Ultrasound-guided ethanol sclerotherapy for non-surgical treatment of Warthin's tumor

Mamidi, Ishwarya S.; Lee, Esther; Benito, Daniel A.; Li, Lilun; Goodman, Joseph; Thakkar, Punam; Joshi, Arjun S.

doi:10.1016/j.amjoto.2020.102813

Cited by 9 publications

(10 citation statements)

References 11 publications

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“…Previous case reports on ultrasound-guided ethanol sclerotherapy showed similar results in two patients: the tumor volume shrank by 55-98%, but follow-up time was only 2-5 months. (12,13) Sclerotherapy is considered less painful than RFA or MWA, which use thermal energy, and potential thermal damage to the facial nerve should also be considered. (12-15) One post-procedural infection occurred in the present series, which most likely was more due to the puncture itself.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided bleomycin sclerotherapy for Warthin’s tumor: preliminary results of a prospective study

Castren,

Sirviö,

Aro

et al. 2023

Preprint

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Background: Warthin′s tumor (WT) is the second most common parotid gland neoplasm with rising incidence. As some WT patients are not suitable for surgery, non-surgical treatment options are needed. This is the first study to evaluate the feasibility of ultrasound-guided bleomycin sclerotherapy (UGBS) for WT. Patients and methods: WT patients with concordant clinical, imaging, and cytology data were included. UGBS was proposed for patients who desired non-surgical intervention and fulfilled the inclusion criteria. Tumor volume and tumor-related symptoms were registered before UGBS and six months after. Results: Nine patients underwent UGBS between September 2021 and September 2022. In seven of the nine patients (78%), the tumor volume had diminished on average by 34% at six-month follow-up. Also, tumor-related pain, and cosmetic and functional discomfort decreased during the follow-up. One patient was later referred to partial parotidectomy. Conclusion: UGBS could be an alternative non-surgical treatment for WT, especially for patients with risk factors for surgery.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-guided bleomycin sclerotherapy for Warthin’s tumor: preliminary results of a prospective study

Castren,

Sirviö,

Aro

et al. 2023

Preprint

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“…Patients experienced no complications, minimal pain, with satisfactory cosmetic and symptomatic resolution. 12 Previously documented complications of ethanol sclerotherapy include immediate mucosal swelling, discomfort, swallowing difficulties, nerve damage, hypotension, skin necrosis, and haemoglobinuria. 15 With US-guidance, however, the procedure can be accurate, safe, and reliable with few complications.…”

Section: Discussionmentioning

confidence: 99%

“…Recent case reports have documented the use of ethanol sclerotherapy as a minimally invasive alternative to surgical excision or observation alone for a variety of head and neck masses. 12 Ethanol sclerotherapy has been previously used in HIV-positive patients with benign lymphoepithelial parotid cysts. In one recent series, 10 out of 11 patients were satisfied with the cosmetic results after a six-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided ethanol sclerotherapy for multifocal unilateral Warthin’s tumor after partial parotidectomy

et al. 2021

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Introduction Warthin’s tumor, also known as papillary cystadenoma lymphomatosum, is one of the most common benign salivary gland neoplasms. The current first-line treatment for Warthin’s tumor is parotidectomy. However, surgical resection has the risk of complications including facial nerve weakness and Frey’s syndrome. Recently, ultrasound-guided ethanol sclerotherapy (UGES) has been found to be efficacious in the treatment of a variety of head and neck lesions. Case report We present a patient with multifocal Warthin’s tumor who was managed with partial parotidectomy and two cycles of ultrasound-guided ethanol sclerotherapy. Discussion Ethanol sclerotherapy has been used as a minimally invasive alternative to surgical excision or observation alone for a variety of head and neck masses. To our knowledge, this is the first case presented in the literature where sclerotherapy was used in conjunction with a partial parotidectomy. Minimizing the extent of surgical resection can reduce the risk of facial nerve weakness and Frey’s syndrome and negate the need for fat grafting for defect reconstruction. Conclusion UGES may serve as a safe and reliable procedure that can be performed in conjunction with partial parotidectomy for patients who wish to achieve definitive diagnosis while also minimizing the risk of complications associated with extensive parotidectomy.

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“…Experience with non-surgical options in the management of WTs is limited. Three recent studies described three potential new approaches: microwave ablation (MWA) [48], radiofrequency (RF) [49], and ultrasound-guided ethanol sclerotherapy (UGES) [50]. The first two options have a long history in the treatment of other neoplasms, especially liver tumors, with a therapeutic effect based on thermal injury.…”

Section: Alternatives To Surgery and Asmentioning

confidence: 99%

“…Recently, Mamidi et al [50] published the first study of UGES for management of WTs. They treated two patients with a total of three WTs.…”

Section: Ultrasound-guided Ethanol Sclerotherapy (Uges)mentioning

confidence: 99%

Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland

et al. 2021

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Purpose: To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. Methods: A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality. Results: The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient’s wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases. Conclusions: The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies.

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Ultrasound-guided ethanol sclerotherapy for non-surgical treatment of Warthin's tumor

Cited by 9 publications

References 11 publications

Ultrasound-guided bleomycin sclerotherapy for Warthin’s tumor: preliminary results of a prospective study

Ultrasound-guided bleomycin sclerotherapy for Warthin’s tumor: preliminary results of a prospective study

Ultrasound-guided ethanol sclerotherapy for multifocal unilateral Warthin’s tumor after partial parotidectomy

Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland

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