Ablation of Benign Thyroid Nodules: Indian Society of Vascular and Interventional Radiology Consensus Statement

Minimally invasive image-guided ablation techniques are increasingly used as alternatives to surgery for symptomatic benign thyroid nodules. However, variability in operator expertise, technique selection, and follow-up practices may influence outcomes. To standardize clinical practice, the Indian Society of Vascular and Interventional Radiology (ISVIR) convened an expert panel to develop consensus-based recommendations aligned with contemporary evidence and Indian clinical practice. A modified Delphi process was used to formulate the ISVIR consensus guidelines. Experts from multiple institutions developed evidence-based statements addressing indications, preprocedural evaluation, technique selection, procedural steps, complication management, criteria for repeat ablation, assessment of therapeutic response, and follow-up protocols. Nineteen statements were anonymously scored using a Likert scale, with agreement graded from poor to excellent. Statements not achieving excellent consensus or receiving any disagree or strongly disagree votes in Round 1 were revised and rescored. All 19 statements achieved excellent consensus greater than 85% in Round 1; however, three statements were revised following individual disagreement. After structured discussion and modification, all revised statements achieved excellent consensus in Round 2. Key recommendations include ablation for symptomatic benign and autonomously functioning nodules; mandatory cytological confirmation; standardized biochemical evaluation; use of hydrodissection when indicated; preference for the moving-shot technique; selection of the ablation modality based on nodule morphology; and predefined follow-up intervals. Therapeutic success was defined as greater than 50% volume reduction at 6 to 12 months. The ISVIR Consensus Statement offers evidence-based guidance to improve consistency, safety, and the standardized adoption of image-guided thyroid ablation across routine clinical practice.