). Results: Ewes were sacrificed 6–13 days after HIFU treatment and the anterior part of the neck was fixed in formalin before macroscopic and microscopic examinations. Adverse events occurred mainly for the first treated ewes before the energy delivered to the thyroid tissues was fully mastered: one animal died 3 days after HIFU, most probably because of inhalation pneumonia; the ultrasound beam hit adjacent organs in three animals. As expected, typical histologic lesions of the thyroid were obtained: central coagulative necrosis with ghost vesicular structures, disappearance of the nuclei, and cytoplasmic flocculation. At the periphery of the necrotic zone, a cell reaction was observed with fibroblastic granulation tissue, mononuclear cell infiltrate and regenerating thyroid tissue. Conclusion: The results of this preliminary study confirm the possibility of using HIFU in order to destroy a defined area in thyroid tissue. Future experiments in ewes will be focused on the safety of the method by refining the HIFU parameters and by developing a new equipment specially built for the thyroid.